Wednesday, 15 February 2012

Mental health problems worsen after cosmetic surgery

Are people who opt for medically unnecessary, cosmetic surgery psychologically vulnerable? Does having such surgery bring them psychological relief?

These are tricky questions. There's actually evidence of increased mental health problems among people who've undergone cosmetic surgery. But whether that's a harmful side-effect of the surgery, or a hangover from pre-operative problems, it's difficult to say.

Randomly controlled trials would help, but of course that's not possible in this situation for ethical reasons. What's needed is a large-scale prospective study that follows thousands of people up over many years. Hopefully a sub-set will opt for cosmetic surgery during that time and then it should be possible to look for any psychological vulnerabilities preceding the surgery and any changes post-surgery.

That's exactly what a team of Norwegian researchers have done. Tilmann von Soest and his colleagues began in 1992 with a sample of over 12,000 school students aged 12 to 19 years, and then surveyed them periodically for several years. Attrition of the sample left 2,890 participants at the final survey in 2005 (many participants were lost early in the study, in 1994, because they changed schools). By 2005, 106 of the participants had had at least one cosmetic surgery procedure. This included 78 women - that's 4.9 per cent of women in the sample; and 28 men - 2.2 per cent of the men in the sample.

Because of the lack of men, the researchers focused only on the women. The majority of their operations were for breast augmentation (26.8 per cent) or reduction (19.5 per cent), with other procedures including liposuctions, ear and nose modifications.

There was strong evidence that women with psychological problems were more likely to opt for surgery. The female participants who went on to have cosmetic surgery were more likely to have a history of poorer mental health, including more depression and anxiety, more illicit drug use, self-harm and suicide attempts. Unsurprisingly, the women who had breast surgery more often had a history of less satisfaction with that part of their body (although general appearance satisfaction wasn't related to undertaking surgery). By contrast, sociodemographic factors were not related to who had surgery and who didn't.

Did the surgeon's scalpel benefit the psychological health of these women? With one specific exception, it seems the answer is a categorical "no". Breast surgery was associated with increased satisfaction with that part of the body, but having cosmetic surgery of any kind was associated with increases in anxiety and depression, eating disorders, more alcohol use and more suicide attempts. Surgery didn't boost general appearance satisfaction.

The study isn't without its shortcomings, as the authors acknowledge. For instance, the apparent adverse effects of cosmetic surgery may not be specific to cosmetic procedures but could apply to having surgery of any kind. The study also relied on participants reporting their own mental health.

This study provides "no evidence that cosmetic surgery should be used to alleviate mental health problems in women dissatisfied with their appearance," the researchers concluded. "Nor do the results support the notion that cosmetic operations in exceptional cases should be covered by the public health-care system due to a potential psychotherapeutic effect for the patient."
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  ResearchBlogging.orgvon Soest, T., Kvalem, I., and Wichstrøm, L. (2012). Predictors of cosmetic surgery and its effects on psychological factors and mental health: a population-based follow-up study among Norwegian females. Psychological Medicine, 42 (03), 617-626 DOI: 10.1017/S0033291711001267

Post written by Christian Jarrett for the BPS Research Digest.

17 comments:

  1. Interesting study design, but that's what, 80% attrition? I think that just makes it hard to trust these findings.

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    1. Hi Neuroskeptic - the details behind the recruitment are quite complicated and I didn't feel it was appropriate to get into them in the blog post. This study uses data from the Young in Norway Study, which began with 12,287 students. At T2 in 1994 a large proportion of the students had changed schools and the study only continued with those who remained at the same school. So there were 3844 participants left in 1994. By 2005 this has reduced further to 2840. The researchers compared the female participants who left the study early with those who didn't. Participants who smoked at T1, who had conduct problems, who had parents with low educational background and/or who were from a low population density area were more likely to drop out of the study.

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    2. It presents a dilemma even on the individual's health insurance. If treatment for mental illness is covered by his policy, the cause (plastic surgery), which is not covered can give the insurer reason not to pay.

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    3. nashra4:24 pm

      i have a question that maybe you can answer... is it at all possible that plastic surgery in a mother can cause psychological problems in the child?

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  2. PS, I'm going to add in something into the post about the early loss of participants. Thanks for raising this issue.

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  3. The lack of men available for such studies is truly worrying. Anecdotally in our practice in Sydney - Australia, we are seing evidence of an increase in symptoms clusters similar to Body Dismorphic Disorder where men seek to rectify issues like hair loss, acne, body hair, or more radical true surgeries and then develop greater anxiety once this does not relieve their original concenrn.

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  4. Scary.

    In essence, I would guess that the person who opts for surgery does not see his or her way open to achieving any other solution. My guess would be a common denominator of a low self esteem and a lack of confidence...

    Which is breeding ground for emotional issues anyway.

    just my 0.02c

    Peter

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  5. It would have been interesting if the study and in depth "emotional health" testing before, as well as at consistant intervals of the study. I realize that funding was most likely an issue, but its hard to make up a decision with such a small sample size of data and participants.

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  6. This finding seems impossible but believing this won't hurt us. Anyway, I really don't see the relation between the two. I'm hoping to read further about this study.

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  7. If surgery went wrong its natural the mental problems could be increased in people because of the wrong effects of surgery.I think proper knowledge should be gained before doing such procedure.
    Scott Loessin

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  8. I agree with Scott. Any surgical procedure is not without risk. If a surgery goes wrong then it is possible that it can affect the patients mental health. It is a must therefore to choose a board certified and experienced surgeon. Also, you need to discuss every detail regarding what result you wish to have to hopefully have a good result.

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  9. Now this is scary! And good thing I was able to read the disclaimer first before I post this comment. I see this post as another version of how women release emotions through getting a hair cut or a tattoo or anything that may look at them as if they changed. Sort of diversion thing.

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  10. Anonymous11:46 pm

    Maybe the ones who were fine couldn't be bothered to stay in touch. The ones that had problems may have been likely to have more inclination to stay in touch anyway.

    Not that I'm a fan of plastic surgery but isn't that something to consider?

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  11. Undergoing plastic surgery really needs preparation and careful consideration. It would greatly help if there’s a good communication between the patient and the doctor so post-surgery anxieties could lessen. Hopefully, further studies about this would produce more successful results. =)

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  12. Hmm... interesting, but now depends a lot from person to person if they are satisfied with their results. I also underwent a liposuction procedure by Dr. Jerome Edelstein and everything went smoothly without problems and I love my results.

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  13. I had liposuction when I was 21 years old to my hips, thighs, and abdomen. The reason was low self-esteem and poor body image as a result of reading fashion and fitness magazines in my youth. Now 38, I have a daughter who has the exact same body as me, and she is beautiful and perfect, and now I realize that I was beautiful and perfect too. I was only 150 lbs, which is not obese. I did not need the surgery, but the plastic surgeon did it anyhow. I am filled with so much grief about this. I will never share the same body as my daughter because of the surgery.

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  14. It's interesting to see the psychological effects of cosmetic surgery. It isn't surprising to me that people who opt for cosmetic surgery are more likely to suffer from mental health issues afterwards. They have drastically changed their bodies and that can take its toll.
    Ron Johnson | Brisbane Aesthetic & Plastic Surgery Centre

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