Quarta-feira, 2 de Abril de 2014

Some Q&A about Body Dimorphic Disorder (BDD)

Body Dimorphic Disorder (BDD): what is it?

 

BDD is a psychiatric disorder with different severities and a broad spectrum of presentations. The diagnosis criteria to BDD are:

       i.     Preoccupation with a imaginary defect or disproportional extreme concern with a slightly defect in appearance
      ii.     Significant distress or impairment in social, occupational or other areas of functioning, resulting from the appearance preoccupation.
     iii.     The preoccupation is no due to other psychiatric disorders (e.g. eating disorders)
The treatment depends on the severity of the disorder.
BDD is included in a group of psychiatric disorder called “somotoform disorders”. However this is controversial, and many experts consider it as a obsessive-compulsive disorder.

 

 What are the signs and symptoms, who is this more prevalent in,males or females and around what age does it begin exhibiting?

  1. The persons who present for cosmetic treatment have  some degree of body image dissatisfaction, and that is the reason why they seek for correction. Plastic Surgeons are trained to identify and correct these problems. So it can be difficult to diagnose BBD based on the above criteria.
  2. For me the most important diagnostic tool is the dimension and the degree of distress the impairment causes. A slightly nose defect is not a reason to abandon school or a job. I value this more than the defect itself when suspicious of a BBD case.
  3. Most of the cosmetic patients are self conscious of an appearance defect, but don’t “allow it” to interfere with their lives, and are functioning appropriately. These are the ones we can help with Plastic Surgery, and affect them positively in improving their body image and appearance and their self-esteem.
  4. It appears to occur equally in both genders. However they differ in their concerns.
  5. Regarding BBD the patients tend to focus more on the skin, hair and nose. But there is also some differences regarding the gender. Man are more preoccupied with their genitals, height, hair and body, where women show more concern about weight, breasts, hips and legs. But there is no rule, as any body details can be of extreme importance and relevance and can cause disproportionate  impairment for persons with BBD.
  6. Typically it begins in the adolescence, as this is the most exposed period regarding body transformation. This age is also prone to other behaviour and somatic disorders like major depression, anorexia or obesity.

  Is this triggered by something in the environment or some kind of media influence

  1. There is a familiar tendency as it is more frequent in families of individuals with obsessive-compulsive disorders. Also 20% of patients with BBD do have a first-degree relative with the same disorder.
  2. From the neurological point, it seems there is an abnormality on one of the neurotransmitter secretion (dopaminergic system).
  3. Psychological and behavioural factors are also involved, as it seems these patients have an increase aesthetic sensitivity. Also they show an increase tendency to display compulsive behaviours in order to reduce their anxiety.
  4. Social and cultural factors can also trigger BBD. Specially if raised in neglectful or critical environments regarding appearance. Also there is a higher incidence of childhood abuse (emotional, physical and sexual).
  5. The media and modern society pressure regarding physical perfection can also be taken in consideration regarding the etiology of body dissatisfaction and BBD.

  What is the link between BDD and plastic surgery addiction?

  1. Plastic Surgery can be a way of treating the problem, if you are not in the pathological range. Actually that is the ultimate goal of Plastic Surgery, considering the reconstructive and cosmetic aspects of it. To enhance the proportion and to correct deformity.
  2. But BBD patients will not be satisfied by one single correction, as the problem doesn’t lie in the body but on their perception of the body. So they will find another problem to correct and to blame for their lack of success and functional impairment. This is the reason why we should pay attention and avoid to treat this patients. They should be referred to Psychiatric care and that will be right way to be treated
  3. But it is not always so simple. Some of the situations are border line and associate with other psychiatric comorbidities like anxiety, substance abuse and dependence, personality, eating and mood disorders.
  4. Mainly because BBD is very difficult to diagnose at the beginning and patients tend to look for different doctors until one will agree to perform what they want to do. We are coming more aware of this condition and avoid to take these individuals into our care. 

How common is this?

  1. It is estimated to occur in 1 to 2% of the population
  2. In the cosmetic surgery patients population the incidence is higher in a range from 3.2 to 16%.

How can you tell if a patent is addicted to plastic surgery?

  1. When I see unusual or excessive request for surgery. But that doesn’t mean that they are BBD patients.

 How ethical is it for the doctor to keep performing surgery on a patient such as this?

  1. In my opinion it is not an ethical problem at the beginning. It could be a diagnosis error or anwarenness of the problem. It will be ethical if the doctor knows that BBD is present and keeps performing treatments (surgical or non surgical) without psychiatric counselling, just for the sake of business.

 Do you have any anonymous case study you are able to share with us?

  1. I have a 36 years old patient that come to my Lisbon office asking for a eyelid surgery. It would be her 34 surgical procedure and the second one for the correction of eyelid excess skin. It was obvious and I refuse to do it on the base that there were no surgical indication for it. With extreme carefulness we (I and my non medical staff) were able to get her in to psychiatric counselling and end the endless surgical pathway that she was going to.

 How do you, as the doctor, convince the patient that the procedure they are requesting (in the case of addiction) is not necessary? Do you turn the person away?

  1. For me Cosmetic Surgery is like any medical treatment: there is a problem and different therapeutic alternatives to treat it. We just have to find the one that is more adequate to this particular patient. If I cannot do any good or if I am not able to perform what it is required, I just refuse the patient or refer him to someone with the right qualification to handle is problem.

 Are there some celebrities who you feel are visibly addicted to plastic surgery? Who?

  1. Yes. I think any one can spot them. As a doctor I cannot come public with my comments. That would not be ethical.

 What role do media play in all of this in your opinion?

  1. I think media is just doing their job. They inform their public. What the public does with that is their personal concern.
  2. But if we take in consideration that a great number of similar disorders start at the adolescence, than we should be much more careful on what we publish and how we inform. This is a very vulnerable group, particularly when dealing with body and fashion issues. Take the example of fashion models and anorexia.

What are the most addictive kinds of procedures in your opinion?

  1. The ones that work. Specially the small invasive or non invasive as these are not so prone to complications and they have no downtime.
  2. Regarding surgical procedures, liposuction and rhinoplasty are the ones more often repeated. 

Tradução para português: faça copy do texto e use o link: http://translate.google.com/#pt/en/

publicado por Francisco Falcão de Melo às 13:08
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Dr Francisco Falcão Melo

Licenciado em Medicina pela Faculdade de Ciências Médicas de Lisboa, fez o Internato Complementar em Cirurgia Plástica e Reconstrutiva nos Hospitais Cívis de Lisboa. Actualmente é Assistente Graduado sendo o responsável pelo Serviço de Cirurgia Plástica e Reconstrutiva do Hospital Militar Principal. Membro da Sociedade Portuguesa de Cirurgia Plástica Reconstrutiva e Estética, da Sociedade Portuguesa de Cirurgia da Mão e da Sociedade Portuguesa de Queimaduras.Exerce a sua actividade privada em Lisboa e em Leiria.

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E-mail: franciscofmelo@sapo.pt

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