When I was pregnant with my children, something weird happened to my body. I'm not referring to the swollen ankles, or the stretch marks, or the smattering of broken blood vessels across my chest (in case you were searching for reasons to avoid becoming pregnant.) No, I'm talking about my nose. During those magical, perplexing nine months, my nose became plumper and rounder and wider. At first I thought I was imagining things; somehow directing all the anxiety about my pregnancy weight gain towards my nose. But it was true - my nose definitely changed. Now I had this thing, this snout on my face. I was Christina Ricci's character in Penelope, a girl cursed with a pig nose. An awful, protruding, pig nose.
Miraculously, things went back to normal after giving birth. But the post traumatic stress disorder remained. When I put on my makeup on the morning, my vision pinpoints directly to my nose. Has it become rounder? Is that a bump? I preen and examine, turning my head this way and that to be sure nothing has changed.
I have never considered a nose job, but I can certainly see why some women have. There are women who are at war with their big noses, though I kind of think a big nose can be striking on some. Nose jobs have become so socially acceptable that teenage girls are asking for them as sweet sixteen presents. And just weeks ago Nightline ran a story a thirteen year-old girl who got who to prevent being bullied at school. Nose jobs these days are no big deal.
Or so we think. The New York Times recently reported that about one in three people who seek rhinoplasty (aka, a nose job) have symptoms of body dysmorphic disorder (BDD), "a mental health condition in which a person has an unnatural preoccupation with slight or imagined defects in appearance." BDD, first introduced in the revised third edition of the Diagnostic and Statistical Manual of Mental Disorders in 1987, is characterized by a preoccupation with an aspect of one's appearance. People with BDD repeatedly change or examine the offending body part to the point that the obsession interferes with other aspects of their life.
Belgium researchers studied 266 patients over a 16-month period and say that as many of 43 percent of nose job patients may have the condition. The study, published in the August issue of Plastic and Reconstructive Surgery, shows a surprisingly high rate of body dysmorphic disorder among nose-job patients. Previous studies have shown that about 10 percent of patients seeking plastic surgery suffer from the condition.
“We know body image dissatisfaction falls on a continuum, and there has to be some degree of dissatisfaction that leads us to see a plastic surgeon in the first place,” said David B. Sarwer, associate professor of psychology at the Center for Human Appearance at the Perelman School of Medicine at the University of Pennsylvania. “It’s when it begins to interfere with daily functioning. Patients with more severe B.D.D. struggle to maintain social relationships and have difficulty getting to work or staying employed.”
It's important to note that the majority of BDD patients who have cosmetic surgery do not experience improvement in their BDD symptoms, often asking for multiple procedures on the same or other body features. 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. A related 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.
It's kind of terrifying to imagine that there are physicians performing cosmetic surgery on patients with a mental illness who believe their looks are so damaged that they require it. It is the rare woman who can see herself honestly in the mirror without negative body thoughts clouding her perception. How many plastic surgeons actually turn away people who really look fine but are obsessed with changing a nose - or some other body part? This sort of obsession, fed by media presentation of impossibly perfectly beautiful women, fuels the plastic surgery industry. It is this anxiety, this quest for perfection based on skewed perceptions of appearance, that keeps surgeons in business. If every appearance-obsessed plastic surgery-obsessed patient was turned away, plastic surgeons would go broke in a hurry.
Have you ever considered a nose job, or other plastic surgery procedure? What do you think of this study? Are you surprised by the high correlation between body dysmorphic disorder and nose jobs?
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