Cosmetic byte

If you hate your nose, eyes or lips despite repeated assurances from family and friends, then cosmetic surgery is certainly not for you.

Cosmetic surgeons and psychiatrists say such people actually suffer from Body Dysmorphic Disorder (BDD). Those suffering from it have compulsive mirror checking or mirror avoidance behaviour.

"These patients are convinced they will feel better about themselves after surgery, but they actually feel the same, if not worse," said Anup Dhir, a senior consultant in the department of cosmetic surgery at Indraprastha Apollo Hospital.

Take the example of college student Rina Singh. She hated her nose and would spend hours in front of a mirror. Her parents tried in vain to convince her that there was nothing wrong with her, but that didn't help.

It was only when she met a psychiatrist at a city-based hospital that she was diagnosed with BDD. The disease affects one in 50 people, mostly teenagers and 20-somethings and could either be a gradual development or be abrupt.

Cosmetic surgeons and psychiatrists say that a person who has low-self esteem, eating disorders or feels he or she is a failure because of perceived physical flaws should not go for plastic surgery.

"While plastic surgery is great for the majority of the population, some people's desire for plastic surgery goes beyond wanting to enhance or maintain their appearance," said Dhir.

"At one time or another we all worry about our appearance, but when you wake up degrading your nose, hair, chest, weight and then continue to have these thoughts all day, that's when there is a problem. This small minority of people may be driven by an obsession or psychological disorder called BDD," Dhir told IANS.

BDD is a preoccupation with a slight or imagined defect in appearance, he said. "Often, the preoccupation creates serious disruptions in the person's daily activity."

In fact, many people with this illness have difficulty maintaining a job or sustaining social relationships.

Dhir said he has met several people with these symptoms who came to him for cosmetic surgery.

Psychological evaluation and even consultation with a professional psychiatrist are a part of the patient selection process for cosmetic surgery.

"Before we start the process, we find out about the person. And if it becomes clear they are obsessed with their looks then we send them to a psychologist," Dhir said.

This is because doctors know that even after cosmetic surgery the situation will be the same. "They will continue to find fault with their looks and the whole exercise will be a waste," he said.

BDD could also lead to other psychiatric problems.

Said M.S. Bhatia, professor and head of department of psychiatry at the Guru Tegh Bahadur Hospital, "All self-degrading thoughts among such people about a perceived flaw are distorted.

"Many times the supposed flaw doesn't exist or an 'imperfect' body part is blown entirely out of proportion. However, the person himself cannot see that."

In India, however, it is not a recognised problem, he added. "It should be taken seriously as it could lead to other complications like a person feeling withdrawn from society and having suicidal tendencies," he added.

"Depression, obsessive compulsive disorder, eating disorders, anxiety issues, agoraphobia, and trichotillomania (hair pulling) are all problems that commonly follow or trigger BDD," he said.

Often the ailment is misdiagnosed because doctors tend to have a lack of familiarity with the disorder, said Deepak Raheja, a psychiatrist at Paras Hospital.

He said many times those afflicted feel so ashamed and worthless that they downplay the problem or do not even recognise that they need help.

Families too may trivialise this problem, not realising that this extreme distortion cannot be resolved by "getting over it" or calling it a "phase", he added.

"It is often misunderstood as a vanity-driven obsession. But it is quite the opposite. People with BDD believe themselves to be irrevocably ugly or defective," he said