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Maxillofacial Surgery
Psychological Ramifications of Facial Deformities
Built from Facial Aesthetics — Concepts and Clinical Diagnosis
What’s inside
10 sections · 110 slides
Overview
- What this topic covers
The face and identity
The most individual feature we have, and the one we cannot hide
- The face as the seat of identity
- Why the face matters so much
- Three reasons a clinician needs to understand the mind
- Health is more than the absence of disease
- Health-related quality of life
- How facial function and appearance feed quality of life
- What the diagram is telling you
- Three labels for facial surgery
- What the surgery is really aiming at
Self-image
What the patient believes they look like
- “
- Children give everything a face
- Reading a child's body image from a drawing
- How the drawing test is run
- A child's self-drawing before and after facial surgery
- What to notice in those two drawings
- People differ enormously in how they cope
How other people react
Where most of the damage actually happens
- From a visible difference to unhappiness
- The difficulty is social, not just physical
- Facial deformity as a social disability
- The surprise: milder can hurt more
- Why unpredictability is so corrosive
- How a visible difference shapes an encounter
- Blaming every reaction on the face
- The Dartmouth scar experiment: the question
- The Dartmouth scar experiment: the set-up
- The Dartmouth scar experiment: the trick
- The Dartmouth scar experiment: what was measured
- The Dartmouth scar experiment: what they found
- Two routes, one outcome
- What this means in clinic
Teasing and bullying
Words that leave scars
- “
- Teasing at school
- The same patient ten months apart
- What those two photographs show
- When the trouble peaks
- 'Sticks and stones' is bad advice
- “
To treat or not to treat
A long-standing and unresolved debate
- The contentious question
- The two camps
- Both sides can be right
- Public attitudes are changing
- The media and the 'perfect' face
- Withholding treatment is not the answer
Body dysmorphic disorder
The delusion of deformity
- A woman seeing a distorted reflection
- Why start with a painting
- The woman and her reflection do not match
- What she sees in the mirror
- Her mind has deformed her face
- The patient you will meet
- Naming the condition
- The psychiatrist who named dysmorphophobia
- The leading modern authority on the disorder
- Who defined the modern picture
- One old term, split into two
- What body dysmorphic disorder is
- Which parts of the body
- The four DSM-5 criteria
- Read the full criteria on the next slides
- Criteria required to make a diagnosis of body dysmorphic disorder
- Criteria required to make a diagnosis of body dysmorphic disorder (continued)
- You cannot argue them out of it
- When BDD starts and how it runs
- What travels with BDD
- A dental clue to an eating disorder
- What the disorder does to a life
- 0.7-5%
- Reading those numbers with care
- Why the diagnosis matters to you
- How the diagnosis is actually made
- Red flags in the history
- Two questions worth asking every time
- The signals in the table that follows
- Signals indicative of potential body dysmorphic disorder in the consultation and patient interview (Modified from Naini, 2017 37 /Oxford University Press.)
- Signals indicative of potential body dysmorphic disorder in the consultation and patient interview (Modified from Naini, 2017 37 /Oxford University Press.) (continued)
- Signals indicative of potential body dysmorphic disorder in the consultation and patient interview (Modified from Naini, 2017 37 /Oxford University Press.) (continued)
- Signals indicative of potential body dysmorphic disorder in the consultation and patient interview (Modified from Naini, 2017 37 /Oxford University Press.) (continued)
- Why patients stay silent
- Where to ask about it
- Telling the patient
Managing body dysmorphic disorder
Why the knife is the wrong instrument
- Surgery is not the treatment
- The management pathway
- Talking therapy that works
- The two proven CBT methods
- Medication
- The challenge for clinicians
The neurotic-dysmorphic patient
A real deformity, and a mind in trouble
- “
- The hardest patient of all
- Similar to BDD, but not BDD
- Two ways this presents
- If the red flags show before treatment
- If the trouble appears afterwards
- Holding the line
- Prevention beats cure
Conclusion
The scholar who made disfigurement a disability
- “
- The social scientist who studied facial disfigurement
- Who she was
- How the work began
- What her work changed
- “
- Key takeaways: the psychology
- Key takeaways: the practice
- References
- References (continued)
- References (continued)
- References (continued)
- References (continued)
- References (continued)
- Further reading
- Facial Aesthetics: Concepts and Clinical Diagnosis, 2nd Edition