It is commonly believed in many communities that doctors and surgeons tend to be arrogant and self-centered (
1). However, if this is true, does the narcissism personality trait match the responsibilities of healthcare professionals well? Is empathy and genuine care crucial to the medical field? (
2) Do traits such as narcissism, Machiavellianism, and psychopathy contradict the objectives and principles of providing healthcare services? Research indicates that optimal performance in any profession relies on the harmony between individuals’ personality traits and job demands, and doctors are no exception to this rule (
3). In many cases, individuals fail to perform their duties effectively, not because of a lack of intelligence or technical skills but rather because of the mismatch between their personality traits and their jobs (
4). Employed individuals who choose a career based on their personality traits can engage in work with good conduct and patience without enduring excessive psychological pressure and can be productive (
4). The greater the compatibility and alignment between an individual’s personality traits and their job, the more feasible it becomes to achieve organizational goals (
4,
5).
In recent years, psychologists have paid considerable attention to subclinical forms of socially harmful behavior. Among the most undesirable and dangerous social personalities identified by psychologists, three have attracted the most attention. These three personality traits include Machiavellianism, psychopathy, and narcissism, which have led to the introduction of a new facet of personality known as the dark triad (
6). These personality traits have been conceptually clustered because of their multidimensional nature (
7). Machiavellianism’s personality traits possess several distinct characteristics: Cold beliefs; manipulative, fault-finding, action-oriented, and unethical behaviors; lack of empathy and compassion; strategic long-term planning; profit-seeking motives (such as money and power); pursuit of personal goals; deceitfulness; exploitation; duplicity; and antisocial tendencies. Additionally, individuals with high levels of Machiavellianism exhibit traits such as dominance, mistrust, inflexibility, perfectionism, negative characterization of others, weak social cooperation skills, limited social and emotional understanding, artificial and planned intimacy, attempting to embarrass or portray others as guilty, selecting friends who can easily be deceived (
8).
Narcissism is another personality trait of the dark triad (
6). This trait refers to relatively stable individual differences characterized by arrogance, selfishness, grandiosity, self-love, and inflated self-perceptions. Furthermore, narcissistic individuals exhibit self-importance, fantasies about advancement, a strong desire for admiration despite a lack of social and interpersonal functionality, exploitation of others, a lack of empathy, boasting, aggressive behavior towards others, verbal abuse, emotional instability, low desirability, and extreme outwardness (
9,
10). Narcissistic personality traits encompass self-centeredness, self-regulatory interpersonal relationships, and self-regulatory strategies. Self-centered individuals constantly seek respect, attention, and credibility at any cost. Their social relationships are more like role-playing games than genuine human relationships (
11).
The third facet of the dark triad is psychopathy, which acts as the third side of the dark personality triangle (
6). These individuals are not easily identifiable because they wear masks that allow them to adapt to their environment (
12). Overall, psychopathy comprises a set of aggressive and unpleasant personality traits and behaviors that oppose societal norms, classified into four categories: Impulsiveness, thrill-seeking, and irresponsible behavior; deceitfulness and manipulation; playing games with others in interpersonal relationships; cruelty and lack of empathy; and antisocial behaviors. Various studies have shown that this personality trait is associated with overt aggression and relationship problems in ethical judgment, distinguishing right from wrong, self-serving righteous judgments, difficulties in accepting moral responsibility for actions, and explosive anger (
12,
13).
The selection of these traits — Machiavellianism, narcissism, and psychopathy — for this study is rooted in their potential to disrupt the core principles of healthcare, which rely on empathy, integrity, and collaboration. Healthcare is fundamentally a service-oriented profession, where patient welfare and ethical responsibility take precedence. However, traits associated with the dark triad, such as manipulativeness, lack of empathy, and self-centeredness, directly conflict with these ideals. Understanding how these traits manifest in healthcare workers can provide insights into their influence on interpersonal relationships, teamwork, and patient care outcomes.
The study conducted by Claes et al. aimed to explore the personality traits of healthcare professionals participating in a clinical leadership program with a focus on Belgian physicians, comparing them to non-physician healthcare staff and physicians in the United States. Utilizing the Myers-Briggs Type Indicator (MBTI), participants assessed their preferences across four dimensions. Results revealed that Belgian physicians showed a preference for 'Thinking' over 'Feeling', whereas non-physicians demonstrated higher levels of 'Sensing' and 'Judging' traits. These findings suggest inherent differences in personality preferences between physicians and non-physicians, emphasizing the importance of understanding individual traits in clinical development programs (
14,
15).
There has always been disagreement among theorists regarding the existence or nonexistence of dark personality traits. Some groups believe that these three traits indicate a single general personality trait and have failed to provide sufficient evidence for their existence (
16,
17). Conversely, some researchers argue that, despite overlapping in some aspects and correlating with each other, these constructs are separate and exist (
18,
19). Additionally, studies indicate that the role of these dark triad personality traits in health-related professions has received less attention (
15).
Personality traits, including the dark triad, can also be shaped and influenced by cultural and societal contexts. For instance, collectivist cultures, which emphasize community and interdependence, might place a lower value on traits such as psychopathy, narcissism, or Machiavellianism, compared to individualist cultures. Healthcare workers in such cultural contexts may develop stronger tendencies toward empathy, collaboration, and self-sacrifice, which align more closely with the demands of their profession (
20). Conversely, in cultures where individual success and self-promotion are more highly valued, traits like narcissism may be more prevalent or accepted. Therefore, it is important to emphasize that this study was conducted in Iran, and readers should carefully consider the generalization of these findings to other cultures, particularly Western cultures.