Body dysmorphic disorder is a mental illness which manifests with strong belief and concern that one is deformed without any evidence. Affected individuals get to point of seeking medical assistance to correct their purported deformity. Currently, there is no clear statistical data on body dysmorphic disorder, but it is alleged that, approximately between two to six percent of patient who seek cosmetic or dermatology interventions are affected.
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Mostly, affected individuals rarely seek psychiatric interventions, but frequently visit plastic surgeons and dermatologists for treatment. Onset of Body dysmorphic disorder is commonly in mid teenage to late teenage.
Its clinical features include, an individual suddenly getting worried of her appearance and believing that she has deformities. Most of patients who have this disorder claim that, the deformity is on their face or head (Cotterill, 1996).
Many people who suffer from body dysmorphic disorder visit psychiatric hospital with chief complain of spending a lot of time looking their face on mirror. They frequently complain of their deformed facial appearance that is contrarily. Some of those affected get to an extent of covering their face to hide the purported deformity.
In other scenario, people with this disorder ask their friends if the deformity is visible or recognizable. Most of the affected individuals are always anxious and afraid of being in public places or meeting people. This change in behavior negatively affects their school or job performance (Cotterill, 1996).
Joan Rivers a 79 year old female who works as an American television personality, actress and comedian in the past years has portrayed features related to body dimorphic disorder. She has undergone cosmetic surgeries several times to change her facial appearance. Evidently, this indicates that she believes that her facial appearance is deformed and needed to be changed.
In 1965, she underwent her first eyelift cosmetic surgery. Since then, she has undergone several other facial plastic surgeries. She claims that, doing facial cosmetic surgery boosts her career (Rivers, 1997).
In her past psychiatric history, Joan Rivers is reported to have suffered from bulimia nervosa. This is an eating disorder where by individual consumes large quantity of food followed by efforts to get rid of it by either vomiting or taking laxatives. Also, she confessed of suicidal ideation which characterizes psychiatric disorders. In her family history, Joan Rivers currently lives with her daughter and granddaughter in Larchmont, Westchester county New York.
Her Husband committed suicide in 1987. It is reported that she was so devastated by her husband’s death to extend of quitting her job for a short period. In her family history, there is a case of mental health disorder. Her older brother was diagnosed with Bipolar disorder 15 years ago (Rivers, 1997).
Regarding her personal history, Joan Rivers was born and brought up in Brooklyn, New York city. Her birth was complicated; her mother experienced prolonged delivery and doctors had to perform caesarian section. Her childhood developmental milestone was normal. She did not have any delay or abnormalities during her developmental stages.
She attended school up to College level and she did not have problems related to school attendance like truancy. Mostly, she was cooperative in class and she did not have major problems with her class mates. She had friends at school most of which are in contact up-to-date. Her school performance was average as compared to the other students. She graduated from Bernard College in 1954. She lives in her home together with her daughter and granddaughter (Rivers, 1997).
In her premorbid personality history, Joan Rivers is reported to have suffered from bulimia nervosa. She could purge in large quantity of food and then induce vomiting to get rid of the food.
She confessed to have thought of committing suicide following her husband death in 1987 and after she realized that she suffered from bulimia nervosa. During stressing moments she likes sharing her problems with her friends as a way of relieving her stress. When tired, she prefers sleeping as way of relaxing. Her hobbies include travelling and reading novels.
She also likes company of her daughter, granddaughter and other friends. Regarding alcohol and drug history, Joan Rivers used to drink and smoke when she was in college, but stopped later. She started drinking and smoking when she was 16 years old (Rivers, 1997).
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Joan Rivers physical examination reveal that she has added quite amount of body weight recently. This could be related to bulimia nervosa and depression associated with losing of facial appearance. She does not have any physical evidence of drug abuse like tattoos. In most cases tattoos are interpreted as evidence for someone with history of drug abuse. This evidence can be backed up by lack of needle tracks on her body skin. Joan River has no history related to cardiovascular, respiratory, gastrointestinal and neurological systems illnesses.
Regarding Joan Rivers mental state examination, she is always appropriately dressed, well-groomed and can maintain eye contact during conversation. Also, she maintains upright sitting posture. Regarding her overt behavior and motor activity, Joan River is always active. She does not appear agitated or lethargic. In public, she is always jovial and friendly. Always, she answers questions well and calmly. Also, she responds to questions appropriately.
She is always cooperative throughout in any activity she is involved in neither does she portray hostility nor resistance. She has good rapport with people around her. Her speech is always of good flow and quality. Her effect is mostly flat and she does not have thought process disorder like neologism.
Her thought content is abnormal. From her history, she portrayed signs of obsession. She insists on having facial plastic surgery regularly to boost her career. She is delusional; in her history, she has features of paranoid delusion. She has a false belief that her face appearance is not appealing for her career and that is the reason she prefers having cosmetic surgery frequently.
Joan Rivers has a good abstract reasoning. Her general intellectual reasoning is appropriate. She can come up with appropriate solution to problems. She has insight; she has the ability to recognize a problem, understand its nature and severity then act accordingly. She is always conscious and well oriented with different situations. She is able to recognize her present location, time and date. Her long-term, short-term, immediate, recent, and remote memory is normal.
These are Joan Rivers’ multiaxial assessment results based on her history, physical examination and mental status examination.
- Axis I: Joan primary disorder (clinical disorder) is body dysmorphic disorder. It is portrayed by her habit of undergoing cosmetic surgeries frequently to change her facial appearance. She claims the reason for having frequent plastic surgery is to boost her career.
- Axis II: She has history of eating disorder (bulimia nervosa). It is portrayed by her habit of purging in large quantity of food followed by induced vomiting to get rid of the food.
- Axis III: She does not have history of any chronic medical condition.
- Axis IV: Joan Rivers’ Psychological and environmental problems include family and marital problems. She was divorced by her first husband after six months of marriage. In 1987, her second husband committed suicide. Her job has been faced by many challenges which forced her to quite for a while in 1987.
- Axis V: Global assessment of functioning (GAF). From the assessment she scored 78 percent (American Psychological Association, 1994).
The appropriate treatment plan for Joan Rivers includes combination of various therapies. Psychotherapy is one of the therapies. This therapy is a form of individual counseling. It incorporates cognitive therapy that is aimed at changing individuals thinking. Also, it incorporates behavioral therapy which targets at changing behavior of the patient. The major objective of psychotherapy is to alleviate the false belief about the deformity and reduce the compulsive behavior (Phillips, 2004).
Administering medication (pharmacotherapy) is another form of therapy for body dysmorphic disorder. Selective serotonin reuptake inhibitors (SSRI) are drugs of choice in treating this disorder. Fluoxetine and Clomipramine are effective in reducing the intensity of the patients’ concerns (Phillips, 2004).
Group or family therapy is useful in treating this disorder. Family should show necessary support to the patient and the treatment interventions in order to achieve better prognosis. Family should be informed on body dysmorphic disorder signs and symptoms. They should also understand the disorder very well (Phillips, 2004).
American Psychological Association. (1994). Diagnostic and Statistical Manual of Mental Disorders, (4th ed.) Washington, DC: American Psychiatric Association.
Cotterill, J. A. (1996). Body dysmorphic disorder. Dermatol Clin, 14 (3), 457-463.
Phillips, K. (2004). Body dysmorphic disorder: recognizing and treating imagined ugliness. World Psychiatry Journal, 3(1), 12-17.
Rivers, J. (1997). Bouncing back: I’ve survived everything… and I mean everything…and you can too. Waterville, Thorndike Press.