There was a comment about Body Dysmorphic Disorder in another thread, and someone asked what it was.

Body Dysmorphic Disorder is why a girl might become anorexic, for example. Her ribs might be protruding, she might look skeletal, but when she looks at herself in the mirror she sees "fatness".

Here's a few clues about "Body Dysmorphic Disorder" as it pertains to the world of commercial hair transplantation, though.

You will notice that whenever a hair transplant patient gets accused of having "BDD", they are always told that's their problem AFTER a doctor has taken their money and performed a surgery, and not BEFORE getting TURNED DOWN for a surgery.

Hmmm...I wonder why THAT is? Why couldn't the clinic make that diagnosis BEFORE they performed their unsatisfactory surgery?

Why do these hair transplant patients who supposedly have "Body Dysmorphic Disorder" suddenly develop this problem out of the clear blue sky, only AFTER spending thousands of dollars on an unsatisfactory hair transplant?

Could it be a bit of fast-talking psychological mumbo-jumbo used as a "smoke screen" to try to get the patient to shift the blame off of the consultant at the clinic, or the doctor who did the surgery, and place the blame for bad results on the patient himself?

A similar line of bullsh*t used as a smokescreen is that the patient has "unrealistic expectations". Maybe it was "unrealistic" for the patient to "expect" that his results wouldn't look "crappy"??? By saying the patient has "unrealistic expectations", the clinic tries to shift the blame for the unhappiness off of their own shoulders, and back onto the patient's shoulders. It's a little bit of psychological trickery that is sometimes needed to "complete the con", often seen at clinics that specialize in high volume instead of high quality.

I suspect the "body dysmorphic disorder" line is a modern twist on that old trick.

If you look in the mirror and see plugginess or an unnatural hair line, it is because your clinic did a poor job with your surgery. It is not because you are delusional. It is not unrealistic to expect a non-pluggy natural looking result.

If you still get told you have "unrealistic expectations", ask your clinic or your consultant WHO exactly was responsible for creating those false expectations in the first place? Who was negligent in dispelling false expectations? Who was supposed to educate the patient on all of the realities of hair transplantation, and FAILED to fulfill their responsibility?

I would like to propose there is a psychological disorder seen in commercial hair transplant professionals, usually manifesting only when the patient is unhappy with their hair transplant: "Don't Blame Me" syndrome, also known as "Your Fault" disorder. It is characterized by rapid "shirking" motions, averting the eyes, fast talking, and spontaneous blame-shifting.

[This message was edited by arfy on December 28, 2002 at 09:17 PM.]

There was a comment about Body Dysmorphic Disorder in another thread, and someone asked what it was.

Body Dysmorphic Disorder is why a girl might become anorexic, for example. Her ribs might be protruding, she might look skeletal, but when she looks at herself in the mirror she sees "fatness".

Here's a few clues about "Body Dysmorphic Disorder" as it pertains to the world of commercial hair transplantation, though.

You will notice that whenever a hair transplant patient gets accused of having "BDD", they are always told that's their problem AFTER a doctor has taken their money and performed a surgery, and not BEFORE getting TURNED DOWN for a surgery.

Hmmm...I wonder why THAT is? Why couldn't the clinic make that diagnosis BEFORE they performed their unsatisfactory surgery?

Why do these hair transplant patients who supposedly have "Body Dysmorphic Disorder" suddenly develop this problem out of the clear blue sky, only AFTER spending thousands of dollars on an unsatisfactory hair transplant?

Could it be a bit of fast-talking psychological mumbo-jumbo used as a "smoke screen" to try to get the patient to shift the blame off of the consultant at the clinic, or the doctor who did the surgery, and place the blame for bad results on the patient himself?

A similar line of bullsh*t used as a smokescreen is that the patient has "unrealistic expectations". Maybe it was "unrealistic" for the patient to "expect" that his results wouldn't look "crappy"??? By saying the patient has "unrealistic expectations", the clinic tries to shift the blame for the unhappiness off of their own shoulders, and back onto the patient's shoulders. It's a little bit of psychological trickery that is sometimes needed to "complete the con", often seen at clinics that specialize in high volume instead of high quality.

I suspect the "body dysmorphic disorder" line is a modern twist on that old trick.

If you look in the mirror and see plugginess or an unnatural hair line, it is because your clinic did a poor job with your surgery. It is not because you are delusional. It is not unrealistic to expect a non-pluggy natural looking result.

If you still get told you have "unrealistic expectations", ask your clinic or your consultant WHO exactly was responsible for creating those false expectations in the first place? Who was negligent in dispelling false expectations? Who was supposed to educate the patient on all of the realities of hair transplantation, and FAILED to fulfill their responsibility?

I would like to propose there is a psychological disorder seen in commercial hair transplant professionals, usually manifesting only when the patient is unhappy with their hair transplant: "Don't Blame Me" syndrome, also known as "Your Fault" disorder. It is characterized by rapid "shirking" motions, averting the eyes, fast talking, and spontaneous blame-shifting.

[This message was edited by arfy on December 28, 2002 at 09:17 PM.]

Arfy,

I fully agree w/you on this issue, I feel BDD is not an excuse that any sub-par Physician should be utilizing as a ploy for shoddy work.

We should expect and receive the highest standard of care in ALL situations, sure some patients are a bit more picky than others, but no Dr without the advice from a professional Phyciatric Physician should EVEN consider this a scapegoat clause for less than acceptable results. For this variety of doctor, perhaps becoming a lawyer is a better idea than continuing in the medical field.

I feel we have come to a very acceptable level of hair transplant results, lets just say no to the shoddy practices....and hey ! maybe we can help the airline industry recover, by traveling to the Docs that produce quality.

Grrrrrrr !!!
NW

I hadn't heard about BDD coming up in relation to hair loss and hair transplant surgeries. It seems like a clever and cruel tactic for a surgeon to employ after doing lousy work.

BDD is a real phenomenon, but it is a really low blow when employed by a cosmetic surgeon of any sort to deny responsibility for poorly done work. BDD is a relatively recently coined term for a long observed symptom associated with very serious underlying psychological disturbance. So,it is indeed reprehensible for a hair transplant surgeon to use this term "as a shield."

I don't believe that surgeons are particularly equipped to diagnose this condition, especially if it's someone's first cosmetic surgery and they do indeed have a cosmetic complaint that can be improved. However, it is really irresponsible for a surgeon to perform repeated cosmetic surgeries on someone who is going to look worse as more surgeries are performed (e.g. Michael Jackson). Generally, it seems to me that hair transplant surgeons, when they are capable, may perform several surgeries because they can improve the patient's appearance. But, I'd imagine that patient and surgeon usually agree when realistic goals have been attained and no more surgery can or should be done.

When a patient is relentless in demands for more surgery, and the surgeon sees no value to be gained from further surgery, that's a strong indicator that BDD symptoms could be present - I emphasize the word "relentless," because this is how these patients present.

In my practice, I have seen several patients (none were hair transplant patients) who have had cosmetic surgery with fantastic results judging from before photos I'd seen and their appearance in my office. It is startling to encounter a beautiful woman, for example, who will sit down in my office for a first meeting (sent to me by a relative or her surgeon) and hear her say "well, it's obvious why I'm here," upon my initial inquiry.

Then, I may say something like, "please tell me." The patient will go on to describe how hideous her face looks, how "obviously" she can't go out in public etc., and yet the person I'm looking at might be very attractive and showing no evidence that her appearance is the result of cosmetic alteration. The relentless insistance that there is an appearance problem and the level of distortion is startling. These individuals always have very troubled personal histories and are also highly resistant to treatment.

In women, as most everyone knows, BDD appears most frequently with Anorexia Nervosa and opinions about their facial appearance. In men, it most frequently appears in relation to body build. Really muscular guys will see themselves has weak and small. As might be guessed, all of these distortions relate to durable internal views of the self as defective in some serious ways.

I can only speculate with regard to hair transplants, but most of us on the board know of people who freak at the first sign of recession. Something may be wrong in such cases. But, I have to imagine that in virtually every case of a patient unhappy AFTER a hair transplant surgery, it is because the surgery was done badly. There is such an extensive history and ongoing problem with poor to disastarous results, that lousy surgery must account for virtually every complaint other than those cases when an individual might have had an unrealistic expectation about density after surgery. But, I see that as a problem of the surgeon not communicating with the patient beforehand regarding what to expect, not a problem caused by BDD.

I just wonder, where is the evidence that BDD is expressing itself significantly in disatisfaction with hair transplants? It seems to me that patients who have had subpar work generally are the one's who adjust to the fact that they had bad work done. And, certainly, if the work can be corrected, it would be a completely normal desire to have the poor work improved.

My sense of BDD, if it were to show up in a person complaining about the appearance of their hair, is that one would be looking at a person with a thick, attractive head of hair who was complaining that their hair is thin, sparse, ugly etc. The distortion involved would be obvious to anyone.

paul148:
That was a good post.
Are you a cosmetic surgeon? There are several references in your posts that suggest that you might be. Just curious.
It is sad that some people become so self-conscious without need. It is one thing if you've heard from others about what they see (which may or may not matter to the person) and entirely another to appoint your own judge within you to carry out a sentence that no external jury has ever handed down.

__________________
vocor1
Knowledge is Power
-- If the worst question is the one never asked, then the worst answer is the one never shared.
-- The truth only matters if you know about it.

Vocor,

Thank you for the compliment. I'm a clinical psychologist.

Paul

This is an interesting subject. It has occurred to me on many occasions that guys (like me) that seek HTs are too self-conscious. Have you ever noticed that we are the same guys that worry what people will think when we do it? I noticed that I cared much less about what others thought when I got my recent "repair" HT work done then I did when I got the first HT 20 years ago. And, while I'm on the subject, why do some guys just shave their heads and say "so what, who cares" and some guys are really worry about their hair loss to the point where it affects their ability to be happy with their lives?

At some point, I guess when the self-conciousness becomes an psychological obsession, it becomes BDD? Or, are there just degrees of BDD? It can't be an all-or-nothing thing, can it? Maybe Paul can chime in on this one.

Gary,

You raise some very interesting questions that are not easy to answer. I don't want to condescend by saying it's to complicated to answer on the board, but I realize I'm getting into things that are usually covered in long books and many journal articles. The complexities and subtleties just can't be covered here. But, I'll try to give a sort of thumbnail sketch for any who might be interested - with the caveat that this represents an oversimplification of the subject. There are many areas of this subject both broad and subtle that I can't adequately discuss here.

One thing I want to clarify is that my own position is that there should be no such "Disorder" called "Body Dysmorphic Disorder." That's because the distortion involved is not a "stand alone" personality or brain disorder, but a symptom. It's analogous to having a fever and calling the fever the disease itself. A fever can accompany many primary illnesses, but it is a symptom of a primary underlying illness.

The dynamics underlying extreme distortion of body image are varied. Fundamentally, there is a weakness in reality testing that would show in other areas of the person's life - that is, other symptoms would be present. It's virtually impossible to have only this symptom when reality testing is poor.

Is the BD symptom simply an amplified form of shyness or self conciousness? The simplest answer is no, because it is not just a matter of quantity of a difficulty, but quality of the difficulty. Many people can obsess, get anxious, feel down, be shy etc, but there are disorders involving these tendencies that are not only amplified in power, but differ in underlying "quality" of thought, logic and reference to reality and ability to perceive reality in ways that others generally do.

There are two general categories of personality disorders where body dysmorphia often appear (but, by no means does it always occur with these disorders). They are Borderline Personality Disorder and Narcissistic Personality Disorders or as some call the latter, "disorders of the self." In each of these there are fundamental developmental flaws related to perception of the self (internal and external), as well as many symptoms that vary widely from person to person. The term narcissism often confuses lay people, because the "self-centered, conceited, overly-entitled type of character is only one class of this group.

In Borderline Personality organizations, the self-image is highly unstable. At times the individual can feel worthless, hideously ugly and repugnant. At other times, this same individual can feel convinced that they are the greatest thing to come along since sliced bread. This is a severe level of personality disturbance that manifests in many other symptoms, but the diffuse sense identity and unstable sense of self is a component that can contribute to a highly distorted body image. These people can look like they are doing okay on the surface, but underlying reality testing is fragile and certain triggers can kick off some pretty nasty symptomatic episodes that reach far beyond bodily image.

Narcissistic Personalities relate more to a relatively stable, but "false self." This false self can be one of superiority, arising in compensation for an underlying sense of inadequacy, or it can be primary - the person believes to the core (and unrealistically) in their own flawlessness. But, there are many other reasons for a false self and they are not all about superiority.

Underlying most cases is a fundamental need to be, feel and know oneself as something different than one is. Sometimes it is to serve the need of a parent, sometimes it develops from a basic rejection of "parts" of oneself. The reasons are so varied and complex from person to person. And yes, there is at least a little bit of this in everyone, but a little bit does not make for a personality disorder.

One could say that extreme sensitivity (I mean at the margins of extreme sensitivity) about baldness - feeling chronically humiliated by it, particularly if it's only moderate baldness, can be a kind of dysmorphia. Again,if we are talking especially about individuals whose appearance is generally socially acceptable. This sensitivity could arise from the fact that baldness doesn't fit with the false image of the self as perfect, or an exagerated sense of the need to maintain a particular image. In narcisstic disorders, the word exagerated is extremely important, because the degree of humiliation felt over baldness is affected by the degree of investment in a false self that has no tolerance for being bald.

Great question then, why do some guys get-off on shaving their head? Some may do it because they do look better in the opinion of others. There may be absolutely nothing wrong with them.

Some may do it because of the disorders I was referring to above. To some, a shaved head may represent an appearance of power and toughness. It may project an image that is intimidating in some people. So, the effort is the same, to create a false self, typically, but not always compensating for an underlying "unacceptable" sense of self or an unstable and vulnerable self.

Another kind of shaved head character I see occassionally arises from a histrionic personality. A feature of this personality is the need to draw attention, feel special and feel noticed. Some males who shave their heads are clearly operating from this psychological platform. You might wonder, if narcisstic types and histrionic types can go hand in hand within one person? The answer is yes, and often. So, when conceptualizing why a person does a particular thing, it's important to remember that when there are pathological reasons, there is almost always more than just one purpose being served or more than one cause for a symptom. There is a phrase in psychology referring to this: "symptoms are over-determined" or determined by several underlying causes at once.


Finally, Gary, while you make the point that it can't be an all or nothing thing, I think you are correct to an extent. There are seeds of problems and degrees of problems in anyone. But, what is significant clinically is not only degree, but the underlying dynamics behind the problem. These dynamics affect not only the array of accompanying symptoms, but approach to psychotherapy (& possiby medication in some cases), resistance level to treatment and prognosis or expectable outcome of the problem.

Anyone who gets a hair transplant is almost surely a bit self-conscious or maybe "alot" self-conscious. That doesn't mean they have a diffuse and unstable identity, poor reality testing or a fundamentally false sense of self.

To think of minor degrees of self-consciousness as a problem means that people shouldn't care about their social presentation at all. They may smell bad, look disheveled, wear clothing inappropriate to an occassion, interupt others or just plain fail to stop and think before they speak. Self-consciousness has it's good side - it reflects awareness of others as seperate beings upon whom our behaviors, attitudes and appearances have an impact. Yes, self-consciousness can become excessive and overly-inhibiting. But, on the other hand, an inadequate level of self-consciousness can be incredibly obnoxious, rude and difficult to put up with. It can render a person incapable of forming normal human attachments.

So, I wouldn't really worry about the fact that you notice that the degree of your self-consciousness has changed with/without hair.

Finally, the point with dysmorphia is that the poor image doesn't really change even when the external circumstances change. That's why anorectics see themselves as fat when they weigh only 65 lbs.

paul148: Another great post. Thanx.

Gary:
You bring up a really good point. I'm no MD, but I'd like to relate some of my experiences.

I wondered openly about if I myself was being too self-conscious. I too saw the guys, "who just shave their heads and say 'so what, who cares'."
I first thought about an HT when I was 26 and saw Bosley commercials. I thought the commercials were too salesy, plus I thought that, "man, I'm considering surgery for a cosmetic condition, what have I come to?" I had to answer a few questions before I could proceed.
To me, the most important one was, "Why do I care about my hairloss while others clearly don't?" For me, answering "because I just do" doesn't suffice. Over the next 2 years I found so many answers that I was looking for. I began to understand that an HT was the right decision for me. This is a little bit of what I found:

Other people's preception and comments on me:
This is my validation or proof for what I tend to think about myself. I shaved my head. Friends and others responded to that with, "why'd he do that" or "I guess that is his summer look" and what have you. For some reason, shaving my head did not look good. (Head shape, size, and skin tone have more to do with this than you might think). Needless to say, I tried a lot of things, including growing a goatee and what not. Nothing seemed to get the response I'd hoped for, like "you pretty good today", in response to a change in hair.
I can't escape the true fact for me of "young face, old hair". People clearly feel sorry for me because of that. That really does summarize it well. I put on a baseball cap, and everything is different -- people react to me more friendly and positive in social situations, in general.

Other men's dealing with hairloss:
I would say that hairloss bothers more men than are fessing up. Every guy wants to look strong and confident, but we have different ways of doing so. Most will just clam up about their worries. Then they'll throw away their money on "miracle cures" while still preserving their dislike for their hairloss.
Other men can style their hair in a manner that makes their hairloss not an issue. Coarse, thick hair helped some people I know in that area. Other guys do look fine with hairloss. They tend to have darker skin and/or rounder heads, I've observed. A good example is that most black men look great with shaved heads. I'd say that fair skinned white men generally do not. Why? I don't know, but that is what I see.
Other people are at an age when hairloss is more mainstream and expected. And so forth.

My personality:
I'm goal-oriented. I hate complacency and am ambitious. I don't like to "settle" on important manners. Other people are not, so hairloss doesn't matter because they are happy with their lot. I believe in working hard towards something and satisfaction in a job well done.
Those attitudes go to hairloss too. It is something I am unable to fix and choose not to deal with as is any more. I clearly believe that it is hampering some of my other objectives or causing me to start to settle for less than I want to. There is no question that my overall attitude on life affected my decision-making process. But I also have taken time to see how others have reacted to me, tried different things, and decided to move in a direction.

So am I self-conscious? I guess so and so be it. But I think I did my homework and got educated on my situation. That is the only way I can do justice to myself. And everything is a gamble -- there is still no guarantee of success. But things DO look promising -- more promising than before, for sure. I guess you can either step up the table and roll the dice, or sit back and watch someone else do it instead.

vocor1

__________________
vocor1
Knowledge is Power
-- If the worst question is the one never asked, then the worst answer is the one never shared.
-- The truth only matters if you know about it.

How old are you, what class ?