Dysmorphia needs a  (funded)  Poster Girl  

(Wish me luck)

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Today I participated in a meeting about branding for a campaign promoting body confidence in conjunction with the All Party Parliamentary Group on Body Image. This is a campaign aimed at all ages and genders to help improve body confidence. The recent call for change by BAAPS in the way that cosmetic surgery is advertised is one way to help re-build negative self-image by stopping the trivialization and commodification of serious surgery.  The meeting was upbeat and constructive offering refreshments including my current biscuit of choice: the jammie dodger! I was there to represent my website: www.cosmeticsupport.com but, quietly in attendance and invisible to most, was my alter-ego  the Body Dysmorphic Disorder Poster Girl

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After the meeting, we were all invited to retire to the pub for a milk stout (make mine rosé) and there I discovered that many of the groups were receiving funding and awards for the work they do. My ears twigged but my heart sank and my spirit felt demoralized in response to what I was hearing about funding.  If it were not for my Botox, my supportive smile would have slipped right under the table. It was yet another reminder that I have been voluntarily running a website for elective cosmetic surgery patients for nearly 13 years. Yup, that’s right, voluntary, nearly 13 years, no money:  harsh! 

 Neil Young once sang: ‘there’s a shadow running through my days, like a beggar going from door to door’.  Could this shadow be my old compadre, Body Dysmorphic Disorder? How does this much-confused disorder impact on my ability to be taken seriously by either myself or the (funding, etc) powers that be? If Body Dysmorphic Disorder inhibits my ability to recognize either my own value or the value of my projects, how can I expect to be recognized as valuable by others? Isn’t it the case that unless I value myself, others will not, cannot recognize and/or value me? Have I become so good at deflecting attention away from me that when I need to gain attention, I am no longer able to operate the tools required for the job? Does this mean that having Body Dysmorphic Disorder precludes me from successfully receiving funding? Quelle horreur. 

Everyone needs a raison d’etre in life and seeking funding is just not mine. I suspect that even people in the funding world might argue that raising funds is not their passion either. Most of the meeting’s participants worked in organizations with more than one person, which may make the process of seeking funding a tad easier, I have no real idea.  Some organizations pay experts  to raise funds for them. When it comes to understanding funding I feel like a child trying to climb over a very tall wall, bewildered, confused and unequipped for such a climb. Yes, I am aware of my limitations but that only offers me a possible explanation when I really require a solution. Funding is crucial when your Macbook Pro is threatening to stop spluttering through its daily grind of website maintenance and social interactivity.  Yikes!

The disability inherent in Body Dysmorphic Disorder has a great impact on the sufferer’s life. It is not always easy to recognize who suffers with it. It’s not an obvious disability in the way some physical disabilities can be. I am highly aware that due to the confusion around Body Dysmorphic Disorder, the sufferer is often patronized and mistaken for being somewhat mentally retarded. This is not the case at all.  In fact, many people with Body Dysmorphic Disorder suffer with high IQ and/or being over-qualified as it will often prove easier to interact with inanimate objects like books and computers than to interact with human beings.  Pets often make great therapy and my own sweet Maltese dog Amy now has her own Twitter-feed! (www.twitter.com/amypup)and no doubt will have a photo on my blog in the future too. Amy is my sherpa as I am hers although she sometimes forgets this!

I feel wounded, damaged and down-trodden from Body Dysmorphic Disorder but I must clarify that it is not fair to blame everything on that label as my background contains an interesting smorgasbord of other emotional traumas.  As a result, I can only ever talk of my own personal experience of Body Dysmorphic Disorder, but am aware that in so doing, I touch on what might be considered generic traits of the disorder and therefore can help others by allowing them to identify with a fellow traveller. My own experience certainly gives me important insights, but my experience online enables me to have a broader view of the sufferings of other people and offer support. It is a very positive and supportive stepping-stone for anyone wishing to participate. 

 I am neither for nor against cosmetic surgery although I have had some procedures myself. I have had good experiences with it and bad. As a result of the way I am, my remit is to reach out from online to offer clarity in the fields of elective cosmetic surgery patient support and Body Dysmorphic Disorder support. I am able to separate these categories in the same way that the official UK plastic surgery charities can separate cosmetic and reconstructive surgery, whilst still having (more or less) the same surgeons subscribe to their charities.Perhaps, I too, should have changed the ‘l’ in clarity to an ‘h’! 

Wishing alone will not bring about funding but the site’s intentions are truly honourable and spring from that healthier part of me which has had to find a way to circumnavigate my circumstances.  I sometimes think of myself as a sherpa or even the human equivalent of a disability guide dog who offers information and support to both the cosmetic and/or reconstructive surgery patient. I am equally interested in those patients who want another way of dealing with their issues other than elective surgery.  

I will post a separate blog on the history of www.cosmeticsupprt.com for anyone who is not familiar with it; it has changed over the years although it still remains the same. It is a straight-forward, friendly, informative site which welcomes anyone who is interested in cosmetic surgery at any level whether it is cosmetic or reconstructive or general curiosity for emotional or physical reasons. Each visitor will have his or her own personal reasons for joining the site and some will share similar views, creating the online community that it is.  Dysmorphic Discussions may resonate with the reconstructive patient although the surgery may equally be considered cosmetic. I make videos covering various subjects such as ‘realistic expectations from surgery’ etc. 

I am aware that there are many reasons for patients to choose either cosmetic or reconstructive surgery.  Some patients have reconstructive surgical needs for medical reasons (such as trauma, disfigurement, illness etc) and may not consider their surgery in any way cosmetic even though ultimately the surgeon and the patient both desire an aesthetically pleasing outcome.  All surgeries are therefore (at some level) cosmetic. Both of my sites, at all levels, are non-judgmental, informative and supportive.  A welcome retreat from advertising at any level.

It is ironic that I offer support from all my websites and yet receive very little in return from those organizations who are in a position to support what I do.  I am still not properly recognized, understood or supported, let alone funded. In fact, if anything, I am either ignored, criticized, viewed with suspicion or seen as a threat by the very organizations that I take up the slack for.  Communications with these organizations over the years has left me feeling belittled or unworthy but I have never questioned the value of my website.  May I suggest to these organizations that they clean their glasses and their grapevine and let some sunlight in. 

Lately I’ve had to clean my own glasses in order to watch all the celebrities competing with one another in glossy magazines to share their own personal history and struggles with body image issues and alleged Body Dysmorphic Disorder.  The media is now displaying celebrities and PR gurus stepping out of their perfectly crafted image into a less perfect image in an effort to persuade us that ‘not ok’ is the new ‘ok’.  Lined up, as they are, for their photo shoot, what are these celebrities and PR gurus doing? Are they confessing to Body Dysmorphic Disorder?  Are they sharing their body image blues? Are they self-publicizing under the banner of a new world order? Does it matter who is buying the drinks as long as someone else is paying? Photoshop is so amazingly good at manipulating photos and we love the results and buy them in magazines. It surely couldn’t be that this type of software can also make someone look fatter or less perfect? We wouldn’t fall for that old chestnut again now, would we? Uh oh. 

 I also wonder what is happening when ‘independent’ PR gurus hired by the big beauty companies are attempting to help us with empowerment by making positive statements in bold letters? What are they doing when they link their product to the message of the campaign? In what way is a PR guru qualified to release statements about the psychology of self-confidence?  Perhaps I am confused, but isn’t self-worth something that someone in the psychological field is better trained to help others with?  When I have self-worth issues, I generally do not race to Twitter for a 140 character rush of confidence or google with Paypal an appointment with a PR guru.  I don’t remember PR being a module in my post grad dip in existential psychotherapy syllabus. I should have gone for a degree in PR.  Who knew? 

I agree with BAAPS that cosmetic surgery should never be trivialized or commodified (that was less than 140 characters, wasn’t it?) Patients deserve more than to be patronized by a constant stream of short sharp pseudo-scientific sensationalist soundbites pretending not to be an advertising slogan or advertising through the back door. It cheapens the call to change the way cosmetic surgery is advertised. 

Patients deserve better when they are spending so much money on elective surgery. If this service I offer were not required, I would not have survived nearly 13 years alone on the internet. Sometimes I even get to go for a dinner break! 

The lack of reality in the media and lack of recognition from the organizations my site complements is in complete contrast to the positive outcomes and experiences that visitors enjoy on my site, blogs and twitter feeds. Subscribers on my site are delighted to find an empathetic, constructive, interactive forum with a real human at the other end of the screen or by email offering to share information and experience. Reality-based issues are key concepts on my website with real people and real patients exchanging real photos and real experiences with one another. It is a great service even if I say so myself. It is my therapy as much as it is theirs. Social media can never replace the beauty of a fully functional forum dedicated to a particular topic. 

Around the conference table at the meeting I mentioned at the beginning of this blog were intelligent, educated people all contributing to a campaign to help boost body confidence. The job itself is something akin to turning an elephant around in a small room. Some of these people are employed by organizations to do the job they do. I do not know if any of them are voluntary and independent as I am.

Anyone who mistakes Body Dysmorphic Disorder for a type  of body image blues is either kidding themselves or attempting to kid us. I would suggest they might need to re-visit the definition in the DSM-IV or make it their mission to meet someone who suffers from the disorder for some first-hand descriptions. I have often suspected that understanding Body Dysmorphic Disorder from the perspective of a non-sufferer is a bit like two people trying to speak to one another using different languages. I can’t understand them but I try my hardest to do so. Reaching out to them is my best hope for survival and relief.  Let’s hope they find a way to do the same for us in return. 

The mission in under 140 characters is still the same: 

Dysmorphia needs a Poster Girl

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Dysmorphic Discussions has Whooping Cough and Flu

We hope to see you before the New Year but if not 

We wish everyone a 

Happy New Year

Recently I’ve been considering having a facelift. I am tum diddily tum years old now and my face is showing signs of age, wear and tear. I would like to look younger for a while before facing looking older. Life throws us challenges and one of my many challenges has been living with Body Dysmorphic Disorder.  I have had two previous experiences of cosmetic surgery, one good and one bad.  

Psychiatrists and psychologists have created optional screening tools for cosmetic surgeons to help them assess patient risk. How would I be assessed if I turn up for a consultation with a cosmetic surgeon? Would I be dismissed as a risk? How would I be told? Would I be told at all? Would I be considered a safe bet given that I have had at least one previous successful cosmetic surgery? Would I be considered a hedge bet? How would I be dealt with if the surgeon was not sure? Would I even be assessed at all? 

If I was unhappy with my assessment, what would my options then be? Would I just go to another surgeon? If one surgeon assesses me as a bad risk, would all other surgeons then be alerted? Would I go abroad for surgery? Change my mind?  Obtain a second opinion from a psychiatrist? 

What would you do? Dysmorphia Needs A Poster Girl

I consider myself a relatively unusual case. Many cases of Body Dysmorphic Disorder consider themselves cured when they no longer see any need to make changes to their appearances. I believe that it is possible to believe that you are not ugly while also holding the view that improvements to the appearance can be achieved. Let’s say I am assessed to be a safe surgical bet and provided I find enough money, I can go ahead with my surgery. What other emotional considerations are there? 

 My circumstances are that I live alone. My mother is too ill to look after me. Many of us either live alone or prefer not to confide in friends and family about cosmetic surgery. This throws up some major obstacles. I would have to find some way of being looked after. My friends lead busy lives with their own families and may not be available for me when I am going for my surgery. My relatives are not people I keep in touch with let alone ask for help. Who would come and pick me up from hospital to take me home? Who will look after me? Who will I talk to about the experience I am going through? How can I know if what I feel is normal or typical? How can I find out what to do to ease my mind? Who is going to let me sob irrationally into my bandages or laugh hysterically at the relief from finally undergoing surgery? 

Isn’t it time everyone knew where to go to discuss these issues? 

I could hire someone to come and look after me for a few days or a day or two until I felt safe enough to be left alone. This creates additional cost. How would I feel about a stranger coming to take me home after surgery? What if they don’t speak the same language as me? What if they don’t approve of cosmetic surgery? Would they understand the emotions that I am going through? What if I thought I could cope and then found the post-surgical emotions too much to cope with alone?  This can happen to anyone whether you have Body Dysmorphic Disorder or not. Intense and unusual emotions before and after surgery are quite common. General anaesthetic can trigger periods of tearfulness, sadness, nausea , fear or even euphoria. Post-surgical depression is very real and can take any patient by complete surprise. Pain medication and post-surgical antibiotics can create moodiness. 

Every type of cosmetic surgery presents unique post-operative challenges. 

Rhinoplasty patients may have difficulty with their reading glasses. 

Blepharoplasty patients may also have difficulty with blurring and vision. 

Breast Augmentation patients may have difficulty being able to lift things (the kettle, the phone). 
Liposuction patients may have problems with specialist post-surgical garments. 

Abdominoplasty patients may have pain sitting, standing or walking. 

The problems may be physical but they have emotional knock-on effects. Isolation, fear and loneliness make for more challenging recoveries. We all benefit from having someone to help us gain perspective and keep grounded. 

Cosmetic surgery is unique because as a physically healthy individual, I am presenting myself for a surgery that will limit my activities for a period of time after surgery. This will bring up feelings of helplessness and frustration at having to ask for assistance or do without. It is important that I remain happy to ease my recovery. 

Like many other patients, I will worry a great deal in the early post-operative days about how I am going to heal and how I am going to look once I heal. Not having much to do except heal and recover leaves me with time on my hands to worry. 

Cosmeticsupport.com is a voluntary independent non-profit website offering emotional support to cosmetic surgery patients for 13 years on 14 January 2013

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Apologies for the delay 

Dysmorphic Discussions has the FLU.

We will return with a Xmas special as soon as the coughing stops and the virus is killed. 

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This week I had a consultation with a BAAPS surgeon about the possibility of replacing my breast implants. They are McGhan high profile placed sub-pectorally. I have not had any problems with them but recently I have been sensing changes and have some concerns. Quietly in attendance throughout the consultation and invisible to most was my alter-ego  the Body Dysmorphic Disorder Poster Girl

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Cognitive Behaviour Therapy is the current treatment of choice for this often misrepresented disorder. The theory implies that if the ugliness is imagined then the thoughts linked to the imagination or the imagination itself need to be changed to something better for recovery to happen. Some therapists like to use ‘flooding’, a technique which confronts the patient all at once with the maximum fear stimulus. ‘Desensitization’ involves repeated exposure in increasing amounts. It might be over-simplified to suggest that CBT views Body Dysmorphic Disorder patients as suffering from a case of mind over matter. If the mind is dealt with, then the implants won’t matter. For an existentialist psychotherapist, the focus is on the individual and his/her world-view rather than guiding someone’s thinking.  Existential therapy invites the individual to investigate meaning through four different dimensions: physical, social, psychological and spiritual. The individual is encouraged to explore his/her existence with all its isolation and anxiety. Enquiry into these dimensions will reveal and welcome diversity in body image. It does not necessarily negate the ideas behind cognitive behavioural therapy. Dysmorphia Needs A Poster Girl! 

Fourteen years ago, the family health clinic on a routine check-up, noticed a lump in my breast. The tests revealed that the lump was benign and the consultant told me that the lump would never grow to be anything larger than a small pea. Almost immediately that I walked out of that consultation, the lump started growing and became the size of large golf ball which on a 32a breast was horrifying. It was worrying, too, as it was contradicting the information that the consultant had given me. I waited again for another appointment and was told that the lump was still benign but would have to be removed.  I could deal with that.  Ok. So far, so good. Proceed. 

Waiting in a tiny ward for surgery at my local London hospital, I discovered that the young and very beautiful girl in the next bed to me had had the same thing happen to her and was also waiting to have a lump removed. The surgeon came and visited each of us individually in the ward to have a pre-operative chat. I overheard the surgeon telling the girl in the next bed that he would make sure not to leave a scar on her breasts and would try to go in from under and to the side to minimize any scar. The consultant pulled open the curtain and then came and sat next to me to explain the surgery to me. He did not offer me those same assurances. I asked him if he would be kind enough to make the scar as small as possible and he told me that was more than possible and promised me he would. 

As I came round from surgery, I overheard the girl in the next bed talking to someone about the tiny elastoplast she had under her breast.  As I heard this, my hand went to where my bandage was and it was across the front of my breast right in the middle. Uh oh + anger + tears followed by futile attempts to appear as if I was not terrified by all of this. This was not good.  

What happens when the realization of a larger than expected wound is dawning on a patient with Body Dysmorphic Disorder?  Does the imagined ugliness just expand to incorporate the new problem? Is it like being the boy with his finger in the dyke? When the doctor came by, I pulled my courage together to say that I was surprised to see where the wound was made and he replied with ‘we didn’t realize you wanted a scar underneath your breast’. It was not the same surgeon that I spoke to earlier. Horror. I held it together and I was told that I would have to wait for the wound to heal and the scar to form and to come back and re-assess how I felt at that point. They told me I would probably feel happier by then. 

Are you kidding me? I don’t have enough fingers to plug that dyke? 

When I returned for the follow-up appointment in out-patients, I started the complaint procedure. As the complaint escalated with one person after another coming to examine me and explain that the surgeon was unaware that I would have preferred a more discreet scar, I was becoming more and more dumbfounded. Really? They didn’t think I would want a more discreet scar? Seriously? Eventually they sat me down and said those famous words: ‘wait here’. 

After about half an hour a man came into the cubicle where I sat and attempted to reason with me that the scar would not stop me from living. I was about ready to faint with all this rationality when eventually, pleadingly, he asked in what he hoped was a rhetorical way ‘what would you have us do?’ I guess they expected me not to have thought this through and not to have an answer because so far they had not offered me any suggestions as to what to do. They kept me with the feeling that there was no answer to my dilemma even though they acknowledged it was unsightly and could have been avoided.  By this time, half of the hospital had seen my breasts: a deeply unpleasant experience! Some of them said the breast looked ok.  Others responded with ‘oh’ biting back their real response. It is very difficult to be indignant when you are naked from the spare tyre up. The worst part was that it was totally impossible to work out from their dishonest reactions whether this particular ugliness was real or imagined. The answer would have been irrelevant anyway because the fact was that there was no need for me to have had to sport a long and wide scar for life across a tiny breast. Had I been warned ahead of time that a scar would be a non-negotiable part of the removal of this particular lump, then I would have psychologically prepared myself to deal with it. I would not have been happy but I would not have been complaining to whoever it was that I was complaining to. 

After all the powers-that-be had examined my breast, I gathered my courage together and without pause for breath, explained to them that I believed that if they put a set of breast implants in me, this would lift (stretch) the skin and reposition the scar. They were shocked and horrified that anyone would suggest this to them.  It was 1996.  Dear oh dear. Women don’t speak surely?! Where was her consent form for this outbreak of speech? I had friends who had breast implants and they all had shown me their results and I had noticed that the skin was stretched, shiny. The medics huddled together and then turned to me saying that they agreed that I was now a suitable candidate for a consultation in the plastics department. They said it as if it was their idea! Should I mention how shaken I was by all of this? 

It took about two years before I was seen and the surgeon did agree that a pair of breast implants would help to reposition the scar so that it would be less noticeable. By this time I was running a patient support site for cosmetic surgery patients and had received many photos from many women who all talked about the skin stretching in response to the implant.  I brought two or three friends with breast implants to my consultation so that I could specifically point out to the surgeon the type of result I hoped to achieve.  

I will always be grateful to those friends (I met them on my website) that came along with me for morale support and for educational purposes! I’m not suggesting that everyone takes someone along as an example to show a surgeon but sometimes it is helpful if you don’t know how to say something clearly.   Also, I was very worried that the surgeon might change his mind about my surgery and I needed friends there to help pick me up off the floor from the potential disappointment I worried about. It is massively important to have real patients share real experiences (good and bad) with real photos so that other patients can gain better understanding about procedural possibilities or even impossibilities. Supplementing consultation information with other patients’  experience is a joy and a lesson for all. I am proud to have been the first woman online in the UK to voluntarily offer (and benefit from) free cosmetic surgery patient support . Fortunatley, this particular surgeon was happy with the concept. 

I was absolutely delighted that the surgeon I consulted approved me for breast implants to disguise the unsightly scar.  I waited nearly another two years to have the surgery. I was given surgery dates which were cancelled over and over again in those two years. Each time the disappointment sickened me. It was a torturous wait. When I called to see if anything could be done to get me into surgery any sooner, I was always reminded how unimportant my procedure was to them. I did not ask for a scar but I was being asked to live with it for longer than I felt necessary. I empathize with anyone who is waiting for any surgery on the NHS. Time passes s-l-o-w-l-y. 

Four years of misery. I agree that this is not the same type of misery that others with more serious medical conditions suffer from but within the parameters of my universe, this felt like a lifetime. 

I had a pre-op consultation to discuss the surgery and the size and shape of the implants. This is where the nature of the surgery changed slightly.  I was informed that 310cc round, sub-pectoral McGhan implants would be adequate to move the scar. I asked if I could have a larger size of implant arguing that the results might be more aesthetic (to me) with a larger size. I was granted my wish. It was a nice feeling. I was kind of excited. 

When I woke up from surgery, my alter-ego was in a very anxious state. One quick look down ‘neath the sheets told me that I did not look any less ugly! How predictable. So my ugliness had not gone away. Not at all. I was disappointed. I hoped the imagined ugliness would just disappear as soon as I saw my nice new shiny breasts. That isn’t what happened though.  I felt exactly the same about myself as I have always done. I had learned to incorporate being flat chested into my imagined ugliness and now I was resigned to learning how to incorporate being a new size and shape into my imagined ugliness. Same thing different day. No change there then!  I will say though that I was totally delighted that the scar was moved out of sight. Thoroughly and utterly delighted. Oh and I also love wearing bikinis on the beach now. I still imagine I am ugly but I feel that I look better. How weird is that? It’s not an absence of pain but it is a reduction. So far, one plus point! That is a great result for the pro cosmetic surgery within Body Dysmorphic Disorder group! If only I lived on a beach more of the time! 

I think this helps to illustrate how in some cases, plastic surgery for body dysmorphic disorder can be acceptable. Part of my imagined ugliness was about the size of my breasts. Yes, I understand that cosmetic surgery may not change that part of me that refuses to budge from imagined ugliness. That was not the main goal of this surgery anyway. As long as any patient knows before surgery that the results of the surgery may not alter their feelings/thoughts about themselves, then it might be a marriage made in heaven or at least an acceptable proposition. 

Not everyone will be in my boat. In cases of Body Dysmorphic Disorder patients, there are similarities and there are also differences.  There are degrees of suffering. There are different levels of self-awareness. Some patients with Body Dysmorphic Disorder who come from a family of other sufferers may have to find different ways of dealing with the disorder compared to other patients who are unique in their family with this disorder. Different people will have different reasons for presenting themselves for cosmetic surgery. If a patient can see that part of their problem will remain or possibly get worse with the results of plastic surgery but part of their problem may be resolved, then it is a case of appreciating the individual concerned. Partial relief of pain is better than no relief of pain. How can we tell which patients are able to accept what can and can not be changed psychologically from cosmetic surgery? Whether it is cognitive behavioural, existential, integrative or any other type of psychotherapy, a patient must at least be attempting to gain some insight into their condition before they can gain any possibility of benefit from cosmetic surgery. Ultimately, the benefit must outweigh the risk. 

Anyone who undergoes cosmetic surgery takes a risk whether they have Body Dysmorphic Disorder or not. The question is whether or not the possibility of the benefit outweighs all the risks involved. I wish anyone who chooses to undergo cosmetic surgery all the best of luck in the world. Oh and have a look at my sister site: www.cosmeticsupport.com

sister site to Dysmorphic Discussions

First edition of New Blog
http://cosmeticsupport.blogspot.co.uk