Cosmetic surgery in inpatients with eating disorders: attitudes and experience

Body image disturbance is frequent among individuals undergoing cosmetic surgery and core to the pathology of eating disorders (ED); however, there is little research examining cosmetic surgery in ED. This study examined body image related measures, ED behaviors, and depression as predictors of attitudes toward cosmetic surgery in 129 women with ED. Patients who had undergone surgery (n = 16, 12%) were compared to those who had not. Having a purging diagnosis, linking success to appearance, and making physical appearance comparisons were predictive of more favorable cosmetic surgery attitudes. All of those who had undergone surgery had purging diagnoses and, on average, were older, had higher BMIs, and were more likely to make physical appearance comparisons and know someone who had undergone surgery. In ED, acceptance and pursuit of cosmetic surgery appears to be related to social group influences more than weight and shape disturbance, media influences, or mood.     

Body dysmorphic disorder and appearance enhancing medical treatments

This article reviews the literature on body dysmorphic disorder (BDD) in persons who seek appearance enhancing medical treatments such as cosmetic surgery and dermatological treatment. We begin with a discussion of the growing popularity of cosmetic surgical and minimally invasive treatments. The literature investigating the psychological characteristics is briefly highlighted. Studies investigating the rate of BDD among persons who seek appearance enhancing treatments are detailed and, collectively, suggest that approximately 5–15% of individuals who seek these treatments suffer from BDD. Retrospective reports suggest that persons with BDD rarely experience improvement in their symptoms following these treatments, leading some to suggest that BDD is a contraindication to cosmetic surgery and other treatments. The clinical management of patients with BDD who present for these treatments is briefly described and directions for future research are provided.     

Predicting excessive body image concerns among British university students: The unique role of Appearance-based Rejection Sensitivity

The present research examined the extent to which interpersonal concerns about rejection based on appearance, or Appearance-based Rejection Sensitivity (Appearance-RS), serves as an indicator of risk for excessive body image concerns. Extending previous research, we examined the association between Appearance-RS and symptoms of body dysmorphic disorder (BDD) and cosmetic surgery attitudes among 106 British university students. Consistent with predictions, Appearance-RS uniquely predicted greater degree of BDD symptoms after controlling for other known predictor variables. Also, as expected, Appearance-RS uniquely predicted acceptance of cosmetic surgery for both intrapersonal and social reasons and greater consideration of having cosmetic surgery in the future. These findings highlight the importance of assessing individuals’ sensitivity to rejection from others based on their physical appearance in investigations of excessive body image concerns.     

The role of aesthetic sensitivity in body dysmorphic disorder

Individuals with a higher aesthetic sensitivity may be more vulnerable to developing body dysmorphic disorder (BDD). Aesthetic sensitivity has 3 components: (a) perceptual, (b) emotional, and (c) evaluative. Individuals with BDD (n = 50) were compared with a control group of individuals with an education or employment in art and design related fields (n = 50) and a control group of individuals without aesthetic training (n = 50). A facial photograph of each participant was manipulated to create a 9-image symmetry continuum. Presented with the continuum on a computer, participants were required to select and rate the image representing their self-actual, self-ideal, idea of perfect, most physically attractive, most pleasure, and most disgust. Control symmetry continua examined the specificity of the disturbance. As predicted, BDD participants displayed no distortion in their perceptual processing but were disturbed in their negative emotional/evaluative processing of their self-image. A significant discrepancy between their self-actual and self-ideal, resulting from an absent self-serving bias in their self-actual (a bias exhibited by controls) appears to be the source of their disturbance. They also overvalued the importance of appearance and self-objectified. These aesthetic evaluations may predispose individuals to BDD and/or maintain the disorder.     

Multidimensional body image comparisons among patients with eating disorders,body dysmorphic disorder,and clinical controls: A multisite study

Body image disturbance is considered a core characteristic of eating disorders and body dysmorphic disorder (BDD), however its definition has been unclear within the literature. This study examined the multidimensional nature of body image functioning among individuals with either anorexia nervosa (AN; n = 35), bulimia nervosa (BN; n = 26), or BDD (n = 56), relative to female (n = 34) and male (n = 36) psychiatric controls. Participants were recruited from 10 treatment centers in the United States and England and completed psychometrically validated and standardized self-report measures of body image. Overall, the AN, BN, and BDD groups were characterized by significantly elevated disturbances in most body image dimensions relative to their gender-matched clinical controls. There was variability, however, in the comparisons among the three groups of interest, including foci of body dissatisfaction and body image coping patterns. On omnibus indices of body image disturbance and body image quality of life, patients with BDD reported more body image impairment than those with eating disorders. Although AN, BN, and BDD are characterized by body image disturbances, similar and partially distinctive cognitive, behavioral, and emotional elements of body image functioning exist among these groups. The study's empirical and clinical implications are considered.     

Measuring "negative body image": validation of the Body Image Disturbance Questionnaire in a nonclinical population

Despite numerous measures of facets of the body image construct, no single assessment broadly measures a continuum of body image disturbance. Accordingly, this study developed the Body Image Disturbance Questionnaire (BIDQ), derived from the Body Dysmorphic Disorder Questionnaire. Participants were 220 college women and 75 college men who completed an online survey containing this new assessment and established measures of body image and psychosocial functioning. Results confirmed that the Body Image Disturbance Questionnaire was internally consistent and free of impression-management response bias. For both sexes, the measure converged appropriately with other body image indices (evaluation, affect, investment, and impact), was positively correlated with depression, social anxiety, and eating disturbance. Scores on this assessment also predicted psychosocial functioning above and beyond body dissatisfaction as a predictor. Greater body image disturbance was observed among women than men, among heavier than lighter women, and among White than African American women. Limitations and future research implications are discussed.     

Body Dysmorphic Disorder among Diverse Racial/Ethnic and Sexual Orientation Groups: Prevalence Estimates and Associated Factors

Body Dysmorphic Disorder (BDD) is a psychological disorder characterized by excessive appearance concerns. This cross-sectional study assessed an undergraduate sample of 1,041 participants from a southeastern American university to estimate an overall prevalence of BDD; investigate differences by gender, race/ethnicity, and sexual orientation; and also examine the contributions of other related constructs including appearance comparison, obligatory exercise, body image disturbance, and self-esteem. Results indicated an overall prevalence of 4.9%. Women endorsed more symptoms of BDD than men, among women Caucasians and Latinas endorsed more symptoms than African Americans, and sexual minorities endorsed more symptoms than heterosexuals. Overall, BDD symptomatology was negatively correlated with body satisfaction and self-esteem and positively correlated with appearance comparison and obligatory exercise.     

Body image in patients with body dysmorphic disorder: Evaluations of and investment in appearance,health/illness,and fitness

Body image is an important aspect of body dysmorphic disorder (BDD) which has received little investigation. Ninety-two BDD participants who participated in one of three BDD pharmacotherapy studies completed the Multidimensional Body-Self Relations Questionnaire, which assesses attitudinal body image, specifically evaluations of and investment in appearance, health/illness, and physical fitness. Scores were compared to population norms. Compared to norms, BDD participants were significantly less satisfied with their appearance. Less satisfaction was associated with more severe BDD and greater delusionality. Men with BDD were significantly more invested in their appearance compared to male population norms. Compared to population norms, males and females with BDD felt less physically healthy and females were less invested in a healthy lifestyle. However, compared with population females, females with BDD were less alert to being ill. These findings suggest that patients with BDD differ from population norms in a number of important aspects of body image.     

The impact of appearance-focused social comparisons on body image disturbance in the naturalistic environment: the roles of thin-ideal internalization and feminist beliefs

Drawing on Festinger's (1954) social comparison theory and its modern applications, this research investigated the relationship between upward appearance-focused social comparisons and body image disturbance using ecological momentary assessment, which allows for examination of these phenomena in their natural context. Participants were 91 undergraduate women who answered questionnaires five times per day for five days using Palm Personal Data Assistant (PDA) devices. Analyses were conducted using hierarchical linear modeling, which allows for examination of longitudinal data both within and across participants. Results revealed a positive relationship between upward appearance-focused social comparisons and body image disturbance. Upward appearance-focused social comparisons were associated with greater body image disturbance for those with higher levels of thin-ideal internalization and with greater body checking for women with lower levels of feminist beliefs. These findings further illuminate the nature of the relationship between social comparisons and body image disturbance.     

The relationship between body dysmorphic disorder behaviors and the acquired capability for suicide

In a sample of 200 individuals diagnosed with body dysmorphic disorder (BDD), we utilized the interpersonal-psychological theory for suicide as a framework to examine BDD behaviors that might be associated with suicide risk, insofar as they might increase the acquired capability for suicide. We predicted that physically painful BDD behaviors (e.g., cosmetic surgery, restrictive eating) would be associated with suicide attempts but not suicide-related ideation because these behaviors increase capability for, but not thoughts about, suicide. Our hypothesis was partially confirmed, as BDD-related restrictive food intake was associated with suicide attempts (but not suicide-related ideation) even after controlling for numerous covariates.     

Immediate breast reconstruction and psychological adjustment in women who have undergone surgery for breast cancer: a preliminary study

Current debate exists regarding the timing of reconstructive surgery following mastectomy for breast cancer, with research pointing in favour of immediate reconstruction. This cross-sectional study sought to compare the psychological outcome of breast cancer treatment in women who had either received mastectomy and immediate reconstruction using autogenous tissue (n?=?30), or mastectomy alone (n?=?34), and also determine adjustment factors in this population as a whole. Participants completed measures of depression, anxiety, body image, self-esteem, coping and perceived social support at a time point 3?-?15 months after initial surgery. No significant differences were revealed between the two groups on any of the outcome measures. Poor body image, low self-esteem, and a tendency to use coping strategies characterized by helpless/hopelessness and anxious preoccupation, rather than fighting spirit, were highly predictive of distress. Reasons for the lack of differences between the two groups are explored.     

Discrimination of facial appearance stimuli in body dysmorphic disorder

Cognitive-behavioral models of body dysmorphic disorder (BDD) propose that information-processing biases--in particular, selective attention to a defect in one's appearance as well as improved aesthetical perception--might contribute to the development or maintenance of the disorder. In the present study, the authors tested the hypothesis that patients with BDD discriminate facial appearance stimuli more accurately than controls. Sixty female patients from a dermatological clinic participated in the study: 21 patients with BDD, 19 patients with disfiguring dermatological conditions, and 20 patients with nondisfiguring dermatological disorders. Participants rated dissimilarities between pictures of neutral faces that had been manipulated with regard to aesthetic characteristics. Manipulation ratings of participants with BDD were significantly more accurate than those of both control groups. Implications of these results for cognitive theories of BDD are discussed.     

Existential motive underlying cosmetic surgery: A terror management analysis

Why do people consider cosmetic surgery? Based on the terror management theory, the present research identifies an existential motive: Through cosmetic surgery, people can symbolically defend against their death anxiety. A correlational study and an experiment showed that death terror, whether operationalized as individual differences in fear of death or experimentally manipulated mortality salience, was associated with stronger acceptance of cosmetic surgery. This association was absent among participants who did not consider physical appearance important, and weaker among those who were satisfied about their appearance. Also, this association was particularly strong among those with high explicit self‐esteem. This concurs with the recent theoretical development about the role of self‐esteem in symbolic defenses against death terror.     

Mirror gazing in body dysmorphic disorder and healthy controls: effects of duration of gazing

Cognitive-behavioural models of body dysmorphic disorder (BDD) suggest that mirrors can act as a trigger for individuals with BDD, resulting in a specific mode of cognitive processing, characterised by an increase in self-focussed attention and associated distress. The aim of the current study was to investigate these factors experimentally by exposing participants with BDD (n = 25) and without BDD (n = 25) to a mirror in a controlled setting. An additional aim was to ascertain the role of duration of mirror gazing in the maintenance of distress and self-consciousness by manipulating the length of gazing (short check vs. long gazing). Findings demonstrated that contrary to what was predicted, not only participants with BDD, but also those without BDD experienced an increase in distress and self-focused attention upon exposure to the mirror. In addition, people without BDD, unlike those with BDD, experienced more distress when looking in the mirror for a long period of time as opposed to a short period of time. This lends some support to the idea that, for people with BDD, gazing in a mirror, regardless of duration, might act as an immediate trigger for an abnormal mode of processing and associated distress, and that this association has developed from past excessive mirror gazing. Further theoretical implications of these findings, as well as subsidiary research questions relating to additional cognitive factors are discussed.     

体像困扰与社会文化因素

数据显示大多数人对自己的体像不满意,而对体像的不满意可能形成困扰。存在体像困扰的个体更多体验抑郁、焦虑等负面情绪,且体像困扰和进食障碍、体像障碍等精神疾病均存在密切的关系。在介绍概念的同时,本文还对体像困扰相关社会文化因素的影响进行了综述。已有研究表明女性较男性更容易受到体像困扰的影响;体像困扰存在跨文化的一致性,也存在文化差异;家庭、同伴和媒体对于体像困扰均有影响。     

Perceived teasing experiences in body dysmorphic disorder

Individuals with body dysmorphic disorder (BDD) are excessively concerned about imagined or slight defects in their appearance (e.g., asymmetrical facial features). Cognitive-behavioral models of BDD propose that several factors, including dysfunctional appearance-related beliefs and life experiences, such as teasing, contribute to the avoidance behaviors or rituals (e.g., mirror checking, grooming) characteristic of BDD. Previous research has demonstrated an association between perceived teasing and body dissatisfaction. In the current study, we examined whether individuals with BDD (n = 16) report to have been teased more often than do mentally healthy controls (n = 17). The group comprising individuals with BDD reported more appearance- and competency-related teasing than did control participants. This study provides preliminary evidence for the association between perceived teasing and BDD.     

Victimization,social anxiety,and body dysmorphic concerns: Appearance-based rejection sensitivity as a mediator

Body dysmorphic disorder (BDD) is characterized by extreme preoccupation with perceived deficits in physical appearance, and sufferers experience severe impairment in functioning. Previous research has indicated that individuals with BDD are high in social anxiety, and often report being the victims of appearance-based teasing. However, there is little research into the possible mechanisms that might explain these relationships. The current study examined appearance-based rejection sensitivity as a mediator between perceived appearance-based victimization, social anxiety, and body dysmorphic symptoms in a sample of 237 Australian undergraduate psychology students. Appearance-based rejection sensitivity fully mediated the relationship between appearance-based victimization and body dysmorphic symptoms, and partially mediated the relationship between social anxiety and body dysmorphic symptoms. Findings suggest that individuals high in social anxiety or those who have a history of more appearance-based victimization may have a bias towards interpreting further appearance-based rejection, which may contribute to extreme appearance concerns such as BDD.     

Attitudes toward cosmetic surgery patients: the role of culture and social contact

Cosmetic surgery is increasingly popular globally, but how cosmetic surgery patients are socially evaluated is largely unknown. The present research documents attitudes toward these patients in multiple cultures (Hong Kong, Japan, and the United States). Across these cultures, attitudes toward cosmetic surgery patients were predominantly negative: Participants ascribed more negative attributes to cosmetic surgery patients and found cosmetic surgery not acceptable. Also, participants in Hong Kong and Japan were not willing to form social relationships, particularly intimate ones, with these patients. These attitudes were less negative in the United States than in Hong Kong and Japan, partly because social contact, which reduced negativity in attitudes toward cosmetic surgery patients, was more prevalent in the United States. These findings bear important implications for the subjective well-being of cosmetic surgery patients, who very often expect improvement in their social relationships through the surgery.     

Examining the impact of acculturative stress on body image disturbance among Hispanic college students

This study investigated the impact of acculturative stress on psychological well-being and body image disturbance in a sample of female and male Hispanic individuals. The unique protective effects of differing social support sources, including family and peer support, were examined against acculturative stress and body image disturbance. A total of 399 participants of Hispanic origin were recruited from Texas Tech University in West Texas. Students completed a battery of measures of acculturative stress and internalization of the thin ideal, as well as perceived social support. Hierarchical regression analyses indicated that acculturative stress is a significant positive predictor of body image disturbance among Hispanic college students. Thin ideal internalization was found to mediate this relationship such that acculturative stress was associated with heightened body image disturbance through its impact on thin ideal internalization. Social support significantly reduced acculturative stress as well as body image disturbance but did not moderate the relation between these 2 factors. Results highlight the importance of considering acculturative stress as a strong predictor of body image disturbance among college students of Hispanic origin. The mechanisms of influence of acculturative stress on body image disturbance are discussed in relation to thin ideal internalization. The protective role of social support on these negative psychological outcomes is also clarified. This study is the first to examine these issues in a sample of female and male Hispanic college students and provides avenues for clinical interventions and future trials with diverse populations.