HeARTbreaking ART

Korean artist Ji Yeo took these depressive shoots from ladies recovering from plastic surgery. Her description to the models – they were very emotional.

In respect of plastic surgeries, we care about the before/after; little did we know what goes on during the recovery period. According to Yeo, her models were isolating themselves from their families and friends, and were handling the post-surgical pain alone.

Yeo stated that recruiting these models was no easy task. Given their low self-acceptance (which was why they seek surgical help at the first place), they wouldn’t wish to record the transition period that was brutal to both their physical and psychological well-being. As expected, none of the models were willing to reconnect with Yeo after their recovery.

Personally, these photos are simply more than words.

There is the potential in some individuals with low self esteem and psychological issues to fixate on certain features, such as a prominent nose or a weak chin or a heavy neck. When the concern about your appearance or specific features starts to border on obsession, that can be a red flag.

Recent studies found that people in this century, highly influenced by the social media, are having more concerns to look good on online social platforms like Facebook, Twitter, and LinkedIn etc. Dr. Sam Rizk, an AAFPRS member and director of Manhattan Facial Plastic Surgery in New York, claims, “Between high definition television, Facebook, YouTube and Instagram, how you look in photos and video clips has definitely become a driver for all cosmetic procedures from Botox to neck lifts.”

Clinical Psychologist’s role in handling BDD patients

1. Identify cases
2. Assess severity
   – How much is  the impact on patient’s ability to function in everyday life
3. Assess risk of self-harm or suicidal ideation
4. Assess presence of comorbidity
5. Ensure continuity of care to avoid multiple assessments and gaps in service
6. Promote understanding
   – Raise patients’ and their families’ awareness of the involuntary nature of symptoms
   – Provide patient information leaflets and contact numbers of self-help groups
7. Consider the bigger picture
   – Cultural, social, emotional and mental health needs
8. Patients can be managed with
   – CBT plus ERP
   – SRIs

Reference:

(2005) Obsessive-compulsive disorder: Core interventions in the treatment of obsessive-compulsive disorder and body dysmorphic disorder. NICE Clinical Guidelines, -. Retrieved December 7, 2013, from http://publications.nice.org.uk/obsessive-compulsive-disorder-cg31

How do we treat BDD?

           1. Serotonin reuptake inhibitors (SRIs) 

• SRIs are antidepressant medications that helps to diminish obsessional thinking and compulsive behaviors
• SRI (Selective Serotonin Reuptake Inhibitors) such as Fluoxetine, Fluvoxamine, Citalopram appear to be effective in treating BDD
• Community treatment is usually inadequate (low dosage and short duration)
• Fluoxetine is significantly better than placebo (35% decrease in severity vs.14% on placebo)
• Non-responders should switch to another SRI, or augmented with Buspirone
• Patients should receive an SRI for at least 12 weeks before switching, and that the highest SRI dose recommended by the manufacturer (if tolerated) be reached if lower doses are ineffective.
• Long-term treatment appears often necessary
• Adding an antipsychotic to an SRI is worth considering for delusional patients
• Highly anxious patients often benefit from a benzodiazepine in addition to an SRI
• Behavioral symptoms may improve less on medications than distress measures
• Symptoms continue to improve with maintenance treatment up to several years
• Side effect: Black Box warning of increased risk of suicidal ideation

  2. Psychotherapy  (CBT)

• Cognitive
  • Identification of appearance related automatic thoughts
  • Identification of cognitive distortions and self-defeating thoughts
  • Cognitive restructuring aimed at challenging faulty appearance-related beliefs
  • Cognitive Interventions
    • Rehearsing/journaling adaptive responses to thoughts
    • Replacing critical self-talk with more descriptive/objective remarks
• Behavioral
  • Exposure and Response Prevention
  • Reduce social avoidance and repetitive behaviors
  • Engaging in social setting without  engaging in preferred compulsion (e.g. camouflaging)
  • Refraining from mirror checking
  • Setting limits on grooming time

  3. Psychoeducation

• Referrals to relevant books or websites
• Emphasize that treatment is likely to decrease their suffering and improve functioning

References:

Phillips, K. A. (2004). Body dysmorphic disorder: recognizing and treating imagined ugliness. World Psychiatry, 3(1), 12.

Phillips, K. A., & Hollander, E. (2008). Treating body dysmorphic disorder with medication: evidence, misconceptions, and a suggested approach. Body Image, 5(1), 13-27.

Substance Abuse in BDD

Statistics of SUD (Substance use disorder) in BDD (Body dysmorphic disorder) patients:

• Males > Females = 2:1
• Younger patients more prone to develop SUD
• Nearly half of BDD subjects in this study had a lifetime SUD
• Order of onset
  • BDD first = 60%
  • BDD + SUD concurrently = 21%
  • SUD first = 19%
• 68% report that BDD contributed to SUD
• 30% report BDD as main reason for SUD
• Higher rates of suicide attempts

Why?

• Attempt to cope with BDD by using alcohol or drugs
• Decrease the preoccupation
• Ease the emotional pain
• Lessen anxiety and self-consciousness in social situations

Case Study – Adam

“You might not believe this, but my alcohol and drug abuse problems were totally and completely due to my appearance problem. A lot of counselors have told me that’s just an excuse, but I think they’re wrong. It was a crazy way I tried to block the pain of my obsessions, and it never worked. I tried to numb myself to my perception of my body, but it didn’t change. It actually made the pain over my appearance worries worse.”

Treatment

Studies found that some patients might not reveal their BDD symptoms to their clinician because of embarrassment and shame, which highly undermine the successfulness of the corresponding treatment and therapy.

With a focus to treat patients who are struggling with both BDD and SUD, the Los Angeles BDD & Body Image Clinic developed an integrated addiction medicine track which is customized to the needs of each client. Treatment involves individual and group psychotherapy as well as medication management as appropriate.

References:

Grant, J. E., Menard, W., Pagano, M. E., Fay, C., & Phillips, K. A. (2005). Substance use disorders in individuals with body dysmorphic disorder. The Journal of clinical psychiatry, 66(3), 309.

Gunstad, J., & Phillips, K. A. (2003). Axis I comorbidity in body dysmorphic disorder. Comprehensive psychiatry, 44(4), 270-276.

Phillips, K. A., Menard, W., Fay, C., & Weisberg, R. (2005). Demographic characteristics, phenomenology, comorbidity, and family history in 200 individuals with body dysmorphic disorder. Psychosomatics, 46(4), 317-325.

12 Hilarious Slimming Products from Japan

As I was researching for the previous posts, I came across these wacky products that claimed to provide the results from cosmetic surgeries, but at a much cheaper cost. These products are so ridiculously funny that I find it really hard to focus on their functions.

Here you go:

1. Newest Japanese creation – the Face Slimmer. Bite onto this silicon and recite the vowels to achieve slim face, V jawlines, and a reduction of wrinkles around the mouth. (What??)

2. Chew on this plastic cookie 30 times a day to slim down your face! (*0*)

(Slim Mouth Piece comes with the ladies and gents versions too)

3.  Stroke and massage your face with this miracle plate; it improves blood circulation and tighten the skin around eyes and mouth area, performing the function of whitening and rejuvenating the skin (Oh wow!)

4.  Meet the Hana Tsun Nose Straightener that promises you a straight nose after sticking the device up your nostrils. (Oh god)

(Or a fancy version that clamps your nose straight)

5. Eye Lifting Goggles – 5 mins a day and off go your wrinkles around the eye. (With an extra effect of brow bone lifting)

6. Dark eye circles? The Eye Slack Haruka is a vibrating device that improves the blood circulation at the eye bag region, resulting in a youthful after 3 mins of daily use.

7.  Face Slimming Rollers – rolling on the face helps exercise face muscle and promotes blood circulation. Helps removing double chin and slimming down the face!

 

8. This face belt produces heat and sweat, which burns  fat from the face. Available for men too! (Never thought this is sold is real life)

   

Use it when you are bathing or sleeping:

9. Combat those unsightly wrinkles that develop on your brow or between the eyebrows with this Oyasumi Goodnight Stretcher. (How can you sleep in this?)

10. Sleeping Anti-Wrinkle Pad fits around your neck to provide gentle pressure on your chin area during the night, resulting the perfect chin and neckline.

11. Calorie Breath shrinks your stomach from approximately 30 inhales/exhales per day, resulting in weight loss and slimming effect. (I don’t get it)

     

12. Slim Legs Rollers massages and improves the blood circulation of the legs, thereby producing the perfectly slim legs.

 

Talking about obsessiveness!
Hope you enjoy this entry 🙂

Asian Makeover Essential Tools (Cont’d)

As promised, this post introduces how asian girls cover up their unwanted “flaws” via various makeup tools and technique, namely tackling these:

* Small iris
* Light eyebrows
* Flat nose
* Large cheek bones

*Circle contact lens (widen the circumference of the iris, hence enhance the size of the eyes, comes with different sizes, colors, and patterns)

*Eyebrow gel/powder (darken and shape the light brows)  

*Nose shadow powder (produce the effect of a higher and narrower nose)

 

* V Shape face serum and bronzer (smaller cheekbones and ultimately achieve face with the shape of ‘V’)

Do you think these makeup tools and tutorials are an alternative to plastic surgery? To what extend do we determine someone with excessive makeup? The amount of cosmetic products used? The time spent on applying makeup? From my point of view, the fine line that separates normal makeup wearing and BDD is the level of obsessiveness and impairment from the dissatisfaction of one’s body.

If “excessive makeup” is accompanied with the following symptoms, chances are high that it is related to BDD:

• obsessively checking your appearance in mirrors or avoiding them completely
• picking your skin to make it smooth
• unnecessary worries of the body
• seeking cosmetic surgery

For severe cases:

• recurrent feelings of shame and guilt
• depression/anxiety
• misuse of alcohol or other drugs
• self-destructive behavior
• suicidal thoughts

Asian Makeover Essential Tools

After addressing the makeup trend in Taiwan, this post features some of the most popular “camouflage” skills in Asia. Generally, girls who are not pleased with their faces name the following oriental “flaws” that they’d like to hide:

* Tiny eyes
* Single eyelid
* Small pupils
* Light eyebrows
* Flat nose
* Large cheek bones

And what are the makeup solutions to these “flaws”?

* Fake eyelashes (comes in different length and density, girls in video piled up 3-4 pairs of lashes to achieve the “big eye effect”)

* Double eyelid glue/sticker (popular in Japan, Hong Kong, Taiwan and Korea)

To be continued … Stay tuned for more essential tools and related BDD cases in the upcoming posts!

Secrets behind Taiwanese Makeup Culture

As my blog covered a lengthy portion of the relationship between BDD and cosmetic surgery, I would like to introduce a milder symptom that is highly common, especially with females, than undergoing the surgical knife – excessive makeup.

Some says that putting on makeup is a way to show one’s manners, especially under the corporate setting. However, what about those who apply makeup so excessively, just to camouflage and hide their imagined “flaws”? How much do we know about the related tools and inventions that put the girls to such obsessive level?

According to the research “The study of body image in people of Taiwan – an exploration of body dysmorphic disorder”(2009), Taiwanese ladies are more prone to have BDD than the gents, as the Chinese culture somewhat values the female with their physical attractiveness and feminine features. The pressure from the society seems to be the strong force behind the growing plastic surgical and makeup trend in Taiwan.

Various Taiwanese variety shows invited girls to compete with their makeup skills. The before/after comparisons are astonishing. Take a look below a slice captured from one of the shows *(Diamond Club):

References:

Wang, Y. H., & Liao, H. C. (2009). The study of body image in people of Taiwan an exploration of body dysmorphic disorder. International Journal of Chinese Culture and Management, 2(1), 73-82.

The Broken Mirror: Understanding and Treating Body Dysmorphic Disorder

Written by Katharine Phillips, The Broken Mirror is named “The BDD Bible” by BDD patients and their families and friends. With vast descriptions and information about BDD, the book focuses on how to treat the disorder. Psychiatrists, other mental health professionals, dermatologists and plastic surgeons also find this read essential and professional. I have added this book into the GoodReads column on my blog, please check out the related readings too!

“Dr. Phillips’ book is a landmark in the recognition and treatment of imagined uglyness. This book. beautifully written, provides a great deal of hope for patients with body dysmorphic disorder and their family members and should help speed recovery for countless sufferers of this common, fascinating, and disabling illness.” — Eric Hollander MD, Professor of Psychiatry, USA

About the Author
Katharine A. Phillips is R.I. Director of the Body Dysmorphic Disorder and Body Image Program at Butler Hospital in Providence, Rhode Island, and Professor of Psychiatry and Human Behavior at Brown University School of Medicine.

Click onto link for a preview of the book in pdf. Enjoy!
books.google.com.hk/books?isbn=019516718X