Mind and body

When not to cut: Cosmetic surgery cannot fix body dysmorphia

People with body dysmorphic disorder see themselves as ugly, malformed, misshapen or hideous.

Most of us have some insecurities about how we look, and some aspects of our appearance that we might secretly wish were different. But for people with body dysmorphic disorder, these issues become an obsession and constant focus of concern.

Body dysmorphic disorder is a psychiatric condition that leads people to adopt extremely distorted negative beliefs about their appearances: seeing themselves to be ugly, malformed, misshapen or hideous. Such beliefs do not reflect the reality of how they appear to others. The degree of concern and distress they may feel about their appearance is vastly out of proportion to any actual physical “defect”.

A small minority of the population is believed to experience the condition. One study found about 2.3% of participants had the condition.

The mirror is a major problem for people with body dysmorphic disorder. Some sufferers become fixated with mirror checking, with hours of their day absorbed in inspecting their appearance. Mostly this checking is counter-productive, making them feel worse and increasing their distress.

Other people with the condition may avoid mirrors altogether. Some can even have catastrophic reactions should they happen to glance at themselves in a reflective surface such as a shop window. Lots of sufferers conceal themselves under hats, scarves, wigs, dark glasses or excessive layers of makeup or concealing clothing in an attempt to hide their supposed defects.

Body dysmorphic disorder should not simply be dismissed as an expression of extreme vanity or insecurity about looks. This condition often leads to substantial distress and social and occupational impairment. Rates of depression are high, while suicide is not an uncommon outcome for those who do not receive appropriate treatment. Many avoid social situations for fear of others judging them negatively because of how they look.

Cosmetic solutions?

Because people with body dysmorphic disorder “see” themselves as having a cosmetic problem, it’s not surprising they often seek a cosmetic “solution”.

The highest rates of body dysmorphic disorder are found among people using cosmetic services like plastic surgeons, cosmetic dermatologists and cosmetic dentists. One study found up to 70% of people with body dysmorphic disorder had sought cosmetic procedures, and half had received such interventions.

The tragedy is that cosmetic procedures – by definition – do not solve the underlying psychological problem. They leave a majority of sufferers worse off: they pay for the procedure and suffer the pain and inconvenience of it, yet “see” the resulting cosmetic outcome as unsatisfactory, even if objectively the result is excellent.

This often leads to requests for more treatments, with ensuing worsening of the mental state of the patient and increasing frustration on behalf of the cosmetic specialist. The situation can become so heated that legal action, physical threats and even homicide have been known to be perpetrated by body dysmorphic disorder patients.

Screening for body dysmorphia

Cosmetic interventions of all types are becoming increasingly accessible to a wider public. Therefore, it would be ideal for cosmetic specialists routinely to screen for body dysmorphic disorder.

Australian cosmetic specialists are not mandated to screen for body dysmorphic disorder and there’s no available information on the proportion of cosmetic clinics that screen for the condition. From my experience of speaking to patients who have sought cosmetic intervention, screening is variable at best.

There are certainly some practitioners who are very aware of the risks associated with body dysmorphic disorder and ensure their clients are screened and offered referral for further help if required. Unfortunately, too often screening is not performed and patients suffer as a consequence.

Screening should be mandated for people seeking any cosmetic procedure that might be seen as “enduring”: this includes surgical procedures. My colleagues and I have developed a questionnaire for practitioners, which through a series of simple questions can help diagnose body dysmorphic disorder.

For those who may body dysmorphic disorder, careful further questioning and referral to a body dysmorphic disorder specialist is required. A range of psychological therapies (such as cognitive behaviour therapy) and medications (mostly antidepressants) can be very effective at treating the condition’s underlying problems.

Simply providing cosmetic clinics with screening tools won’t guarantee all doctors accurately assess for body dysmorphic disorder. This is because we cannot expect all clients to answer questionnaires truthfully. However, in my experience, having seen hundreds of people with body dysmorphic disorder, they usually do.

At the end of the day, it would be ideal if cosmetic specialists did everything in their power to fulfil their ethical obligations. To not screen and then deliver cosmetic procedures to people who may have body dysmorphic disorder goes against the medical dictum “first do no harm”.

The writer is chair of psychiatry at the University of Melbourne.

This article was first published on The Conversation.

We welcome your comments at letters@scroll.in.
Sponsored Content  BY 

How technology is changing the way Indians work

An extensive survey reveals the forces that are shaping our new workforce 

Shreya Srivastav, 28, a sales professional, logs in from a cafe. After catching up on email, she connects with her colleagues to discuss, exchange notes and crunch numbers coming in from across India and the world. Shreya who works out of the café most of the time, is employed with an MNC and is a ‘remote worker’. At her company headquarters, there are many who defy the stereotype of a big company workforce - the marketing professional who by necessity is a ‘meeting-hopper’ on the office campus or those who have no fixed desks and are often found hobnobbing with their colleagues in the corridors for work. There are also the typical deskbound knowledge workers.

These represent a new breed of professionals in India. Gone are the days when an employee was bound to a desk and the timings of the workplace – the new set of professionals thrive on flexibility which leads to better creativity and productivity as well as work-life balance. There is one common thread to all of them – technology, tailored to their work styles, which delivers on speed and ease of interactions. Several influential industry studies and economists have predicted that digital technologies have been as impactful as the Industrial Revolution in shaping the way people work. India is at the forefront of this change because of the lack of legacy barriers, a fast-growing economy and young workers. Five factors are enabling the birth of this new workforce:

Smart is the way forward

According to the Future Workforce Study conducted by Dell, three in five working Indians surveyed said that they were likely to quit their job if their work technology did not meet their standards. Everyone knows the frustration caused by slow or broken technology – in fact 41% of the working Indians surveyed identified this as the biggest waste of time at work. A ‘Smart workplace’ translates into fast, efficient and anytime-anywhere access to data, applications and other resources. Technology adoption is thus a major factor in an employee’s choice of place of work.

Openness to new technologies

While young professionals want their companies to get the basics right, they are also open to new technologies like Augmented Reality, Virtual Reality and Artificial Intelligence. The Dell study clearly reflects this trend — 93% of Indians surveyed are willing to use Augmented/Virtual Reality at work and 90% say Artificial Intelligence would make their jobs easier. The use of these technologies is no longer just a novelty project at firms. For example, ThysenKrupp, the elevator manufacturer uses VR to help its maintenance technician visualize an elevator repair job before he reaches the site. In India, startups such as vPhrase and Fluid AI are evolving AI solutions in the field of data processing and predictive analysis.

Desire for flexibility 

A majority of Indians surveyed rate freedom to bring their own devices (laptops, tablets, smartphones etc.) to work very highly. This should not be surprising, personal devices are usually highly customized to an individual’s requirements and help increase their productivity. For example, some may prefer a high-performance system while others may prioritize portability over anything else. Half the working Indians surveyed also feel that the flexibility of work location enhances productivity and enables better work-life balance. Work-life balance is fast emerging as one of the top drivers of workplace happiness for employees and initiatives aimed at it are finding their way to the priority list of business leaders.

Maintaining close collaboration 

While flexible working is here to stay, there is great value in collaborating in person in the office. When people work face to face, they can pick up verbal and body language cues, respond to each other better and build connections. Thus, companies are trying to implement technology that boosts seamless collaboration, even when teams are working remotely. Work place collaboration tools like Slack and Trello help employees keep in touch and manage projects from different locations. The usage of Skype has also become common. Companies like Dell are also working on hi-tech tools such as devices which boost connectivity in the most remote locations and responsive videos screens which make people across geographies feel like they are interacting face to face.

Rise of Data Security 

All these trends involve a massive amount of data being stored and exchanged online. With this comes the inevitable anxiety around data security. Apart from more data being online, security threats have also evolved to become sophisticated cyber-attacks which traditional security systems cannot handle. The Dell study shows that about 74% of those surveyed ranked data security measures as their number one priority. This level of concern about data security has made the new Indian workforce very willing to consider new solutions such as biometric authentication and advanced encryption in work systems.

Technology is at the core of change, whether in the context of an enterprise as a whole, the workforce or the individual employee. Dell, in their study of working professionals, identified five distinct personas — the Remote Workers, the On-The-Go Workers, the Desk-centric Workers, the Corridor Warriors and the Specialized Workers.

Dell has developed a range of laptops in the Dell Latitude series to suit each of these personas and match their requirements in terms of ease, speed and power. To know more about the ‘types of professionals’ and how the Dell Latitude laptops serve each, see here.

This article was produced by the Scroll marketing team on behalf of Dell and not by the Scroll editorial team.