BODY DYSMORPHIC DISORDER: WHEN WE CROSS THE LINE

A few weeks ago, the public was left in shock as a young woman lost her life following a plastic surgery procedure. It was very sad to see a young family go through such loss, robbing such young babies of a mother.

As public discussions carried on in both mainstream and social media, the contentious issues arising were just as varied. The expertise of the surgeon was questioned, the post-operative care given to her and management of the complications that arose.

The other end of the fulcrum asked the not so pleasant questions. Many wondered why such a beautiful young lady would go under the knife to alter her body. Many viewed it as an assimilation of western culture that may be picking up at an alarming rate, which may be accompanied by unexpected negative outcomes.

Plastic and reconstructive surgery as a medical specialty is not new in Kenya. It may have had a limited number of specialists for many years but it has always existed. It is now gaining visibility because of the increased demand for cosmetic procedures and the increased number of specialists. The University of Nairobi has been graduating plastic surgeons for the last few years, doubling their numbers overnight.

Many patients have undergone plastic surgery for various reasons. Some are patients with physical defects such as cleft lip and mammoplasties for gigantomastia (abnormally large breasts) causing back problems. Most are patient requiring reconstruction following tragic disfigurement from traumatic accidents, burns and explosive injuries.

In the face of such a heavy burden, it is only humane to go the extra mile to restore function and aesthetics to one who has already suffered so much. Plastic surgeons spend hours on end in theatre trying to piece together the smile that was smashed in during the motor accident; release the frozen up scar tissue that has left the hand frozen in a claw-like clasp in the grip of scar tissue; or remove the large benign lump on the back that has caused a young girl to live with the nickname “hunchback” all her life.

But over the last decade, there has been a marked increase in the demand for cosmetic surgery. What was always viewed as the preserve of Hollywood stars became commonplace even in Kenya. The demand for breast augmentation surgery, facelifts, chin lifts and tummy tucks are no longer the preserve of the elite.

This decade heralded the advent of complete body transformation as evidenced by the cropping up of “socialites” who have gone all out to alter their bodies to conform to what is perceived to be perfection. The skin bleaching, hip and breast augmentation, lip enhancement and cheekbone enhancement has been taken to a whole new level. These women are regarded as trendsetters in their social circles with regard to the direction of the demand.

It is therefore not surprising to see that the plastic surgeons are getting very busy. Suppliers of pharmaceutical and non-pharmaceutical products used in plastic surgery have also had to up their game. This has also given rise to another superspecialty, cosmetic dermatology, that is keeping doctors extremely busy. Weekly botox is here with us.

However, while every person has a right to seek plastic surgery services purely for cosmesis, it is important to know here we draw the line. Body dysmorphic disorder is a well-recognized mental illness categorized using the DSM-5 diagnostic criteria. It is a disorder where a person is obsessed with one or more aspect of their own body, deeming it severely flawed and warranting exceptional measures to hide or fix it.

This is a condition that most patients will never discuss with their doctors. First, it is not well recognized in Kenya and it only comes to the attention of the psychiatrist when the patient has inflicted severe self-harm or is suicidal.

This is not to say that every person opting to get a hip enhancement surgery is mentally ill. However, when one is preoccupied with one or more nonexistent or slight defects or flaws in their physical appearance; is repetitively and compulsively responding to this perception to change it; and their preoccupation is interfering with their capacity to function normally, then a diagnosis of body dysmorphic disorder may be considered.

The disorder requires treatment as it greatly impacts on the quality of life of the patient. The patient is greatly debilitated, and may be unable to even hold down a job or concentrate on school. Medication and psychotherapy are the mainstay of therapy. It is even more difficult to institute treatment when the patient fails to understand that they have a problem; what is described as absence of insight.

There is need for public awareness of the condition so that we are better able to support those in our midst who are suffering. Therefore, before we judge the neighbourhood campus student who is constantly bothered by her dark skin, or call the office administrator a “slay queen” for perennially wearing huge wigs because she is convinced she has a massively prominent forehead, it is important to remember that their self-esteem may not be only issue taking a beating but their mental health may be in distress too.

In the same vein, our plastic surgeons must always remember that they may be the safety net for our patients, diagnosing those who may need to see the psychiatrist instead of heading to the operating table.