It’s easy to get caught up in the perfectionism psyche when
things are changing so quickly after bariatric surgery. You imagined yourself
thin, fit and svelte, but really, you did not comprehend what it would be like
to have hanging flesh on your body after you worked so hard for that body. Have
you caught yourself thinking, “I just don’t like the way I look in the mirror,”
while naked. Today’s blog is about how
to have a healthy mentality about your body after weight loss surgery,
considerations for a reasonable time frame to pursue plastic surgery,
recognizing unreasonable body image issues, understanding self harm, and
working through those issues with a therapist, and stopping unproductive
negative self talk.
In the case of the bariatric surgery patient, self
acceptance has its limitations, but we must live with the understanding that a
model perfect body isn’t going to happen. Where does the line get drawn in the
sand between trying to achieve a figure that you can be happy with and living
with an obsession with the knife? It’s
certainly possible for anyone to become addicted to ANYTHING. However, in the bariatric
transformation from obese to healthy, thin, or slim, if money is no object: is
there a such thing as an addiction to plastic surgery? Better yet, is there room for concern about
those members of the community who begin the journey of going under the
knife? Should professional psychologist
and mental health professionals look at case history in order to determine if
that person will be stable enough to withstand the psychological impacts of
plastic surgery, or will it become obsessive?
There’s no way to screen for risk in this regard. However, the question has been posed that
maybe those with personality disorders with a history of cutting might take this
journey to extremes. Like I said,
anything is possible with anyone, at any point in time. Having unlimited resources to indulge in
plastics, self harm in pursuit of perfection is certainly obvious with many
mega-stars. Michael Jackson certainly
too it to an extreme if you think in terms of his numerous plastic surgeries
and history of mental and psychological abuse, albeit extraordinarily talents,
he brought it to the max.
Influenced by media, society’s expectations of a perfect
body are skewed. We have to love ourselves, and under no uncertain terms should
be not love our body, imperfections and all. An otherwise successful, yet
dissatisfied bariatric patient’s excess skin removal, coupled with destructive
behavior patterns are indicative of a more severe diagnosis of body dysmorphic disorder
diagnosis, or even, pronounces issues of self harm included, going under the
knife that could be indicative of a borderline personality disorder. How do can
we tell the difference?
To identify behaviors
as unhealthy and unproductive as a chronic mental illness, one must look at the
client’s ability to control the obsessive negative thoughts, (i.e. you can't
stop thinking about a flaw in your appearance — a flaw that is either minor or
imagined) when your appearance seems so shameful that you don't want to be seen
by anyone. Body dysmorphic disorder is intensely
obsessive, image and appearance are often thought about for many hours a day. The
perception of your flaws causes you significant distress and has an impact on your
ability to function in your daily life. If one seeks out numerous cosmetic
procedures or excessively exercise to try to "fix" the perceived flaw
but is never satisfied.
The three essential factors I would use to determine an
unhealthy obsession with appearance (occupies more than 90 minutes a day, of
persistent negative thoughts about self) body image issues, overanalyzes the
perception of others on the individual (implied or stated), personality
disorder, and GAF (Global Assessment of Functioning) Score. Any client with a score below 65 on the scale
would be of concern to me, as a clinician.
So, how do we define an unhealthy obsession with your body,
perfectionism and surgical methods to alter one’s appearance? Where do self harm/self injury,
perfectionism, and personality disorder come into play here? There’s a certain level of desperation that
is a driving motivator to change, but when does it become a disorder? That’s subjective. However, there are some issues to consider
when moving forward to the transformative body reconstructive surgeries. A healthy cognition about when that should be
done is essential.
In my former journey with the Lapband, my mother pestered
about my bat wings. I always said, “Let me get to my maintenance weight for two
years, and then we’ll talk plastics.” Good thing I never got to that point,
else when the band came out I and the slow path of my body fighting back with
regain set in, I would have been a helluva messy rubber-banded skin. If nothing, I am logical, methodical and
grounded in my decision making—after 6 months, I knew that the Lapband had been
a HUGE mistake. (That’s another post, I have been meaning to write out my
Lapband trauma during hurricane Isaac for 10 months now, I owe the public that
story. I want to tell it. It’s just
tough to tell it through the therapeutic lens while I’m still working out the
details on revision, and I still don’t know when that can or will happen.)
My intentions with blog are to discuss the perfecta of
concerns I have for the WLS community.
All of us are crazy, varying degrees of crazy, yes, but some have had
more severe mental illness histories than others. Analysis of previous history of self harm
should not preclude patient disqualification, however certain support services
should be available to those patients who find themselves forming harmful
habits and/or destructive thinking patterns as the transformation of an obese
body becomes slimmer.
Signs are inclusive but not limited to negative feelings or
thoughts, depression, anxiety, tension, anger, generalized distress, self
criticism, self injury, low mood, poor self confidence, preoccupation with
dangerous behaviors, purposefully engaging in harmful acts, urges that cannot
be distracted from or satisfied, negative/harm act results in pleasure,
spending endless time alone in a room avoiding others, and/or
disruptive
influence on interpersonal, academic or other areas of life functioning.
If you find yourself constantly thinking about these issues,
you have options and alternatives. While
I it is important to work with a trained professional, keep in mind that
developing hobbies and interesting that help to take the focus off of your dissatisfaction
help to low your risk:
- Paint, draw, or scribble on a big piece of paper with red
ink or paint
- Express your feelings in a journal
- Compose a poem or song to say what you feel
- Write down any negative feelings and then rip the paper up
- Listen to music that expresses what you’re feeling
- If you cut to calm and soothe yourself
- Take a bath or hot shower
- Pet or cuddle with a dog or cat
- Wrap yourself in a warm blanket
- Massage your neck, hands, and feet
- Listen to calming music
- Call a friend (you don’t have to talk about self-harm)
- Take a cold shower
- Hold an ice cube in the crook of your arm or leg
- Chew something with a very strong taste, like chili peppers,
peppermint, or a grapefruit peel.
- Go online to a self-help website, chat room, or message
board
- Exercise vigorously—run, dance, jump rope, or hit a punching
bag
- Punch a cushion or mattress or scream into your pillow
- Squeeze a stress ball or squish Play-Doh or clay
- Rip something up (sheets of paper, a magazine)
- Make some noise (play an instrument, bang on pots and pans)
- Substitutes for the cutting sensation
- Use a red felt tip pen to mark where you might usually cut
- Rub ice across your skin where you might usually cut
- Put rubber bands on wrists, arms, or legs and snap them
instead of cutting or hitting
Professional treatment for cutting
and self-harm
If your concern is for a loved one because you’ve noticed
suspicious injuries or that person has confided to you that he or she is
cutting, pulling, scraping or harming themselves in this way, whatever the case
maybe, intervention is essential. Speak
respectfully, without blame, and in a calm tone. Address the matter with an open mind and
loving heart. You are extending a hand
to someone who is hurting on the inside.
Deal with your own feelings on the matter prior to the
discussion, the shocked, confused, or even disgusted by self-harming
behaviors—and guilty for your loved one’s distress can be helped by acknowledging
how you feel about this person’s emotional distress. Make the first step by
learning about the problem and overcome any discomfort by understanding why
your friend or family member is self-injuring. This will help you to see the
world from his or her eyes. Avoid judgment and criticisms it is likely the
route of the problem, the person is coping with society’s judgment and
expectations. Find your loved one
support and make your conversation productive.
Availability to listen and find help is a key to recovery. Communicate with them as they seek support and
intervention. Above all, be kind to
yourself and others when you speak about sensitive subjects.
