I think it shows an insecurity, to use Dr. John Smith PhD. Did you know that Deepak Chopra actually uses the TM symbol after his own name? How laughable is that? His views are so large that he thinks of himself as intellectual property that is owned by... himself. I suffer sometimes from mania, so I know what grandiose feels like. LOL.
However, getting back to the PhD, Dr. thing. Medical doctors and surgeons are obviously Dr's. However, if you were to live and train, as a surgeon, in England, then you would initially become a doctor, but when you completed your surgery training you would then become a Mr. again. Isn't that strange?
I am a surgeon. We used to have a joke in medical school. "Surgeons do everything and know nothing, internists do nothing and know everything, and pathologists know everything and do everything one day too late."
I had a paediatric patient once always call me Dr. Andrew. Now I'm just happy to be called mister again. I no longer go by the title doctor.
It is like seeking validation or approval from a source that is outside of yourself. When the only validation that one must get, has to come from within.