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 Body Dysmorphic Disorder - Abnormal Low Self Esteem About A Perceived Flaw
 

• When It's More Than Meds & Let Down

• Body Dysmorphic Disorder (BDD)

• Symptoms of Body Dysmorphic Disorder

• Suggested Reading on Body Dysmorphic Disorder

• Online Support Groups

• References

When It's More Than Meds & Let Down
This is in no way an attack on anyone or a matter of disbelief of the viable reason for depression you may be going through.  This is a proven concern and the rate of incidence is alarming.  Depression can be from medications, anesthesia, mental trauma, pre-existing psychological disorders, unrealistic expectations or post-operative pain, complications, lack of communication, surgeon error or normal after effects that the patient was not aware he or she would experience.

I came across quite a few patients who have Body Dysmorphic Disorder (clinically) who racked up plastic surgery procedures (and many revisions) to attain a happiness that surgery would never bring them.  Obviously the disorder itself has always been around, and seemingly either the diagnoses have increased or the cases, in general, have increased, or the enablers are profiting off of their self-esteem issues.  However, so has the population so one probably cannot make a truly informed opinion without examination of persons with BDD in the past or their case notes.  Regardless, it is a real problem and it must be treated with delicacy.  No one wants to be told they have BDD.  But having friends with BDD, I can say that it was a wonderful day once they realized they did indeed have an issue with their body image and sought help.

If the above is true 1 out of every 4 secondary, or tertiary, rhinoplasty patients who read this page have BDD.   I tend to think that is a little too high of a calculation but it is food for thought and should be considered by all of us.  I know many people who have had rhinoplasty for very real reasons and surely not every fourth person had an image disorder.  Many had issues only with their nose, and no other body part or physical attribute.  After their rhinoplasty, they did not seek out plastic surgery again until the effects of aging set in.

The below information is in no way an accusation but is provided solely for the purpose of research and awareness.  This is not a hypocritical statement either because although there is a fine line between what is healthy and what is not over obsessing and having your nose consume you is very unhealthy indeed. 

I have provided this in case someone you may know may need help or has a self image disorder; know the signs.  This is a very serious disorder and leads to years of unnecessary body modification and severe depression, sometimes even suicide.  You could save your friend years of anguish and maybe even their life.

As a matter of fact, rhinoplasty is the top procedure among those who experience post-surgical depression. Rhinoplasty creates a subtle to sometimes drastic in one's face.  Plus the recovery (although subtle) is lwneghty.  Unfortunately rhinoplasty is also the top procedure of persons with self image disorders, especialy in males.

Body Dysmorphic Disorder (BDD)
The standard or typical description of BDD by the American Psychiatric Association:

• Preoccupation with an imagined defect in appearance.  If a slight physical anomaly is present, the person's concern is markedly excessive.
• The preoccupation causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
• The preoccupation is not better accounted for by another mental disorder (e.g., dissatisfaction with body shape and size in Anorexia Nervosa).

Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition  (also known as DSM-IV). Copyright © 1994 American Psychiatric Association. 

But it really goes further than this.  Speaking as a patient and a person who has come across patients who have been diagnosed with such and who have had extensive surgery,  these patients don't want to hear it, they don't want to admit it and they think most surgeons, psychiatrists or even friends are against them. 

When I first began researching long ago about plastic surgery, in general, I noticed that the diagnosis of BDD was very common and, in my opinion, too often given with a prescription for medications as if it were candy.  I admit it, at first I was very disappointed with the psychiatric society, in general, passing out the BDD diagnosis in the same trend as ADD (Attention Deficit Disorder) until I realized that there was an increasing trend in plastic surgery with persons who were diagnosed with BDD or typical clinical depressions.  This is not because suddenly these patients were seeking surgery as a new form of happiness, but rather because plastic surgery has become very accepted and mainstream, therefore more easily to admit.  It has become more affordable and the information is constantly thrown in in our faces so even if a patient had not thought about it before, after watching the various surgery shows, I assure you they are thinking about it now.  You may think, why not go for it?  Everyone else is doing it, right?

It must be said that although it is difficult to diagnose BDD if you are not trained to recognize the symptoms, these individuals who are afflicted with such do slip through the cracks and onto the operating table and wind up becoming even more depressed and withdrawn from society after their secondary, tertiary, and so on, revision surgeries.  The plastic surgeon, although not having gone through extensive training in psychiatry, becomes experienced in turning patients away who fit certain criteria or give a surgeon a bad feeling or red flag. 

I am not against those who have certain issues about their body having surgery but it MUST be realized that surgery will not help those who are truly afflicted with these disorders.  It will not make you a different person, or make you more popular, get you more dates or make you a super model.  Many BDD patients are not in the mental state to recognize what is considered attractive by most or even by themselves.  They really don't know what they want but they know that they don't want to look like they presently do.  But if given the chance to have the exact result desired, the dysmorphia is still present and presents a problem in the healing stages.  The patient then becomes obsessed even further and convinced that he or she is ugly in general.  Not to mention, dissatisfied with a result that is considered by most to be exemplary.

You may argue that it is the patient that should be satisfied with his or her result, and you are very right.  Patients should be and that is what is truly important.  But if the patient does not KNOW what is attractive to them and will always be dissatisfied with the outcome it is very unhealthy.  If they are not capable of accepting a great outcome and see fault where there is none.  What then?

"BDD and secondary, tertiary, etc. rhinoplasty is most often seen in males" according to Dr. Mark B. Constantian.  It has also been noted by The American Academy Of Cosmetic Surgery that 2% of cosmetic surgery patients have BDD.  That may seem low to you but of this 2% it is most often observed in rhinoplasty and liposuction/lipoplasty patients.  When you do the math -- that's  a lot of nose jobs.

This is in no way an attack on those with BDD, rather a means with which to ask yourself if you are truly in possession of an unattractive nose (or other body part) or a normal one.  Please seek help or at least research this disorder even if you do NOT think you have it.  It is good to read up on and you just may realize that you have more in common with some BDD patients than you'd think.  At the very least you could understand the pains that others who DO have BDD go through and perhaps help someone with your knowledge.  I do ask that you do NOT research BDD for the sole reason of fooling or tricking a plastic surgeon into thinking that you are normal and I use that term very loosely.  Of course we all have our different opinions and preferences for what is attractive however repeated dissatisfaction and obsessing is both unhealthy and dangerous, when we repeatedly hear that everything is fine and that we are imagining it.  It pays to listen sometimes.  Do yourself or someone you know a favor and know the warning signs before it's too late.

Suggested Reading on Body Dysmorphic Disorder

Online
Body Dysmorphic Disorder Tutorial

Books 

The Broken Mirror: Understanding and Treating Body Dysmorphic Disorder  by Katharine Phillips, M.D. - click the book to buy or read excerpts review coming soon!

The Adonis Complex covers the male aspect of body dysmorphic disorder ranging from obsessive weightlifting to extreme dieting or supplementation.  Males are no different from females in their desire to look their best.  Due to the majority of pornography targeted at men, for years it was thought image disorders were a thing only women were plagued by.   Wanting to look like Barbie or a centerfold seemed common for women.  Yet for men, seemed to detract from their masculinity.  This book helps show the side of the coin where it isn't how you FEEL about your masculinity that questions it somehow, but how you LOOK to yourself.  Many men feel that if their biceps are not hard as steel or their abdomens cut like a diamond, they somehow do not measure up.  Welcome to the world of what psychologists call the Adonis Complex, hence the book's name.

I have come across several men who feel they must look their best no matter what and CONSTANTLY worry what they eat or how they look and still walk around in sweats without showing an inch of abdominal flesh.  Many aren't hitting the gym for strength or jogging for great distances in the heat for cardiovascular health, these men are striving to become an ideal which in the end, is unattainable.

The Adonis Complex covers symptoms to look out for and offers understanding to the many men who are determined to have the body of a Roman God and will do almost anything to get there.  A definite read if you a male and in need of answers or have concerns which need to be quelled.  Male body dysmorphia is sometimes compared to anorexia nervosa and can be equally harmful.  Even if you do not feel that you have an image disorder, if you are active in the gym and are concerned with ideal (there's that word again) body fat percentages perhaps you could look upon this book to help understand those you may come into contact with at your gym.  While there is nothing wrong with wanting to look our best or feeling better when we do look tanned and tone -- putting ourselves into harms way or letting this desire take over our social life is unhealthy and should be addressed.

We all know that there are two sides to every coin but we also know that society and eve our own family members may show intentional, or unintentional, favoritism to those whose appearances shine.  And I don't mean from an oily T zone.  I mean true beauty.  Everyone would be lying if they say that they don't feel better when they look their best than when they have gained a little (or more) weight, have a break out or even as something simple as having nothing flattering to wear.  We have all been affected by how we look to ourselves and how others believe we look.  

Some may argue that this book is not for those who truly need to lose weight or have plastic surgery and that it is more for people who are attractive and are too affected to see it.  This is ludicrous.  Beauty is relative and that is just another ridiculous arm of society depicting what is more attractive than the other.  This book is helpful for ALL people in ALL walks of life which way be uncomfortable with the way they look.  It is about being unhappy or self conscious with the way you look, not how maybe you are a little over or underweight than the next person.  It is about feeling the need to look good and realizing what can be changed healthily.

This book is a first person account of the authors pain growing up and realizing just exactly how events can trigger neuroses or lack of esteem, at a very young and impressionable age.  It contains questionnaires and surveys to determine your level of self esteem and just how much you are affected by media coverage of the beautiful.  Personally I am a little tired of hearing that it is JUST the media's fault.  People know what is attractive to them -- it isn't like we are THAT impressionable.  Nature takes precedence.  Read Nancy Etcoff's Survival of the Prettiest for a not so new look at what drives us to become attracted to those who are considered beautiful.

I still recommend this book, however.  I like the way it is written and enjoy reading and comparing the author's experiences. It contains helpful advice and offers support ion an seemingly individual level.  Just don't allow yourself to use the media as a crutch for any lack of esteem you may have.  I think there are far more issues at stake to cause image problems, such as personal experiences, relationships or lack thereof, chemical imbalances and random incidents can all trigger low self esteem.

For more information on societal ideals and appearance, see our Ideal Beauty? section.

Online Support Groups
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References
Excerpts from this page published in Teen Decisions: Body Image (The Gale Group; Thomson-Gale, Greenhaven Press 2002)
Jacobson WE, et al.  Psychiatric evaluation of male patients seeking cosmetic surgery.  Plast Reconstr Surg, 26:356, 1990
Phillips KA, et al.  body dysmorphic disorder.  Am J Psychiatry 148:1, 1991.
Pertschuk M.  Psychosocial considerations in plastic surgery.  Clin Plast Surg   18:11, 1991
Tardy, ME.  Rhinoplasty:  The Art and Science, Volume II, Saunders press, 1997
Goin M, Rees T, Plast Surgery, 27:3, 1991 
Constantian, MB: Identify BDD patients prior to rhinoplasty; Cosmetic Surgery Times, pp21-22, June 2001