Does Cosmetic Surgery Help Body Dysmorphic Disorder?

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ScienceDaily (Aug. 11, 2010) — A new study finds that while many who suffer from body dysmorphic disorder (BDD) seek cosmetic procedures, only two percent of procedures actually reduced the severity of BDD. Despite this poor long-term outcome, physicians continue to provide requested surgeries to people suffering from BDD. The study was recently published in Annals of Plastic Surgery.

Katharine A. Phillips, MD, is the director of the body image program at Rhode Island Hospital and a co-author of the paper. Phillips says, "BDD is a psychiatric disorder characterized by preoccupation with an imagined or slight defect in appearance which causes clinically significant distress or functional impairment. A majority of these individuals believe they have an actual deformity that can be corrected by cosmetic treatments to fix these perceived defects rather than seeking psychiatric intervention."
Phillips and her co-author, Canice Crerand, PhD, of The Children's Hospital of Philadelphia, reported in previous studies that BDD appears relatively common among individuals who receive cosmetic surgery, with reported rates of 7 to 8 percent in cosmetic surgery patients in the United States. Even with the high frequency of those with BDD seeking and receiving cosmetic procedures, few studies have more specifically investigated the clinical outcomes of surgical and minimally invasive cosmetic treatments, such as chemical peels, microdermabrasion, and injectable fillers).
In their new study, the researchers report that in a small retrospective study of 200 individuals with BDD, 31 percent sought and 21 percent received surgical or minimally invasive treatment for BDD symptoms. Nearly all of these individuals continued to have BDD symptoms, and some actually developed new appearance preoccupations. They also note that in a survey of 265 cosmetic surgeons, 178 (65 percent) reported treating patients with BDD, yet only one percent of the cases resulted in BDD symptom improvement. Phillips, who is also a professor of psychiatry and human behavior at The Warren Alpert Medical School of Brown University, says, "These findings, coupled with reports of lawsuits and occasionally violence perpetrated by persons with BDD towards physicians, have led some to believe that BDD is a contraindication for cosmetic treatment."
The researchers found that the most common surgical procedures sought were rhinoplasty and breast augmentation, while the most common minimally invasive treatments were collagen injections and microdermabrasion. Three quarters of all the requested procedures involved facial features. The findings also indicate that more than a third of patients received multiple procedures.
In terms of long-term outcomes from procedures, only 25 percent of the patients showed an improvement in their appraisal of the treated body part and showed a longer-term decreased preoccupation. However, as noted by co-author Crerand, "Only two percent of surgical or minimally invasive procedures led to longer-term improvement in overall BDD symptoms."
The researchers also found that when treatment was sought, 20 percent of the procedures were not received. Cost was the most common reason for not receiving the requested procedure (30 percent), followed by physician refusal to perform the procedure (26 percent).Their findings also indicate that physicians were significantly less likely to refuse a surgical or minimally invasive treatment than other procedures (dermatological, dental and others). Phillips says, "This suggests that many surgeons were not aware of the patient's BDD or do not consider BDD a contraindication to treatment. In a survey of 265 cosmetic surgeons, only 30 percent believed that BDD was always a contraindication to surgery."
The researchers conclude, "This study provides new and more detailed information about receipt and outcome of surgical/minimally invasive procedures, and the findings indicate that there is a clear need to further investigate this topic in prospective studies. In the meantime, physicians need to be aware that psychiatric treatments for BDD such as serotonin reuptake inhibitors and cognitive behavioral therapy appear to be effective for what can be a debilitating disorder."
Also involved in the study is William Menard of Alpert Medical School. The study was funded through a grant from the National Institute of Mental Health.
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'Starved' of Love - Part One

As many of you know who follow this blog I have been working with eating disorder clients for over 31 years.  I didn't begin my second career as a social worker with a passion to work with individual's suffering from disordered eating patterns.  In fact my only passion was that I wanted to work with people suffering from psychiatric disabilities in general.  (But that is a story unto itself perhaps for a different time).  Anyway I was hired and placed on an eating disorder unit as my first job within the psychiatric world - and I never left that specialty! 

I fell in love with this particular population so to speak.  In one respect the eating disorder treatment world is one that appears complex, complicated and misunderstood but in actuality from my perspective it is quite simple.  If I had to reduce it to one or two sentences I would describe it thusly:  An ED individual is 'generally' a quite intelligent, sensitive, creative, passionate, caring and gifted individual who ultimately through intent or not was 'starved' or deprived of a sense of being loved or valued as a uniquely special human being with a valued role or place within their 'world'.  Now that is a mouthful.  But frankly after 31 years there it is - boiled down to 1 probably poorly written run-on sentence!

Don't misunderstand me while it is simply stated it is not so simply fixed!  You would have to imagine that if one was either unloved or felt unloved throughout a majority of their lives correcting that is quite a difficult road to pursue.  Bear in mind if one even 'feels' unloved the mind searches for and successfully creates 'stories' that validates that feeling.  It is within those stories where the problems lie.  Those stories become truths to the individual - whether they are true or not is irrevalant!  From that individual's perspective their 'story' or better stated 'beliefs' are indeed their reality.

From my oppinion no one eating disorder is worse than another.  I personally feel that one is more desparate than the others.  That would be anorexia - I only say that because the symptoms of that ED are so in your face so to speak!  Bulimia and Overeating are such secretive disorders in nature but anorexia screams out to those around them.  It is my oppinion that Bulimia is the most dangerous of the disorders - but again that is yet another article.  There are many commonalities within the EDs like they are 'all about food' in one form or another.  Food is the coping tool for all ed's.

Con't in Part 2

5 Ways to Protect Children from Predators

We hear the stories—about Penn State assistant coach Jerry Sandusky, or more recently, the accusation about the man who's the voice of Sesame Street's Elmo. It’s estimated that one in five girls and one in 10 boys will be sexually exploited before they reach adulthood, according to the National Center for Missing and Exploited Children. And our first thought: "How can I tell if an adult is "safe" to be with my grandkids?"
 
Child predators can be anywhere—in our homes, in our schools, on the Internet—and anyone. And perhaps the most disturbing thing of all—it's not strangers who are victimizing kids. In fact, 90 percent of child victims know their offenders, according to Megan’s Law. What to do? Read on for some guidelines to help protect kids.

How to Spot Predators?
One of the inherent problems with sexual predators like Jerry Sandusky is that they’re not strangers. "We have this idea in our country that only strangers are going to molest children," says youth and family violence expert, Kathy Seifert. Ph.D, DABPS in forensic psychology. "We think that people we know well can't do anything wrong, but it's not just the risk from strangers.” Because child predators aren’t always obvious, it’s important to know some less-obvious red flags:

• Adults who spend excessive amounts of time with children instead of other adults.“There’s a difference between helping children and spending the majority of your time with them,” says Dr. Seifert.
• Adults who are always willing to lend a hand when it involves spending time with your child.
• Adults who breach physical boundaries between themselves and a child. “They’ll sit too close to each other, and the adult always has their hands on the child,” says Dr. Seifert. “You can really spot them in public because their physical boundaries with the child are not there.” The child will often look very uncomfortable and sad in contrast to the adult, who may seem happy and content.
• Adults who buy gifts or presents for children for no reason. In the majority of cases, abusers gain access to their victims through deception and enticement, seldom using force, according to Megan’s Law.

What You Can Do:
1. Get Connected with Your Grandchildren
"You always need to have open communication, so that things that don't feel right to them can come up in the conversation," says Dr. Seifert. One of the best ways to keep an open dialogue with kids is to talk to them on their level, which may mean texting, if that’s their preferred method for staying in touch.
"I think grandparents would be so much more connected, if they'd just text their grandchildren," says Shawn Edgington, cyber safety expert and author of The Parent's Guide to Texting, Facebook, and Social Media. "It's communicating across the generation, and it’s a great way to be involved with their life. Texting them can often get a response when other forms of communication can't."
2. Know Your Grandchild's Social Circle
Pay attention to what your grandchild tells you and ask questions about what's going on in school, who their friends are, and what activities they participate in. Familiarizing yourself with their interests and schedule will make it easier for you to spot any changes in behavior, which could signal a problem.
When it comes to the Internet, it's important to frequently monitor who the child is connected to on Facebook and beyond, and to be sure that their "freinds" are people kids know in real life and people you trust, says Edgington.
3. Educate Yourself and Your Grandchildren
“When I grew up, we didn’t even think about people who were going to behave in such an awful way,” says Dr. Seifert. “We really need to learn to look for things that seem odd and out of place.”
Knowing how to identify the red flags and behaviors in children (see the list of behavioral changes below) and the adults who surround them is the first key to keeping kids safe. The second key is gently imparting that information to your grandchildren in a way that makes sense to them. Establish and maintain a strong connection, so they feel comfortable telling you if something’s wrong.
4. Look for Warning Signs and Don't Dismiss a Child's Accusation
If you suspect that a child is a victim of a child predator, but hasn’t come forward, certain behavioral changes may occur, including:

• A child who is normally pleasant and easygoing becomes irritable and unpleasant
• Trouble sleeping at night and experiencing nightmares
• Extreme sadness or anxiety
• Fluctuations in eating patterns, either loss of appetite or an increased appetite
• Plummeting grades

“Any significant changes in sleeping, eating, grades, social life, and their relationship to you means it's time to talk to your grandchild and find out what’s going on,” says Dr. Seifert.
And if your grandchild does come forward? The accusation should be thoroughly investigated, regardless of the accused. “It is extremely rare for children to report that someone is molesting them and for it not to be the truth,” says Dr. Seifert.
5. Pay Attention to the Internet
With the prevalence of Internet predators, it’s equally important to stay informed about digital trends, such as Instagram (a photo-sharing phone app) and Twitter (an status update-sharing web site and phone app), so you can let children know what images and information are appropriate to share, says Edgington, who recommends taking the following precautions when allowing Internet in your home:

• Check privacy and security settings: Double check all of your grandchildren’s security settings on their social networking sites. Be sure they are all set to private and instruct your grandkids to never share their passwords with anyone.
• Know your grandchild’s friends: Frequently monitor who your grandchildren are connected to on social networking sites.
• Closely monitor Internet use: If you have young grandchildren who are just learning how to use the Internet, keep the computer in a visible place so you can guide them through the wild, wild web as they explore.
• Think before posting: Help your grandchildren manage their online image and reputation, and encourage your them to treat others online as they want to be treated in real life.
• Limit personal information: Be cautious about how much personal information your grandkids post. The more detailed the information, the easier it is for online predators and bullies to use their information to locate them or to commit crimes.

For more tips and information on Internet safety, visit NoBullChallenge.org.

 

Fear of Vomiting: Emetophobia + Anorexia

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Emetophobia, or fear of vomiting, is surprisingly common. The phobia can begin at any age, although many adults have suffered for as long as they can remember. Emetophobia may be related to other fears, such as fear of food, as well as conditions such as eating disorders and obsessive-compulsive disorder.

Causes of Emetophobia

The fear of vomiting is often, but not always, triggered by a negative experience with vomiting. Although cases of stomach flu, overindulging in alcohol and food poisoning happen to everyone, it is easy to feel alone. The risk of emetophobia may be higher if you remember vomiting in public or experiencing a long night of uncontrollable vomiting.

Some experts believe that emetophobia may be linked to worries about lack of control. Many people try to control themselves and their environment in every possible way, but vomiting is difficult or impossible to control. It sometimes happens at times and in places that are embarrassing or inconvenient, which can be highly distressing.

Symptoms of Emetophobia

Interestingly, most people with emetophobia rarely, if ever, vomit. Some sufferers report that they have not thrown up since childhood. Yet they constantly worry that it might happen.

If you have emetophobia, you may have developed certain behavioral patterns or even obsessions in an effort to keep yourself safe. You might be most comfortable in a particular room of your home, or even outside. You might sleep with a towel next to you in case you are ill overnight. You probably feel compelled to learn the most direct path to a restroom in any new building. You may be extremely anxious about long car trips. Many sufferers report that they feel safer when they do all the driving. Some are reluctant to carry passengers, who might see them vomit if they cannot reach a restroom in time.

Many emetophobia sufferers experience frequent nausea and digestive upsets. These are extremely common symptoms of anxiety, and can lead to a self-replicating cycle. You are afraid to vomit, and the fear causes nausea and stomach pain. This makes you feel like vomiting, which in turn makes you more afraid. Research indicates that this cycle may be the result in hypervigilent sensitivity to gastrointestinal symptoms and misappraisal of nausea and other GI symptoms.

Complications of Emetophobia

Over time, you might develop additional fears or obsessions. Cibophobia, or fear of food, is common among many with emetophobia. You may worry that foods are not cooked or stored properly, thus leading to possible food poisoning. You might begin to severely restrict your diet or refuse to eat until you are completely full. Many sufferers feel that being full can lead to nausea and vomiting. In extreme cases, you might even develop tendencies toward anorexia.

Many people with emetophobia develop social anxiety or even agoraphobia. You might be reluctant to spend time with people for fear of vomiting in front of them. Alternately, you may be afraid that someone will vomit in front of you. It is not unusual to become highly afraid of other people’s vomit as well as your own.

Treating Emetophobia

Emetophobia can be somewhat complicated to diagnose and treat, since many people simultaneously experience other phobias and anxiety disorders. Therefore, it is important to work with a trusted therapist with a broad range of experience. See “Finding a Therapist.”
for tips and suggestions.

Cognitive-behavioral therapy can help you confront your fears and replace your negative thoughts regarding vomiting. Hypnosis and relaxation techniques can help to reduce the feelings and symptoms of anxiety. Medications may be indicated in some cases.

Although it will take a great deal of work, emetophobia can be defeated. There is no reason that your life must be controlled by this powerful but treatable phobia.
_{Sources:
American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th Ed.). Washington, DC: Author.}
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The Overview of Eating Disorders and Shame - Ignoring Doesn't Make It Go Away! 11/30 by EDRC | Blog Talk Radio

The Overview of Eating Disorders and Shame - Ignoring Doesn't Make It Go Away! 11/30 by EDRC | Blog Talk Radio

Can't really recover from ED w/o recovering from shame!
There are a series of 3 shows dedicated to recovering from shame - shame ultimately begins the ED and leaving it behind ends the ED! 

Within the Mind of An Eating Disorder

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Eating Disorders Illnesses of the Soul

A video that explains ED to NON ED folks - What do you think?

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