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Current issues in health psychology. Plastic Surgery Alex Clarke, Royal Free Hospital. Gaspali Tagliacozzi 16 th century plastic surgeon.

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Current issues in health psychology

Plastic Surgery

Alex Clarke, Royal Free Hospital


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Gaspali Tagliacozzi 16th century plastic surgeon

“We restore, repair and make whole those parts which fortune has taken away, not so much that they delight the eyes but that they may buoy up the spirit and help the mind of the beset”


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High Distress

Body Dysmorphic Disorder

Cosmetic group

Reconstructive surgery

No disfigurement

Disfigurement

Positive adjustment to unusual appearance

Normative discontent

No Distress


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Is surgery effective?

  • Very little evidence

  • Lack of long term data

  • Internal v external motivation

  • Physical, psychological and social change

  • Multiple procedures


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Healthcare commission

  • 34,646 cosmetic procedures performed in 2003/4 in UK. (Up by 30% last year).

    • Breast

    • Eyelid

    • Nose


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Why is this a problem?

  • Myths of plastic surgery

  • Unrealistic expectations

  • 34% of complaints to HC about cosmetic procedures

  • Impact on NHS

  • Surgical risks ignored

  • Impact on mental health

  • Change in ‘norms’


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Screening for cosmetic surgery

  • Psychiatric assessment:

    • screens ‘out’

  • Psychological assessment:

    • screens ‘in’

    • (Clarke et al 2005)


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Framework for Screening for cosmetic procedures

  • Appearance related concern

  • Specific concern about perceived noticeability

  • Direct impact on behaviour

  • Realistic understanding of procedure and expected outcome

  • Active participation in treatment


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Noticability and Worry

  • How noticeable is your condition?

  • How much do you worry about it?

  • How likely is it that surgery could be successful in treating your condition?

  • ( 0 – 10 scale)


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Patient characteristics for cosmetic sample

  • No assessed: 372

  • Mean age: 33.8

  • Male 11%

  • Female 82%`


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Results:

Anxiety 89%ile normal population

Depression 93%ile


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Predictors of distress

  • Noticability and worry significantly correlated with all measures >.001

  • Depression increases the expectation that surgery offers a solution >.003


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Simple screening tool

  • How noticeable is it?

  • How much do you worry about it?

  • Depression scale


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BBR (N = 352)

  • Mean age 30 ( 13 – 70)

  • Mean BMI 30 (42% too high for surgery)

  • 88% fit Kerrigan criteria for pain and discomfort

  • 98% wrong size bra

  • 43% ‘sometimes’ use analgesia

  • 25% ‘never’ use analgesia


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Psychological measures:

DAS Anxiety Depression

BBA + 1SD 11.62 9.18

BBR + 1SD 9.52 7.51


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Developing cognitive interventions in anxiety disorders (Clark 2006)

  • Identify cognitive abnormality

  • Construct explanatory model for why abnormality does not self correct

  • Test maintaining factors in experimental studies

  • Devise therapeutic interventions

  • Test in RCTs and disseminate


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Role of clinical health psychology

  • Individual

  • NHS – referrals and problems

  • Public health

    • Screening

    • Research

    • Models

    • Alternative interventions

    • Care pathways


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References:

  • Rumsey N and Harcourt D 2005

    The psychology of appearance. Open University Press


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