The strange appearance of ‘dysmorphia’
My name is Debbie. I set my website up 12 years ago in order to create an online community of like minded people looking for facts, information and support with plastic surgery. I am qualified as an existential psychotherapist and have suffered from a life long history of Body Dysmorphic Disorder. I try to blog about Dysmorphia as often as I can so if you want to read more on this subject or my own personal history of BDD or plastic surgery - feel free to nudge me or tweet me either here: www.cosmeticsupport.com or here: @cosmeticsupport
Is the definition of dysmorphia dependent on the definer? Dysmorphia is an abbreviation of a condition listed in the DSM-IV as Body Dysmorphic Disorder or BDD for short. BDD is a disorder best diagnosed by psychiatry and/or psychology. It is listed in the DSM-IV, commonly known as the psychiatrist’s bible.
Dysmorphia is generally understood as someone who suffers from body image issues (nearly everyone has them these days) and BDD has a psychiatric definition of imagined ugliness and is often part of a cluster of other disorders. Someone with BDD will have a preoccupation with a specific body part or parts and believe that a body part or parts is deformed or defective. The preoccupation is significantly excessive and causes clinically significant distress or impaired occupational or social functioning.
How can someone suffering from body image issues be in the same condition as someone with BDD? BDD can (and often does ) immobilize the sufferer whereas many people who suffer from body image issues can and do get on with their day to day lives. I am not suggesting that those who suffer from body image issues are not dis-satisfied with their appearance. I have great empathy for anyone suffering from body image issues. However, a person in this condition must not be confused with a patient diagnosed with BDD. It is further important to note that the DSM-IV is a list of operationally defined syndromes, useful for statistical and research purposes and not the 'final say' on anything. Therefore, the question of whether dysmorphia is an abbreviation of BDD is still under the spotlight.
This confusion between ‘dysmorphia’ and BDD is important to try to clarify given that the laws surrounding the nature of advertising within plastic surgery are about to change. The government wants the advertising of plastic surgery to change in order to reflect more realistic expectations for the consumer/patient. This, they believe, will help to protect the weak and vulnerable consumer/patient from developing body image issues and becoming ‘dysmorphic‘ as a result of measuring themselves against impossible standards and air-brushed imaginations prevalent in advertising. Good call. In 12 years running my website, I have never posted a single before or after photo from anyone that has been air-brushed in anyway. Real people, real photos.
Who has the right to diagnose a patient of mental health problems and just what is the mental health disorder exactly? If consumer/patients are being fed false promises by plastic surgery adverts and air-brushing, can we blame them? Should we insult them further by saying that believing in this advertising, they are now suffering from a mental health disorder? In order to work out which plastic surgery patients may be hiding or vulnerable to ‘dysmorphia’, plastic surgeons are going to work with a questionnaire devised by psychologists and psychiatrists to determine which patients may or may not suffer from .. what? It isn’t entirely clear whether these questionnaires will label a patient dysmorphic or suffering from BDD. This confuses me given that many people suffer from body image issues and are not necessarily suffering from BDD. If the questionnaire is there to help the surgeon work out which patient has realistic expectations, should ‘dysmorphia’ or BDD even be used? Is this questionnaire going to be a glorified screening tool or is it something that will turn a consumer/patient into someone walking around with a mental health label that they may or not merit? Does this beg the question that is always secretly lurking: how do patients rate surgeons? Where is their psychological questionnaire?
I do think it is important for a plastic surgeon to know whether the patient who is presenting themselves for a consultation is (or is not) suffering from BDD. I just wonder how a questionnaire can clarify the condition of dysmorphia as it is generally understood today. Dysmorphia (the more general definition) is more of a cultural condition as a result of certain types of advertising within the plastic surgery field. These kind of cultural body image issues might be better helped by a neutral advisor who has experience in the conditions in question. What will it mean to give someone the label of ‘dysmorphia’? Are we labeling them with mental health problems through the back door? Is that fair when the consumer/patient has been fed so much advertising over so many years. How can we help them unravel their body image issues? Do either of these labels (dysmorphia or BDD) preclude the patient from having plastic surgery? The question of whether plastic surgery helps or hinders the patient of BDD is too big of a subject for this quick blog.
Recently I approached the ‘powers that be’. I made a request to put their surgical information on my website. Their response was that if I put their information about surgery on my site, I would be guilty of plagiarism. Patient support is crucial. Where are we to go to get this information unless it is the ‘powers that be’. Do I have the right to re-write surgical information? I would rather be guilty of plagiarism than re-write surgical information. We are discussing elective surgery and the consumer/patient has a right to information about what it is that he/she is buying. They also have the right not to have to become a super-sleuth to find that information. Their trust has already been compromised.
For 12 years I have run my website voluntarily because I suffer from BDD and it is very typical of many patients to want to give back to their own community and become a wounded healer. My website (www.cosmeticsupport.com) helps to heal me as much as it does others. I have been debunking myths and researching facts and information to share with others for as long as I can remember and certainly for the last 12 years online. I can not force consumer/patients to believe that their expectations must be realistic when going for plastic surgery and that advertising is not the same as research but I know that within the community I created many people have benefitted by understanding the actual facts. If you like my blogs and support what I do then please SUBSCRIBE to www.cosmeticsupport.com
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