Cosmetic Surgery Addiction and Statistics: When Plastic Surgery Might Be More Harmful Than Helpful
According to the American Society of Plastic Surgeons (2008), there were over 11 million cosmetic procedures performed in 2007, a 59% increase from 2000. Medically, cosmetic surgery is the subspecialty of surgery that uniquely restricts itself to the enhancement of appearance through surgical and medical techniques. While in the US, 43% of men and 56% of women are dissatisfied with their appearance, just over 3% choose to undergo plastic surgery (Grossbart & Sarwer, 2003). However, a small percent of cosmetic surgery patients are dissatisfied with their post-surgery results, and some undergo multiple surgeries as they are continually unhappy with their appearance. This post-surgery unhappiness prevalent among these patients is perplexing and unhealthy, and has caused surgeons to study factors that may explain their obsession with physical perfection and cosmetic surgery. A contraindication is a condition or specific situation in which a drug, procedure, or surgery should be avoided as it increases the risks or harm to the patient. In the context of cosmetic surgery, risks refer to an unimproved and decreased psychological well-being post-surgery.
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In this hub, we examine how cosmetic surgery may be contradicted when patients have disorders with a body image component in them. In addition, this paper will look at patients who show symptoms of body dysmorphic disorder, patients who are extreme perfectionists, and patients who have internalized the glamorous aspects of the cosmetic surgery painted by the media to show these psychological factors can contradict the favorable outcomes of cosmetic surgery.
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Cometic Surgery Resources
The first factor, Body Dysmorphic Disorder (BDD), is characterized by a preoccupation with an imagined defect or a markedly excessive concern, where there is slight physical anomaly (DSM-IV; American Psychiatric Association). This preoccupation often consumes and hinders the daily functioning of these patients who turn to cosmetic surgery as their source of hope. One study found that patients diagnosed with BDD comprised 7% of those who sought cosmetic surgery, up from the national level of 2% of those who met BDD diagnostic criteria (Sarwer, Wadden, Pertschuk, & Linton, 1998), implying that BDD predisposes one to get cosmetic surgery. Another study on 25 patients with BDD revealed that these patients were not only prone to getting multiple cosmetic surgeries as they continually relocated their dissatisfaction to another part of their body, but also reported lower body satisfaction with each successive surgery (Veale, 2000). This exacerbated their BDD symptoms and led to suggestions that the onset of BDD might have occurred post-surgery for some patients.
Similar to BDD, perfectionism has also been shown to produce post-surgery dissatisfaction in patients. This refers to the perception or the requirement that oneself or others must actually be perfect. Comparing 16 cosmetic surgery patients to a demographically matched control group revealed that women who had cosmetic surgery scored significantly higher in perfectionism compared to the control group (Hewitt, Sherry, Baggley, & Flett, 2007). Perfectionism can be socially prescribed or self promoted, where one has external or internal motivations for believing and striving to attain perfection of oneself respectively. Using the Multidimensional Perfectionism Scale (MPS) and the Perfectionistic Self-presentation Scale (PSPS) to measure levels of perfectionism, the results obtained supported the hypothesis that perfectionism was elevated in cosmetic surgery patients and also increased the likelihood that these patients underwent cosmetic surgery (Hewitt et al., 2007). Extreme perfectionists scored high on both dimensions, engaging in negative self-evaluations in their bid to project a pleasing public image to others. This continual strive towards an unattainable goal of perfection bears resemblance to the symptoms of BDD and often results in surgical dissatisfaction in this patients. These results were replicated in a separate study that used facial attractiveness ratings to compare the responses of BDD and Obsessive Compulsive Disorder (OCD) patients who had to rate the attractiveness of faces that were below, moderately and above average. (Wilhelm, Etcoff, & Buhlmann, 2008). Both these groups rated their own faces as significantly more unattractive compared to others even if their own facial attractiveness was objectively classified as average and above average. Both groups also scored notably higher compared to controls on the trait of perfectionism according to the Frost Multidimensional Perfectionism Scale (Wilhelm et al., 2008), once again strengthening the link between BDD and perfectionism.
A third factor which can affect a patient’s body image and attitudes towards cosmetic surgery is the media. With a host of new shows about cosmetic surgery makeovers, research shows strong positive correlations between cosmetic reality television viewership with higher body dissatisfaction, favorable attitudes to cosmetic surgery, perceived pressure to have cosmetic surgery and decreased fear of it (Sperry, Thompson, Sarwer, & Cash, 2009). These shows glamorize these cosmetic procedures, increasing their accessibility and appeal to the viewers. Viewers then develop false hopes, overly grandiose and utopic expectations of cosmetic surgery. Thinking surgery can transform their lives like the characters seen on TV, viewers become unhappy with their appearance. (Sperry et al., 2009). This strong body dissatisfaction is also linked to BDD, although there is insufficient research to confirm if the internalization of media portrayals of a perfect body in these shows actually trigger the onset of BDD.
When patients are diagnosed with BDD, or demonstrate extreme levels of perfectionism, or internalize media messages about unrealistic beauty standards, they experience substantial psychological distress. This hinders their daily functioning, particularly in the case of BDD sufferers whose obsession with a minor flaw can ruin their social and private lives. Organizations exist to provide professional help these BDD patients to treat the disorder. A specific example is the OCD-BDD clinic in Northern California. This clinic focuses on the treatment of OCD, BDD anxiety disorders and depression. For BDD patients, this clinic provides individual and family therapy. An interview with Scott M. Granet, director of the clinic revealed they treat about 100 patients annually. Half of these patients are mostly White or Asian middle class women, with an average age of 30 and 1 child. These patients are referred to the clinic through other therapists or insurance companies or find the clinic through its website. As this clinic was set up just 9 months ago, Scott Granet is currently the only clinician who provides the therapy services, which comprise mostly of individual psychotherapy services. Outside of his clinic, he has extensive teaching and professional training engagements in the area of psychiatry and behavioral health. (S. Granet, personal communication, March 11, 2009). As this clinic is still new and expanding, it does not provide support groups for its patients, unlike the more established programs like the Stanford OCD Clinic or the Los Angeles Body Dysmorphic Disorder and Body Image Clinic, which not only has a special treatment programs for BDD patients but also provides therapeutic social support groups for their patients.
While we observe that the number of clinical programs and research on BDD are increasing, BDD is still difficult to diagnose. Many sufferers are secretive and almost shameful about their problem, preventing them from disclosing their problem. Also, screening patients for BDD is a relatively new procedure implemented only in recent years, so not all cosmetic surgeons are familiar with this issue. However more research needs to be done to explore the relationship between these psychological dispositions and the role of media to determine actual causality.
In conclusion, patients who suffer from body image dissatisfactions complexes such as BDD, who display strong traits of perfectionism, and who have tinted and unattainable expectations of cosmetic surgery influenced by the media make bad cosmetic surgery candidates. These people enter into surgery with unrealistic expectations, naïve understandings about the risks involved with cosmetic surgery and are not satisfied with surgery outcomes as their problems have deeper psychological and emotional roots that require counseling or therapy instead of a quick surgical fix. This contraindicates the outcomes of cosmetic surgery when these people do not have improved self-esteem levels or higher satisfaction with their bodies but instead have aggravated BDD symptoms or post-surgery depression.
American Psychological Association. (2000). Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR Fourth Edition (Text Revision). Arlington, VA: American Psychiatric Publishing.
Author, S. Granet (2008). The OCD-BDD Clinic of Northern California. Retrieved March 11, 2009, from http://www.ocd-bddclinic.com./index.html
BDDClinic (2009). Los Angeles Body Dysmorphic Disorder and Body Image Clinic Retrieved March 11, 2009, from http://www.bddclinic.info/joomla/
Grossbart, T., & Sarwer, D. (2003). Psychosocial Issues and Their Relevance to the cosmetic Surgery Patient. Seminars in Cutaneous Medicine and Surgery, 22, 136-147.
Hewitt, P., Sherry, S., Baggley, D., & Flett, G. (2007). Perfectionism and undergoing cosmetic surgery. European Journal of Plastic Surgeons, 29, 349-354.
Plastic Surgery Procedural Statistics Press Kit. (n.d.). Retrieved March 7, 2009, from http://www.plasticsurgery.org/Media/Statistics.html
Sarwer, D., Wadden, T., Pertschuk, M., & Linton, W. (1998). Body Image Dissatisfaction and Body Dysmorphic Disorder in 100 Cosmetic Surgery Patients . Plastic & Reconstructive Surgery, 101, 1644-1649.
Sperry, S., Thompson, K., Sarwer, D., & Cash, T. (2009). Cosmetic Surgery Reality TV Viewership: Relations With Cosmetic Surgery Attitudes, Body Image, and Disordered Eating. Annals of Plastic Surgery, 62, 7-11.
Stanford School of Medicine (2009). OCD research – Stanford School of Medicine. Retrieved March 11, 2009, from http://ocd.stanford.edu/
Veale, D. (2000). Outcome of cosmetic surgery and 'DIY' surgery in patients with body dysmorphic disorder. Psychiatric Bulletin, 24, 218-221.
Wilhelm, S., Etcoff, N., & Buhlmann, U. (2008). Facial attractiveness ratings and perfectionism in body dysmorphic disorder and obsessive-compulsive disorder. Journal of Anxiety Disorders, 22, 540-547.
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