x Abu Dhabi, UAEFriday 19 January 2018

Why it’s best to see a psychologist before a nip and a tuck

People seeking plastic surgery may be suffering Body Dysmorphic Disorder, writes Justin Thomas

Recently, The National reported that the UAE has one of the largest per capita concentrations of plastic surgeons on the planet. According to Dr Luiz Toledo, a Dubai-based plastic surgeon, the UAE has one plastic surgeon for every 18,000 people. Beauty is big business.

Physical attractiveness has always been prized. History is full of beauty inspired prose and poetry, tragedy and drama. Helen of Troy’s face launched a thousand ships, while Layla Al- Aamiriya so preoccupied the mind of Al Qays ibn al-Mulawwah, that he earned himself the eternal epithet: Majnun (crazy) for Layla.

This raises some important questions about our current obsession with physical beauty. Who does cosmetic surgery aim to please? And how do we know when we have achieved a genuinely acceptable physical appearance? How do we know the old nose or the less full lips were not in some way more beautiful than the new enhancements? Do we have personal standards for beauty, or are they prescribed by society?

Psychologists have known for decades that we are often poor judges of our own physical attractiveness. Looking in the mirror (or taking selfies), we often get it massively wrong. Our subjective ratings of how good we think we look, can deviate enormously from how the majority of other people rate us.

The overwhelming message from social psychological research is that the relationship between subjective and objective ratings of physical attractiveness is very weak for men, and extremely weak for women.  

In other words, many beauties see themselves as plain Janes or plain Zains. Meanwhile some of us, unremarkable in terms of physical attractiveness, exaggerate our own beauty way beyond the boundaries of reality.

In terms of psychological well-being, thinking you look good, even if you don’t, is related to higher levels of self-esteem – if you think you look good, you tend to feel good.

Of course, such a poorly grounded basis for self-esteem is not without health implications. In extreme cases, such a state is characteristic of narcissistic personality disorder. Similarly, the opposite extreme can also be problematic, where negative misperceptions of physical appearance are associated with Body Dysmorphic Disorder (BDD), a severe and highly debilitating psychological complaint.

People experiencing BDD are extremely uncomfortable with, and critical of, their physical appearance, despite having no obvious imperfections recognisable to others. This “imagined ugliness” is severe enough to interfere with important areas of a person’s social and occupational functioning.

Individuals may avoid social events altogether, or devise elaborate schemes to camouflage the imagined defect – baggy clothes, excessive make-up, big sunglasses. Ultimately, as many as 50 per cent of all BDD sufferers will pursue cosmetic surgery.   

However, despite this high rate of cosmetic surgery among those experiencing BDD, the evidence suggests that surgery rarely works, and in many cases it actually makes the situation worse.

With the correction of one imagined defect, those experiencing BDD are quick to become fixated and preoccupied with another imagined or exaggerated blemish. And so the futile cycle continues.

Given the high rates of cosmetic surgical interventions undertaken in the UAE, it is imperative that those offering such cosmetic services should screen their patients for BDD. For one thing, this will help reduce the rate of unsatisfying surgical outcomes.

Screening tools for BDD are widely available and well-validated in terms of their ability to identify individuals experiencing the disorder.

Ideally, such a screening would involve a consultation with a psychologist prior to any major cosmetic surgery. If BDD is identified then talk-based therapies could be offered.

Beyond screening for BDD, there are also many other psychological and social consequences to appearance altering surgeries that psychologists can help with; for example, elevated rates of post-operative divorce, and post-operative depression. Unfortunately, the UAE doesn’t come close to having the world’s highest per-capita concentration of psychologists.

Justin Thomas is an associate professor of Psychology at Zayed University and Author of Psychological Well-Being in the Gulf States

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