Cosmetic Surgery, Psychopathology and Body Dysmorphic Disorder in Buenos Aires, Argentina.

A Transcultural Study.

ABSTRACT :
In this article the relation between the practice of cosmetic surgeries and the presence of different mental illnesses, especially Body Dysmorphic Disorder, is analyzed. From an interdisciplinary and transcultural viewpoint the authors have made use of both qualitative and quantitative methods and have integrated perspectives from the respective fields of Social and Cultural Anthropology and Psychiatry in order to evaluate the data in its socio cultural context.

Introduction:
According to the “International Society of Aesthetic Plastic Surgery” (ISAPS) Argentina occupies the third place worldwide regarding the number of cosmetic surgeries practised annually, number one and two being the United States of America and Mexico.¹ Various authors have related preoccupation about body image and the practice of cosmetic surgery (or other cosmetic treatments) and with a number of mental disorders, especially Body Dysmorphic Disorder (BDD) (Dufersne 2001, Hodgkinson 2005, Honigman 2004, Sarwer 1998, Ishigooka 1998). There is no record however of existing studies in Argentina. The objective of the present study is to evaluate the association between cosmetic surgery practice(s) and the presence of different mental disorders, to screen the diagnoses and the most frequent psychiatric symptoms, the difficulties regarding diagnose, the BDD incidence in the studied population, and the consequences for the psycho-social evolution of the patients and the sanitary system.

 

Methodology:
Quantitative methods have been combined for the clinical evaluation of patients who have undergone cosmetic surgery / surgeries and who are in psychiatric or psychotherapeutic treatment. Self-administered questionnaires have been filled out by patients (N=20) and by their respective psychiatrist/psychologist .For the ethnographic research, based on participant observation, qualitative techniques have been used. This part of the study focussed on the phenomenon of cosmetic surgery practice, body image and the concepts of the body and physical beauty.

 

Results and Conclusions:
The data derived from the questionnaires of psychologists and psychiatrists showed that the most frequent diagnoses (DSM IV) in the studied patient population were: Anxiety Disorders (45%), Mood Disorders (20%), Body Dysmorphic Disorder (15%) and Biographic Problems (15%), with an incidence of Personality Disorders of 15%. The data from patients presented a greater frequency of Anxiety symptoms (90%), Avoidance conducts (55%), Social Phobia symptoms (55%) and symptoms of Depression (50%). Also the professionals registered difficulties to establish or maintain relationships among a high percentage of the patients (60%), as well as problems to obtain and uphold professional or academic activity (40%). Coinciding with existing literature, in the present work we found that the majority of the patients (80%) who have undergone cosmetic surgery / surgeries is content with its results. However a smaller group (20%) shows disconformity with the results and patients with BDD predominate among them (15%). As we mentioned earlier we consider the elaboration of diagnostic tools and the training of plastic surgeons and mental health specialists necessary for a correct detection and treatment of the patients presenting risks for a bad psycho-social evolution posterior to the practice of the cosmetic surgery / surgeries, evaluating the predictive factors encountered in this work.

The practice of cosmetic surgery may well rise as an effective and valid form to improve life quality of the patients. Nevertheless we find it appropriate, if not necessary, to open a broad discussion about the topic.

What does the practice of cosmetic surgery entail in terms of discourse and in the opinions and experiences of the individuals?

Coinciding with the fieldwork and the analysis of the historical context in which cosmetic surgery in Argentina has grown explosively, we find that patients turn to cosmetic surgery as a manner to improve or resolve conflicts regarding mood, self esteem, interpersonal relationships and sexual life.

What does the ‘improvement’ by means of the aesthetic transformation, of the physical transformation mediated by medical technology, imply? Could these procedures reinforce mechanisms or cognitive strategies of control, perfectionism or even negation of the physical limit?

During fieldwork we have observed partial or minor forms of BDD among patients who underwent cosmetic surgery: anxiety located in the body or, to be more precise, manifest as aesthetic preoccupation. In this sense an evaluation of the presence of dysmorphic symptoms or “Dysmorphic Syndrome” is essential for patients with anxiety disorders or mood disorders, even if they do not fulfil all BDD criteria. The detection of these minor or partial forms could be useful for the prognosis and treatment of these patients.

The topic of the present work is one of great complexity, involving identity, historic, social, political and economic aspects: the medical perspective is to be understood as located dynamically in the midst of these multifaceted cultural processes. We hope that in future investigations the problematic here proposed can be treated from different disciplines as it transgresses the medical perspective and its diagnostic categories; and that it can be replicated in other countries and populations (i.e. Mexico, Brazil and the Latin population in the United States) where an explosive grow of the practice of alike surgical and cosmetic procedures have been registered.