Body Dysmorphic Disorder Syndrome

[corvettester]

I recently came across this thread which gave me a lot to think about: http://www.hairrestorationnetwork.com/eve/162345-ever-wonder-how-life-would-different.html#post2277622

 

Many of the comments are things which I often come across from posters on the HTN regarding how hair loss has impacted their lives emotionally and physchologically. Some are more mild than others, many of which are textbook examples of Body Dysmorphic Disorder Syndrome (BDD).

 

BDD is a very real mental health issue with very serious potential and actual consequences, which affect both men and women. Unfortunately, BDD isn't frequently discussed here on the HTN.

 

Consulting with a psychiatrist who specializes in BDD may be of more benefit than undergoing an HT, because with an HT you are not addressing the root issue, but rather the object of the neurosis.

 

Personally, I have always heeded the advice of "perspective" as others mentioned above. It could always be much worse, I think to myself. Not a day goes by where I don't see either a disabled, blind, dismembered, burn victim or mentally disabled person. I can't help but realize how trivial my problems must be compared to theirs.

 

However, when dealing with BDD, all reason and logic is moot. Just like an anorexic person is able to see themselves as fat, so does a BDD person see themselves as disfigured, despite reality. Naturally, hair loss will make just about anyone initially self-conscious or hamper our confidence. However, when it's to the point that you can't go outside, dread all social interactions to the point of obsession, causing undue stress and anxiety... that's when it time to seek professional help.

 

Hair loss is not a disfigurement, nor is it a disability. It's all in your head, which does't make it any less real, but does dictate a different and unique approach to treating it. Unfortunately, for men there seems to be an intractable stigma attached to not only cosmetic surgery such as HTs, but also seeking professional help for mental health concerns such as BDD.

 

 

The best advice I could give someone is to go talk to a physciatrist about it, a specialist in BDD. It won't be as emasculating and humiliating experience as you may think. When your car is broke down, you take it to the mechanic; when your sink won't unclog, you call the plumber; when you have a headache, you take a aspirin. Thus, mental health issues should be addressed in the same way as physical health issues, such as the flu, arthritis, hemorrhoids or ulcers... by seeing a doctor!

 

An HT should be for yourself, because you want it, not because you need it. I view it the same way I view physical fitness, good hygiene and dressing / grooming well: to look my best. Sure, even now I could dress better and have more muscles and better skin care products, but I don't need it to function well socially, vocationally or personally.

 

To read such comments as I have by posters about hair loss causing depression, anxiety, social isolation, time wasted fantasizing, occupational and social impairment, etc... is really sad considering that baldness has no effect on performance or ability in any known way. In every field or life endeavor, including entertainment, there are successful bald men.

 

The real problem is obviously the psychological effects of baldness which fall under the umbrella term BDD. For men, it's usually hair, height or weight that are the object of the pathology. Fortunately for us, there are medical advances to address all of those issues... not cures, just advances.

 

The reality is that some of the posters here are actually not good candidates for hair transplantation due to their BDD. An ethical doctor should screen patients for BDD and if they exhibit traits of it, the doctor should not grant them an HT.

 

This is an important topic and it'd be great if some doctors could chime in with their thoughts and experiences.

 

 

 

Corvettester

Edited August 31, 2011 by corvettester

[Cant decide]

CT - I am totally with you on this one. I must admit, I can get obsessive about my hair loss at times but perspective is so key. This also relates a bit to the post Spex just put up on how the brain deals with hair loss.

It is amazing to me how much less anyone notices or cares about ones hair loss compared to the person going through it. This sounds obvious but I don’t think most realize just how much people don’t notice hair loss. People notice what is important to them. Therefore, if you’re going through hair loss, you will notice others with hair loss and the severity and scope of the problem gets magnified in your brain. The way I see it, your hair loss is likely at least 50% less severe from others eyes than your own. I have no data to back this up but just an observation.

It really hit home how much people do not notice hair when I had my 5000+ HT (which I know you have seen the before and after pics) and very few people said anything after it all grew in!!!! How can that be??? In many ways, it bummed me out because I would have liked some positive reinforcement but on the other hand, I was glad that nobody put me on the spot. The reason people did not notice (A few did and telling them I grew my hair out was enough), was because I wore a cap for several months before my surgery and a few months after. Also, I used to apply toppik to my very thin top so at least it looked like my face was sort of framed. These two things were enough to make people forget or not realize where I was before my HT. I am still perplexed that more people did not say anything as the difference is dramatic!!! There could be those who have noticed and simply do not know what to say I mean check this out:

 

[Cant decide]

By the way, I went a little off topic on you again CT. Forgive me bro

[aaron1234]

Good post corv. And I totally agree with you Cant decide about how people notice things that are important to them - or in other words things that they are insecure about. I am definitely guilty of rating other guys NW levels and estimating how many grafts they would need!

 

An extension of your post corv would be for those patients who have an idealized picture of what they want to be and won't do anything socially until that is accomplished. For instance, someone who just had a surgery and is waiting for that perfect result before they ask a girl out. What if, what if they never get that result? Then they are basically putting themselves off the market because of an idea they have of what they should be. I'm sure this could happen professionally as well.

[Janna]

The reality is that some of the posters here are actually not good candidates for hair transplantation due to their BDD. An ethical doctor should screen patients for BDD and if they exhibit traits of it, the doctor should not grant them an HT.

 

This is an important topic and it'd be great if some doctors could chime in with their thoughts and experiences.

 

Corvettester

 

Sorry, I'm not a doctor but I thought I'd add my 2 cents since I think this is a good topic . Here's one tech's perspective.....

 

I recall when I first started as a tech of having a conversation with one of our patients during his procedure of the difficulties of dealing with hairloss. I was surprised at how distraught he was about it. He said, "a real shame for the whole world to see". This was 15+ years ago so it really stayed with me all these years. I believe his hairloss did not progress and he received a good result so he didn't need more ht procedures. But this story could have turned out differently had he had BDD. There's a fine line of determining if someone has BDD. Those who exhibit strong BDD tendancies would be discouraged and turned away from going through with a ht as it would be impossible to satisfy them.

 

There are times when you can't turn them away, such as when they need repair work. Dealing with those with BDD takes a lot of patience.

[corvettester]

Thanks for sharing with us Janna.

 

Any other docs, techs or reps want to chime in? I actually thought that this would be a pretty hot topic...

 

 

Corvettester

[Troll]

A very similar thread was created by Spex many months ago, although he referred to the disorder as OCD (which is closely linked with BDD):

 

http://www.hairrestorationnetwork.com/eve/158067-ocd-aware.html

 

The reality is that some of the posters here are actually not good candidates for hair transplantation due to their BDD. An ethical doctor should screen patients for BDD and if they exhibit traits of it, the doctor should not grant them an HT.

Corvettester

 

Corvettester, if you're going make this kind of statement, you might as well man up and admit that you also suffer from this disorder, which is fairly obvious to all those who have followed your case. But I wish you well and good luck with HT #2.

[aaron1234]

Corvettester, if you're going make this kind of statement, you might as well man up and admit that you also suffer from this disorder, which is fairly obvious to all those who have followed your case. But I wish you well and good luck with HT #2.

 

Let's be honest. All of us here probably suffer at least a little bit from OCD/BDD. For every one of us here on this forum there are probably 2,000 guys who don't give two craps about their hair loss. We just gotta do our best to keep it in check.

[Troll]

Let's be honest. All of us here probably suffer at least a little bit from OCD/BDD.

 

I fully agree, but I don't think "all of us" should then be disqualified from surgery as corvettester suggests.

 

An ethical doctor should screen patients for BDD and if they exhibit traits of it, the doctor should not grant them an HT.

 

We all exhibit traits of it so that's all of us!

[SkinUpPinUp]

This is a complicated one that also feeds into plastic surgery as well as people who diet and exercise.

 

It is entirely human to have insecurities and it is not confined just to hairloss. Some people may feel they are too fat or thin, too tall or too short, perhaps they have a disproportionately large nose, or narrow shoulders, a big chin or weak chin. For women (and some men) it gets even more complicated with insecurities around having weak or low cheekbones (zygoma), even the appearance of - God forbid - wrinkles.

 

I have seen some people justify HT and yet condemn plastic surgery and I think that this a little narrow-minded. We all have insecurities in one form or another as a result of perceived defects or weakness that have been genetically inherited. If someone seeks to address that via diet, exercise, medication or surgery, it is a very personal issue and not for us to judge or condemn.

 

That said, when a person begins to lose a sense of perspective, that's when it becomes a little worrying. People who have changed the entire way they live their lives (personal and professional) based around their appearance have lost their sense of perspective. Which I would then class as BDD.

 

There's a possibility here that if one problem is resolved via surgical intervention (HT or otherwise), they'll simply find another flaw to dwell on and the cycle begins again. Moreover, if surgical intervention fails to meet expectations and need further surgery later on, what will that mean for the patient? How will they mentally and emotional respond to that?

 

I think there is also blurring of lines between what is a healthy interest with appearance and self-improvement and what is not. I don't think that there is a distinct black and white dividing line between interest and BDD, there's a large grey area and a lot of us are somewhere in that grey, myself very much included.

 

Personally, I'm very liberal-minded towards surgical and non-surgical forms of self-improvement and maintenance. If you want to look after yourself or make yourself look better, more power to you. To my mind, the problem is when that person becomes so consumed in their appearance and self-criticism that everything else in their life grinds to a halt. Whether it be having interests outside of self-improvement, sacrificing your professional life for it, or - worse still - neglecting your friends and family.

 

That's my two cents, for what it's worth.

[Dr. William Lindsey]

This is a good thread.

 

I think this is an occasional problem in the hair field, and a moderate problem in the facial cosmetic field.

 

I vividly recall a very attractive teacher whose nose I did maybe 11 years ago. I do computer simulation as a "guide" not guarantee, of results and she had an uneventful surgery. At about 8months out, she comes in crying, saying she looked horrible, and her boyfriend had left.... I personally thought she looked fantastic. So I pulled up her preop, simulated goal, and 8 month postop pics on the computer, side by side. She said if only I'd have gotten her nose to look like the pictures on the screen, she'd be happy, then I hit the button which shows the entire face and her ear-rings which confirmed she was looking at a picture taken 5 minutes earlier. That calmed her down with respect to her nose, but then she complained about her body, teeth...all things I don't deal with. I never picked up any of this preop.

 

What a stark comparision to another young lady who came in, also about the same time, with a large bump on her nose, poor posture, and a boyfriend who I thought needed an attitude adjustment due to the way he treated her. At her 2 month visit, she was a different girl. Dressed well, head high, and no abusive boyfriend....

 

It seems less common in hair....or more easily detectable when someone comes in with a distorted sense of self. Maybe because I'm a guy with insecurities like most other guys, I can pick up on it a bit better, but not always...

 

I personally think the best screening tool for me as a doctor for that is my fairly blunt style. I tell every patient what I think they have going for them and against them and how that can impact expected but not guaranteed results. I can see some people, when I tell them I think they look pretty good preop...roll their eyes, knowing they can't understand why I can't see the image they see in the mirror.

 

Its all about communication. Frankness, and open discussion help, but unfortunately can't eliminate everyone with these issues preop.

 

Good thread.

 

Dr. Lindsey McLean VA

[kathie47]

I think this thread highlight how important and worthwhile it is to find ethical doctors. Knowing how to treat hair loss goes further than knowing how to perform HT surgery: it also means honest consultations and facilitating realistic expectations.

[zenmunk]

Good topic. Thanks for posting.

 

Negative perceptions of MPB are real, and both sexes have them. We've all probably experienced it in our own lives to some degree, but it's interesting to have our personal experiences supported with something a little more controlled. Hence, a study conducted by Thomas F. Cash called, "Losing Hair, Losing Points?: The Effects of Male Pattern Baldness on Social Impression Formation." The abstract states:

 

"In the voluminous research on the psychology of physical appearance, the psychosocial effects of common male pattern baldness (MPB) have been largely neglected. The present experiment examined the influence of MPB on the initial social perceptions of men by both sexes. Eighteen pairs of photographic slides of balding and non-balding control men were matched on the actual age, race, and other physical attributes of the men. In a first-impressions context, 54 men and 54 women rated these stimulus persons on seven dimensions of social perception. MPB caused generally less favorable initial impressions, including lower ratings of physical attractiveness, judgments of less desirable personal and interpersonal characteristics, and misperceptions of age. The moderating effects of perceivers' sex and age and stimulus persons' age were examined, mostly without consequence. The baldness stereotype was substantially attenuated when physical attractiveness was statistically controlled."

 

Granted, these are "initial impressions" we're talking about here. Clearly, if people make the effort to get to know a man with MPB, many will undoubtedly abandon the negative first impression as silly and superficial. However, no one can argue with the power of first impressions, and sometimes people just won't go beyond them.

 

How we are perceived by others is important to most, but the degree to which it matters varies from person-to-person largely according to one's self-esteem. The more you value and respect yourself, the less affected you are by how others perceive you. However, self-esteem is tricky business. There are so many variables which influence it from cradle to grave. It takes a lot of effort to build and maintain self-esteem in the face of a myriad of forces which threaten to destroy it.

 

Considering how difficult it is, I think it's admirable if anyone attempts to increase their self-esteem by visualizing that which they respect and admire most and working a little bit every day to instill those traits in themselves. However, a couple of questions are in order. Is what you're striving to achieve contributing something positive to your life and/or the lives of others? Is it constructive rather than destructive?

 

What you value is yours. You don't have to justify it to anyone else, but you must justify it to yourself. Why do you really want to do it? Is the outcome truly worth the effort? 100% certainty is impossible, but if something keeps nagging at you, then it's not right, and you must address it in the healthiest way possible. That may involve some soul-searching which leads to a change of plans, and the new plan may be to do nothing at all.

 

Unfortunately, people with BDD lack the ability to moderate their extreme insecurities with logical thinking. Their perceptions of themselves and the world around them are severely compromised. It's a very serious psychological condition. Their obsessions greatly reduce their quality of life and may even become life-threatening.

 

Common symptoms of BDD include (from Wikipedia):

 

 

 

• Obsessive thoughts about (a) perceived appearance defect(s).
  
• Obsessive and compulsive behaviors related to (a) perceived appearance defect(s).
  
• Major depressive disorder symptoms.
  
• Delusional thoughts and beliefs related to (a) perceived appearance defect(s).
  
• Social and family withdrawal, social phobia, loneliness and self-imposed social isolation.
  
• Suicidal ideation.
  
• Anxiety; possible panic attacks.
  
• Chronic low self-esteem.
  
• Feeling self-conscious in social environments; thinking that others notice and mock their perceived defect(s).
  
• Strong feelings of shame.
  
• Avoidant personality: avoiding leaving the home, or only leaving the home at certain times, for example, at night.
  
• Dependent personality: dependence on others, such as a partner, friend or family.
  
• Inability to work or an inability to focus at work due to preoccupation with appearance.
  
• Decreased academic performance (problems maintaining grades, problems with school/college attendance).
  
• Problems initiating and maintaining relationships (both intimate relationships and friendships).
  
• Alcohol and/or drug abuse (often an attempt to self-medicate).
  
• Repetitive behavior (such as constantly (and heavily) applying make-up; regularly checking appearance in mirrors; see section below for more associated behavior).
  
• Seeing slightly varying image of self upon each instance of observing a mirror or reflective surface.
  
• Perfectionism (undergoing cosmetic surgery and behaviors such as excessive moisturizing and exercising with an aim to create an unattainable but ideal body and reduce anxiety).
  
• Note: any kind of body modification may change one's appearance. There are many types of body modification that do not include surgery/cosmetic surgery. Body modification (or related behavior) may seem compulsive, repetitive, or focused on one or more areas or features that the individual perceives to be defective.
  

 

 

This excerpt is from an article called, "Psychology of Hair Loss" on hairtransplantguide.com:

 

"Body dysmorphic disorder is an unusual psychological disorder that hair transplant surgeons see frequently. These patients are preoccupied with an imagined or slight cosmetic defect to the point that it becomes extremely distressing and may begin to impair day-to-day functioning. Patients may avoid friends, family, and work in some cases. The disorder can lead to depression and has been implicated in some suicides.

 

These individuals will often have had visits with numerous physicians, frequently complaining of poor care. When surgical attempts are made to correct the perceived defect, the patient usually remains dissatisfied. They are more prone to sue and threaten violence. Typically no amount of talk or ‘common sense’ will dissuade these patients from believing they have a significant problem. It is as if they have a very limited form of psychosis (break with reality which is firmly believed despite evidence to the contrary). If the patient can be convinced that the perceived defect is all right, it is not unusual for them to then fixate on another physical flaw.

 

Basically, this is a psychiatric disorder, not a surgical one. Convincing these patients to see a psychiatrist is problematic since they will frequently remain unconvinced that it is not a physical problem. These patients tend to make themselves miserable, and their successful treatment hinges on making the correct diagnosis."

 

 

Obviously, if you exhibit the above symptoms, then you should not undergo any type of surgery, and seek help as soon as possible.

 

If you have the capacity to think relatively clearly about the subject, then meditate on the fact that no amount or type of cosmetic surgery will solve all of your problems. The desire for cosmetic surgery is often a symptom of a deeper problem(s) which only a deeper solution(s) will truly be able to address. There is a place for HT, or any cosmetic surgery, but be realistic about what you think even an ideal cosmetic outcome will do for you in life.

Edited September 16, 2011 by zenmunk