"Body Dysmorphic Disorder" vs. "Unrealistic Expectations"

[arfy]

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]

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.]

[NW]

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

[Guest]

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.

[vocor1]

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.

[Guest]

Vocor,

 

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

 

Paul

[Guest]

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.

[Guest]

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.

[vocor1]

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

[EastCoast]

How old are you, what class ?

[vocor1]

EastCoast:

 

I'm 28. I would classify myself as a Norwood 4A.

Two weeks ago I had a 2200 FU HT. I would now classify myself as a NW2 based on what I saw post-op.

[EastCoast]

Had 1800, 1000 then 800 six months ago. Was a 5 with no crown balding, still had a hirline, just thin and whispy on the top. No receeding temples.

I had an allegeric reaction to some powerful medicine at 19, Hair thinned considerably till 30 when I got HT. I know the feeling of thinning hair in early twenties. I am a good looking guy but met less girls as it really thinned. It wasn't fair but it's over with. At least I took care of this early. I will have hair when most of my friends go bald in their 40's !!!

[Mr. Hair]

Vocor1, great post.

 

Mr. Hair

[arfy]

This is getting off-topic...

 

Look, lots of girls worry about their weight, want to look skinny etc. However, only a certain percentage will resort to sticking their fingers down their throat after they eat, to make themselves vomit up a meal. And an even smaller percentage will do that relentlessly, even when they weigh 90 pounds.

 

That's the difference between "Body Dysmorphic Disorder" and wanting to look thin.

 

Maybe you guys don't realize it, but people who complain about sh*tty looking transplants, or overly-large donor scars, are sometimes accused of exaggerating their concerns. Many of you have lucked out and gone to quality surgeons, however there are other guys who have gotten poor results. When they complain, the clinic tries to tell them "You look fine! It's all in your head!"

 

That's what this thread is about.

[Guest]

I agree Arfy.

 

What I found confusing in my situation was that just before I was told I had BDD by the doctor, he was examining me and agreed that my transplant looked pretty bad. He actually said he couldve done a better job with his hands tied behind his back and the lights off. So since he acknowledged that it looked bad and especially since he was not even the one who did it, I still wonder why he gave such a diagnosis. In my opinion the two comments just dont go hand in hand.

[Guest]

Arfy makes the distinction perfectly. Lots of people worry about their weight, their skin, their hairstyle, their clothing choices, etc. It is those who go to disturbed extremes that don't reflect reality who are exhibiting BDD.

 

Scarhead: Your surgeon's comments make absolutely no sense in light of his acknowledgement that your transplant work was poor.

 

2nd point I'd like to make: Surgeons are not qualified to make these diagnoses. They are untrained for this - period! It's not a matter of turf, it's a matter of training. I don't do hair transplants and your surgeon has no business throwing out a psychiatric diagnosis at you. Sorry to say, maybe he's a good transplant surgeon, but he's an arrogant, jerk for making this comment to you!

 

Being self-conscious about some aspect of your appearance, when there is a "real" problem that you are self-conscious about, is not a mental disorder. I'd be afraid to let this guy do surgery on me because he sounds too arrogant to be trusted. What would he say to you if he does a bad job on you and you try to address it with him afterward?

[Guest]

Sure. Its a different story if a person already has BDD before surgery, then yes it is very possible that they will still have it after the surgery, whether it turns out good or bad. In that case it is a psychological problem that needs to be addressed.

But if a person has a sound mind to begin with and decides to have cosmetic surgery to fix something and it instead leaves them with an unnatural appearance and/or a scar that can physically be seen I think it would be quite normal to become distressed by it.

Im not sure if the surgeon was qualified to make a pyschological assessment of me, especially in such a short time, but I did have a few other opinions by other doctors and I was told that I did not have BDD, but did suffer from anxiety and depression related to the failed surgery, which is completely different.

[HotCreek]

I think Jotronic is correct on this count. Coursework in psychology and psychiatry is part of the standard curriculum at most American medical schools. In addition, every med school graduate undoubtedly gets training in psychiatry as part of his normal "rotations" as an intern. Also, "psychiatry" is, by definition, a medical specialization in the field of psychology. So every psychiatrist is an MD and the training that surgeons and psychiatrists obtain, at least initially, is very much the same.

 

Of course, no amount of training or degrees precludes the possibility that one person or another may act like a "jerk." So maybe the guy was a jerk and maybe he wasn't. But I do concur that the matter is suspicious as the "BDD" label in this case seems to have been affixed AFTER, rather than before, the HT surgery.

 

So bottom line is that you want a doc who is highly competent as a HT surgeon and is honest enough that he won't "BS" you before or after the procedure.

[Guest]

Physicians in training go through a psyhciatric rotation during medical school - 6-8 weeks typically being exposed in an inpatient setting to severely mentally ill patients in the acute phases of their illnesses - typically various forms of schizophrenia and psychotic depression. They do a little reading during this time - a few articles and a text maybe.

 

Being in the field I'm in, I'm surprised you wouldn't be aware that I'm fully cognizant of the fact that med students do a psych rotation. In fact, one of my roomates while I was in graduate school was a medical student and I talked with him quite a bit while he was doing his psych rotation at a V.A. hospital North of Chicago.

 

And, one year of my own training was actually in a medical school setting at a major Chicago hospital where I trained beside and with psyciatric residents - men and women in training to become psychiatrists in a three year full-time post M.D. program. I saw plenty of med students and nursing students pass through for their psychiatric rotations. I know what their training is.

 

A psych rotation does not even remotely qualify someone to make pyschiatric diagnoses. After getting my college degree in psychology - four years of study and a major loaded more heavily in course work and research than most psychology students, I was not even remotely prepared to render diagnoses. I studied another six years to earn a doctorate and did three years of post doc study. I had to read an average of 600 pages per week for seven years to build a useful knowledge base, earn another 120 credit hours of course work and had 3500 hours of supervised clinical work and small group seminar training. In addition, I was constantly tested and passed qualifying exams for diagnostic work. And then, still had to pass a national test to get a state license.

 

I intend no insult here, but the ordinary physician's training in psychology and psychiatry barely even touches the edges of psychological disturbance for the most brief period in their training. Diagnostic work is extremely complex, tricky and takes a very long time to master.

 

If a cosmetic surgeon runs into someone whom he/she suspects may have a problem connected with their request for surgery or reaction to surgery that surgeon can make a referral to a psychologist and say something to the effect of "I'm not sure you can benefit from this surgery in the way you hope. I'd like you to talk this over first with someone who knows more about self-image and how surgery might or might not be helpful to you."

 

If it's after the fact and the surgery has been done, the surgeon should still not say you have BDD. He/She can say something like "I don't think I can help you more with this. It may be that there are some difficulties in how you are seeing yourself at this point. To be fair though, I can't be sure. I'm really not qualified to render an opinion. So, I'm recommending that you meet with someone who knows more about these sorts of things. Maybe there is something here for you to look at, or maybe my judgment is off here. I'd like a less invested third party to talk this over with you and then we'll go from there."

 

This kind of situation isn't hypothtical, I've had physicians talk with me many times about what to say or how to approach the subject of a referral in a way that increases the probability that the patient will accept their referral. And, typically, physicians say things like "I'm not sure what's going on here, I'm in over my head on this, so I'd prefer to have you look at the situation. Physicians, who are licensed to prescribe medications (I'm a psychologist, so I don't hold have a DEA#) frequently ask my opinion about what medication(s) might be helful in a particular case, because they are aware that their knowledge base in this area is scant and most of what they know about the drugs is from the pharmaceutical company detail men/women who stop buy their office with samples and from the PDR.

 

I stand by my position that the surgeon who pronounces to a patient that they have BDD is an arrogant jerk - escpecially after that surgeon has acknowledged that the patient had poor work done. The whole way it was said points to this - "I could have done a better job with one hand tied behind my back." There's a lot swagger and arrogance driving this surgeon's behavior. And that would include the illusion that he's capable of delivering psychiatric diagnoses.

[HotCreek]

Paul148,

 

Relax! Why expend so much energy convincing everybody here what we all already know? Namely, that people in the "field" of psychology are largely driven by their own need to deal with their own insecurities? Nobody here's really questioning your credentials, we're just trading ideas.

 

Besides, were you there when the surgeon made his "diagnosis?" Do you really know exactly what he said and how he phrased it? Do you know what else he may have said? Do you know that the particular surgeon did not do a residency (at least four years at most med schools) in psychiatry too? Do you know that he doesn't have a doctorate in some field of psychology? Do you know anything about his background at all, except that he's a HT doc? I didn't think so.

 

Nonetheless, after telling us that "Diagnostic work is extremely complex, (and) tricky..." you feel qualified to diagnose the physican as an "arrogant jerk," and that there's a lot of "swagger and arrogance" driving his behavior?

 

Puhleeze!!! Give us a break! Or has your own arrogant attachment to the monumental training you presume we all know you've had convinced you that the hall mark of a good psychologist is complete abandonment of objective, logical and dispassionate analysis?

 

The people who post here are all good men and women so far as I can see. We just want to exchange ideas and obtain information. And while it's one thing for a person with FIRST HAND empirical experience to "vent" over treatment he received from a physician, it's quite another for someone with NO FIRST HAND experience to engage in a childish fit of name-calling.

 

I sincerely mean no offense to you, but if, as you claim, you work in the "field" you ought to know better.

[vocor1]

Someone who isn't qualified to make a BDD diagnosis before (or who didn't) certainly isn't qualified to make one after the HT.

Crappy work by the doc is not equal to BDD in the patient or indicative of an overly self-conscious patient.

The crappy case is that a doc might say prior to the HT, "Yeah, we can do an HT on you, no problem and you'll look great." He does the HT regardless of the patient's mental state or education, and does a poor job. Then post op, when the patient complains of poor work, the doc magical diagnosis is BDD.

The doc has played both sides of the fence and is attempting to avoid blame for a poor job.

Pre-op: "I recommend we do the surgery. You'll look great." Post-op: "You are too worried about your appearance, you know. You look okay. Get over it or get help."

What a bunch of baloney.

 

vocor1

[HarryLemon]

Wow - just a third party view here:

 

I don't think Paul148 was in need of being told to "relax" and to stop being "so childish", actually. No offence either, I think he just gave a very thoughtful discourse on the dangers of generalizations when drawing assumptions, as there are clearly more elements involved in psychology than many of us "Armchair Psychologists" are aware of - doesn't mean we shouldn't take note of them either, whatever one's slant on the angle may be. In retrospect, I think you will see that both of your posts are still being written for the same cause.

 

Everyone IS giving good, well thought-out, and considered opinions and ideas here.

 

I'm sure there was no intention to step on anyone's toes even if that's how one was tempted to feel - at first glance...

 

[This message was edited by HarryLemon on January 03, 2003 at 04:28 PM.]

[Guest]

Thanks for the info. I guess I'm more "normal" than I thought.

[Guest]

Not to beat this one to death any more than it has been, but I was a neuropsychology clinician years ago before respecialising in my current field. I worked with psychiatrists and physicians all the time, as a member of a multidisciplinary treatment team. Though my work was primarily in the assessment of cognitive functioning/dysfunction following brain injury and stroke, I also did my fair share of more general psychological evaluations, which involved personality assessment.

 

The pronouncement of a diagnosis as complicated as BDD is not easily done. I'm with the posters who argue that this is a new means of dismissing claims against HT clinics and companies.

 

I wonder if some of the more reputable surgeons on this site have encountered this syndrome (assuming they could diagnose it if they saw it) in the numerous patients they've seen?

 

Does Bosley have, in addition to their cracker-jack HT services, psychiatric specialists? Maybe those guys in the white lab coats are shrinks -- hell, they're allowed to create a treatment plan, right? Being shrinks on the side would not be a far stretch for them.

 

Or maybe all the wacko patients go to the chain operations for their work, knowing that they will sue in long run, anyway.

 

Where are the ethics in all of this???