How to work with anxious patients in aesthetic medicine

Lyudmila Fedorich, Ph.D., Associate Professor, Course of Dermatology and Venereology, Ukrainian Military Medical Academy (Ukraine)

Who among us as teenagers did not linger at the mirror to examine in detail the features of our appearance: the color and size of our eyes, the clarity of the line of our nose, the presence of pimples on the skin of our forehead and cheeks? Willy-nilly, girls mentally compared their figure with the “parameters” of a girlfriend or favorite actress, and boys strived to be like the main characters of action films and adventure films. The desire to be slimmer, more beautiful and stronger encouraged many to adhere to fashionable diets and attend sports clubs, but intense studies in high school and the ever-increasing pace of life switched the main attention of most teenagers from appearance to the formation of a life position, setting immediate and long-term goals, as well as choosing a profession .

Unfortunately, this “switching” does not happen to all young people. Some of them retain a significantly increased interest in their own appearance even into adulthood. Moreover, it is believed that at the present stage of development of a civilized society, approximately one person in a hundred is focused not so much on the assessment of his appearance by others, but considers himself to be inconsistent with his own standards. This means that such a person may very likely be among those reading this article.

There is no exact information about how many people in the modern world suffer from a painful attitude towards their own physical parameters, because the majority refuses to even talk about their experiences, much less ask for help. In fact, such patients are found quite often, and their greatest concentration is observed within the walls of cosmetology offices and aesthetic medicine clinics.

It is noteworthy that patients with mental disorders do not initially turn to psychiatrists. On average, 65–90% of them visit general practitioners. It is also known that up to 70% of suicide victims with signs of various mental disorders within three months before attempting suicide addressed their problems to doctors of therapeutic specialties, and 35% of them even received long-term treatment from them.

How can a doctor working in the field of aesthetic medicine determine whether a client has excessive anxieties, fears, a tendency to exaggerate existing defects in appearance, or a habit of looking for imaginary ones? It so happens that aesthetic doctors, thanks to their close emotional contact with clients and trusting relationships with them, are often the first among professional healthcare workers who can identify or suspect the presence of mental disorders in a patient, including signs of a distorted perception of one’s own appearance (however , on the other hand, you should not suspect each of the clients of the “beauty industry” institutions of mental disorders.

Errors in the diagnosis of mild forms of mental disorders are due to the variety of external manifestations of psychopathology, especially in the initial stage, with an insignificant degree of severity, as well as somatized (similar to symptoms of internal diseases) “masks” of many psychopathological phenomena. At the same time, a significant role in the incorrect assessment of the patient’s mental state is played by doctors’ insufficient understanding of the etiopathogenetic features and clinical manifestations of many mental disorders.

In this regard, it is absolutely rational that a doctor who does not specialize in psychiatry should not give an accurate definition of the disease. However, it is within his competence to give an adequate general assessment of the degree of severity (severity) of mental and, in particular, psychotic disorders and their possible threat to both the patient himself and the people around him. The main method of such a medical assessment is to determine the areas of disorders in the functioning of mental activity (attention, mood, will, perception, thinking, movement, memory, intellect, consciousness). In this case, a functioning disorder is considered to be dysfunction of one or another sphere of mental activity, which can be expressed either in its increase (hyperfunction) or decrease (hypofunction), as well as in the presence of qualitative changes (dysfunction itself).

Based on the foregoing, the purpose of this article is to attract the attention of doctors working in the field of aesthetic medicine to the problem of the high prevalence of psycho-emotional disorders in patients who come to them with a view to their timely diagnosis and qualified treatment with the involvement of specialized specialists (psychiatrist, psychologist or psychotherapist) within the framework of using an interdisciplinary approach in treatment.

Common with phobias and phobias

The correct attitude on the part of the aesthetician to the patient’s distorted perception of his own appearance can often run counter to the direct benefit for him. But it is extremely professional to put the patient’s interests above your own. After all, the formation of a correct attitude towards oneself can be extremely significant (if not of primary importance at a certain stage of life) for the patient. In addition, such actions help strengthen the existing trusting relationship with the patient and ultimately prolong and strengthen the relationship between the doctor and the patient in the future.

How to help a patient in a situation where his perception of his own appearance is distorted? How to gain or not lose an existing trusting relationship with such a client? How to ensure that a psychological problem does not affect the quality of cosmetic treatment? In what cases does such a patient need the help of a psychotherapist? In order to answer these and many other questions, it is necessary to understand some basic definitions that characterize the psycho-emotional state of a person.

Such definitions primarily include “fear” and “phobia”. It should be noted that these concepts are very close, but there are certain differences between them.

Fear is the body’s natural defensive reaction to a specific real danger, physiologically manifested in the release of biologically active substances into the blood, rapid heartbeat, autonomic dysfunction, etc. In addition, there is a point of view according to which fear arises from a “vital” threat. Everyone knows the fact that a person is born absolutely fearless. Small children are not afraid to fall down a slide, jump into water, or touch a sharp object with their finger. Only later, with experience, does the feeling of fear come, and the fears experienced by a person throughout his life are mainly useful. For example, a feeling of fear can help to escape from dangerous situations or prevent them. Such a feeling of fear is completely conscious and controlled by common sense and the logic of current events.

A phobia is an uncontrollable fear that is not based on common sense (irrational) and is present in the human psyche in certain situations or when expecting a certain known object. That is, a phobia is a strongly expressed obsessive fear that irreversibly worsens in certain situations and cannot be fully explained logically. As a result of the development of a phobia, a person begins to fear and, accordingly, avoid certain objects, activities or situations. In modern society, it is difficult to overestimate the problem of phobias, because, according to world statistics, every eighth inhabitant of the planet has certain phobias.

How to distinguish a phobia from “ordinary” fear?

To this end, we should consider the difference between fear and phobia using a very real example. For example, there are a certain number of people who are afraid to ride in an elevator. If the cause of such concerns is fear, it must be caused by a corresponding negative experience in the past. For example, a person once felt ill in a cabin or got “stuck” in it. If the cause is fear, then the person will try to take the stairs, but if necessary, he will still use the elevator. Naturally, this will be accompanied by certain experiences, but will be controlled by common sense and logical thinking. In the case of a phobia, the problems with riding in an elevator can be much more significant, depending on the severity of the phobia. In the mildest cases of manifestation of such a phobia, a person will still enter the elevator, however, any, even the most insignificant stops of the car between floors can cause a pre-panic or even panic state (people with panic disorders have a specific cognitive deficit: they are not able to realistically perceive their sensations and their interpret). In the most severe cases of such a phobia, a person will not be able to force himself to enter the elevator even in case of emergency, which, unfortunately, happens contrary to logic and common sense. Moreover, any attempts to force such a person to forcibly enter the elevator can cause him severe psychological trauma. Essentially, patients suffering from a phobia are “sensory fantasists,” meaning they imagine a situation or illness and then experience a sensory sensation as evidence that confirms its presence. Such a patient typically experiences sensory or motor abnormalities that support his false imaginary beliefs.

Anxiety disorders and neurasthenia

There are different types of psycho-emotional disorders. Among patients turning to specialists in aesthetic medicine, the most common, in our opinion, are anxiety disorders and neurasthenia.

Anxiety is an emotional state that occurs in situations of uncertain danger. The concept of “anxiety” was introduced into psychology by Sigmund Freud . According to Freud, with fear, attention is directed to the object, while anxiety refers to the human condition and “ignores the object.” But as soon as anxiety goes beyond the initial impulse that forces one to explore danger and prepares a person to escape, it becomes unproductive and paralyzes action. The appearance of anxiety that is disproportionately high in relation to the existing danger or that arises in a situation where there is no external danger at all is a sign of neurotic anxiety. In his writings, Freud repeatedly illuminated and pointed out from various angles the primary source of anxiety, that is, the “separation” of the child from the mother, and, in addition, emphasized the subjective and intrapsychic aspects of neurotic anxiety.

Anxiety is often associated with the expectation of failure in the context of social interaction. At the physiological level, the experience of anxiety can be expressed by the following symptoms: sweating, increased or rapid heartbeat, trembling, dry mouth, pain or discomfort in the chest, suffocation, difficulty breathing, dizziness, numbness or a tingling sensation of the skin, fear of death, fear of loss of control over oneself , depersonalization and even derealization.

Anxiety disorders

According to the ICD-10 definition, anxiety disorders include disorders in which the manifestation of anxiety is the main symptom and is not limited to any specific external situation.

What could be the causes of anxiety disorders associated with a special attitude towards one’s own appearance? The formation of a certain attitude towards one’s reflection in the mirror is influenced by a whole complex of factors - social, psychological, biological. Anxiety, according to Sullivan, arises in the infant's interpersonal world due to fear of disapproval from a significant person. The child begins to experience anxiety through empathy, sensing the mother's disapproval long before he becomes conscious. There is no doubt that the mother's disapproval has a huge impact on the baby. It threatens the relationship between the child and the human world. These relationships are critically important for the baby; not only the satisfaction of physical needs, but also a sense of security depends on them. Therefore, anxiety is perceived as a total, “cosmic” feeling.

A provoking factor for the occurrence of anxiety disorders can be one of the situations that is particularly significant for a teenager or young man - performing on stage or simply answering at the board, communicating with a significant adult - a parent, a person of the opposite sex, contact with a teacher or educator. One of the basic causes of anxiety disorders is concern about social status, especially in those families where the emphasis is often shifted towards assessing factors such as appearance, work, study, and position in society. Sometimes such experiences are associated with parents’ excessive concern for the health of their children. However, excessive emphasis on these problems can also take a painful form.

Research shows that mothers who are overly concerned with their weight and how they look or behave send a clear message to their daughters that physical attractiveness is the key to personal success. And since today in society the “qualities of success” include correct facial features and thinness, the weight and appearance of children from a certain age are under the constant supervision of their parents. As a result, from early childhood, girls are imposed the stereotype of thinking “a losing weight woman with an ideal face”, who must actively play sports, have an ideal weight, and monitor her diet to the detriment of the harmonious and healthy development of the female body. As a result, girls and young women often suffer from problems associated with dysfunction of the digestive and endocrine systems.

Unfortunately, teenagers themselves and their parents, like the overwhelming majority of people who belong to the values of Western culture, become victims of public opinion, evaluations of their photographs on social networks, which generally leads to a distortion of the perception of themselves and their “I”. Thus, in families, against the background of preoccupation with the external attributes of life and the assessment of social status, there may be a lack of attention to the internal experiences of both each other and children. The combination of these two factors creates the main psychosocial basis for the development of any anxiety disorder, including food addiction up to the development of anorexia nervosa (preoccupation with external parameters to the detriment of attention to the individual and her respect).

Hypochondria

One of the most common anxiety disorders in the modern world that an aesthetic medicine doctor may encounter in his work is hypochondria.

Patients with hypochondriacal personality disorder or hypochondriacal symptoms with other nosologies most often become a serious problem for doctors. The main manifestation of such a disorder is the patient’s persistent conviction that he has one or more severe, progressive somatic diseases and an equally persistent refusal to believe doctors that he does not have such a disease, even if these assurances are confirmed by clinical research data. The patient constantly presents numerous somatic complaints and shows excessive concern about his physical condition. He often interprets normal, ordinary sensations and phenomena as abnormal. Attention is usually focused on one or two organs (systems) of the body, which may be called a suspected somatic disease. However, the degree of his belief in the presence of a disease usually changes from consultation to consultation, and he considers one disease more likely than another.

Hypochondriacal disorder occurs in both men and women. Such patients, like patients with other types of somatization disorders, “wander” from specialist to specialist, from study to study, from one course of treatment to another. Some individuals successfully manipulate loved ones, as well as representatives of medical institutions, and they are characterized by persistence and strengthening of querulant traits (irresistible litigious activity in the fight for their infringed, often imaginary or exaggerated interests), and only a small part of patients function normally.

How to distinguish a “whiner” from a hypochondriac?

The whiner and malingerer are not so much concerned about the state of their health as they are eager to attract attention to themselves. He doesn’t need to feel bad at all - it’s enough to talk about it, wringing his hands and demanding special treatment. In the same case, when the attention turns out to be so intense that they try to force unpleasant examinations or procedures on the whiner, he immediately recovers. True, after a couple of days he gets sick again, but... with something safer.

Unlike a whiner, a real hypochondriac suffers absolutely genuinely: he is tormented by a constant debilitating fear of death, a feeling of helplessness, he sincerely wants to be treated and cured. All his thoughts are painfully focused on his own health. Dissatisfaction with doctors is caused not by a desire to manipulate or assert oneself, but by the fear that he is being treated incorrectly, and the confidence that his advanced illness will soon lead to a disastrous end. A hypochondriac can torment himself with diets, medical examinations and very unpleasant painful procedures. He has no obvious bonuses from his condition, and we can say that he suffers “selflessly.”

It is very difficult to supervise such persons even in psychiatric practice. And even more so, it makes no sense to treat them with therapeutic or neurological methods. It is important to remember that attempts to convince such a patient that he does not have a severe somatic disorder are absolutely useless. These patients need adequate, primarily psychiatric treatment.

Socio- and dysmorphophobia

Social phobia is the fear of being the center of attention, combined with the fear of a possible negative assessment of others and the desire to avoid such situations. According to various sources, it occurs in 3–5% of the total population of the planet. As a rule, the first symptoms of this phobia appear in adolescence, often after adverse social or psychogenic influences. There is often a combination of social phobias with other phobias and anxiety disorders (agoraphobia, simple phobias, panic disorders), eating disorders, alcoholism and affective disorders.

Isolated social phobias include monophobias, which are characterized by relative restrictions when carrying out social activities or professional duties: fear of eating or doing work in the presence of other people, fear of communicating with managers, fear of public speaking, ereytophobia - fear of blushing or showing awkwardness in public. . In fact, all of these phobias represent fear and expectation of failure when publicly performing habitual actions and become the reason for avoiding certain situations.

Generalized phobia is a complex disorder that includes a number of simple phobias combined with low self-esteem, ideas of unworthiness and sensitive ideas of attitude. Neuroses of this group are characterized by the syndrome of scoptophobia, or the fear of publicly showing one’s imaginary inferiority, of appearing funny or absurd. Accompanied by a pronounced feeling of shame, which does not correspond to reality, but determines behavior. As a result, a person tries to limit communication as much as possible and avoids contact with other people.

Body dysmorphophobia (dysmorphomania) is a mental disorder in which a person is overly concerned about a minor defect or feature of his body. It usually begins in adolescence and starts from the moment of creating an unrealistic ideal in the imagination, to which the owners of the created image then painfully strive throughout their lives. Body dysmorphic disorder is rarely diagnosed, but at least one in two adults who seek psychological help are known to have suffered from the disorder as children. This illness is often caused by stress and can have very unpleasant symptoms. The incidence of dysmorphophobia among men and women is approximately the same. Compared to other mental disorders, the disease is associated with a high risk of suicide attempts. Patients may complain of one or more specific “defects,” a vague feature or appearance, while important aspects of the patient’s life suffer—the ability to work, function normally in society, and take care of oneself. Unstable, episodic dysmorphophobic experiences of puberty are normal. They arise in connection with real, but insignificant shortcomings (short stature, ugly legs, a hump nose, etc.) and never reach delusional conviction, do not determine the entire behavior of a teenager, are amenable to psychotherapeutic correction, and at the end of puberty disappear without a trace .

Bodysmorphic disorder or schizophrenia?

It is necessary to distinguish between dysmorphophobia as a symptom of borderline states (protracted reactive states, endoreactive adolescent body dysmorphophobia) and as a manifestation of schizophrenia. The monothematic, overvalued or obsessive nature of dysmorphophobic ideas without a tendency to move to a delusional level testifies in favor of borderline states. They are psychologically understandable, without pretentiousness and absurdity, it is often possible to identify the psychogenic moment in their occurrence, they are not accompanied by persistent delusions of attitude towards them. Body dysmorphic disorders, although they affect the behavior of a teenager, do not replace all aspects of life and do not lead to persistent social decompensation. Patients are embarrassed by their “defect”, but do not give up their studies, appear in society if necessary, etc. They insist on cosmetic surgery, but the refusal is not met too dramatically, over the years they begin to successfully hide their painful experiences (compensatory dissimulation), and then caring about appearance is losing relevance.

In schizophrenia (sluggish form, juvenile paroxysmal or paranoid schizophrenia), dysmorphophobia is delusional, with persistent ideas of attitude, and sometimes verbal illusions. The subject of dysmorphophobic ideas tends to expand or replace some “defects” with others. The content of painful experiences and methods of their correction are pretentious and absurd. The schizophrenic nature of dysmorphomania is evidenced by the addition of other symptoms: phenomena of mental automatism, delusional mood, characteristic thinking disorders, emotional changes.

The schizoid state includes a triad of disorders:

• the idea of a physical defect, objectively absent or unreasonably exaggerated;
• idea of relationship;
• depressive mood background.

Ideas of attitude are expressed in the strong conviction that everyone around, immediately noticing a physical defect, pinches their nose, laughs, etc. The combination of dysmorphophobic disorders with psychopathic forms of behavior is quite typical.

Dysmorphophobic patient in the practice of a dermatocosmetologist

There are many common symptoms and behaviors associated with body dysmorphic disorder. For example, the use of cosmetics is most common in individuals with perceived skin imperfections.

• Mirror symptom: patients constantly look into mirrors and other reflective surfaces, trying to find a favorable angle in which the alleged defect is not visible, and determine what kind of correction of the “deficiency” is necessary.
• A symptom of photography is a categorical refusal to be photographed under various pretexts, in fact the fear that the photo will “perpetuate ugliness”; refusal to use mirrors.
• An attempt to hide an alleged defect (cosmetics, baggy clothes, hats).
• Excessive grooming: brushing your skin, combing your hair, plucking your eyebrows too often, shaving, etc.
• Intrusive touching of the skin to feel a “defect”.
• Questioning relatives about the “defect.”
• Excessive passion for diets and exercise.
• Social deprivation and comorbid depression.
• Complete refusal to leave the house or leaving only at certain times (for example, at night).
• Reduced educational activity (problems with grades, school/college attendance).
• Problems with establishing and maintaining relationships - friendly and personal.
• Abuse of alcohol and/or medications (often as an attempt at self-medication).
• Anxiety, possible panic attacks.
• Symptoms of deep depression.
• Low level of self-esteem.
• Suicidal thinking.
• Social withdrawal and withdrawal from family, social phobia, loneliness and social isolation.
• Dependency on others, such as a partner, friend, or parent.
• Inability to work.
• Inability to concentrate on work due to preoccupation with appearance.
• A feeling of awkwardness in society, a suspicion that others clearly see the “defect.”
• Comparing your appearance (or individual parts of the body) with the appearance of your idol, talking about it.
• Using distraction techniques: trying to divert attention from the “defect” by using extravagant clothing or conspicuous jewelry.
• Compulsive information seeking: Reading books, newspaper articles, and websites that are related to the “defect” (eg, baldness, diet, and exercise).
• The desire to correct a defect with the help of plastic surgery, multiple operations that do not bring the desired satisfaction.

The most common, according to Dr. Katharine Philips, there are the following localizations of “defects”: skin (73%), hair (56%), nose (37%), weight (22%), abdomen (22%), breasts/nipples (21%), eyes ( 20%), hips (20%), teeth (20%), legs in general (18%), body structure/bone structure (16%), ugly face (14%), face size/shape (12%), lips (12%), buttocks (12%), chin (11%), eyebrows (11%), hips (11%), ears (9%), arms/wrists (9%), waist (9%), genitals (8%), cheeks/cheekbones (8%), calves (8%), height (7%), head shape/size (6%), forehead (6%), feet (6%), hands (6%), jaw (6%), mouth (6%), back (6%), fingers (5%), neck (5%), shoulders (3%), knees (3%), toes ( 3%), ankles (2%), facial muscles (1%).

Neurasthenia

Some of the most common psycho-emotional complaints in patients seeking cosmetology help are mild disorders in the form of chronic fatigue syndrome, concern about physical ill-being, irritability, slight depression and anxiety. Such complaints may be signs of neurasthenia . The clinical picture of this disease from the group of neuroses is subject to significant variations, however, there are two main types. In the first of these, the main symptom is complaints of increased fatigue after mental work, as a result of which professional productivity and efficiency in everyday activities are significantly reduced. Mental fatigue is commonly described as interference from distracting associations or memories, inability to concentrate, and unproductive thinking. With the second type of neurasthenia, the main symptoms are physical weakness and exhaustion after minimal effort, accompanied by a feeling of muscle pain and the inability to relax. With both types, other unpleasant physical sensations are observed - dizziness, tension headaches and a feeling of general instability, concern about mental and physical ill-being, irritability, anhedonia (loss of the ability to enjoy), slight depression and anxiety. The initial and intermediate phases of sleep are often disrupted, but hypersomnia may also occur. Neurasthenia also includes chronic fatigue syndrome.

Persons with symptoms of neurasthenia are most often treated by a neurologist. At the same time, doctors of other specialties do not always take this pathology seriously: you can often hear something like “everyone is having a hard time now, everyone is tired.” Meanwhile, neurasthenic symptoms not only sharply reduce ability to work and quality of life, but also in the future, often through pathological overcompensation, are transformed into a much more serious mental pathology, for example, into anxious-phobic or depressive states, and also potentiate the development of various psychosomatic (including somatoform) symptoms. disorders.

Patient with a mental disorder: management algorithm

To correctly understand the mental state of your patient, you need to remember that with all mental illnesses there are significant changes in emotional life. If the doctor has any suspicions about possible changes in the patient’s psycho-emotional state, he should ask about his mood, whether it has changed recently, and if so, then after what it happened. It is necessary to determine the presence of fear, anxiety, and irritability, which is quite difficult with mild degrees of emotional disturbance. When diagnosing affective disorders, it is important to take into account the overall picture of the condition, taking into account the patient’s statements, his facial expressions, postures, and gestures.

Of course, making a diagnosis and differential diagnosis of such conditions is within the competence of a psychiatrist. The task of doctors who do not specialize in psychiatry is to pay attention to the psycho-emotional state of the patient and, if necessary, refer him for consultation to an appropriate specialist. As an example, let’s look at our own research in this area.

Study of the psycho-emotional state of patients

We conducted a survey of 30 patients aged from 18 to 55 years (average age 36.5 ± 2.5 years) who contacted a dermatologist with various complaints about the condition of the skin, the presence of signs of aging, changes in the shape and volume of soft tissues in certain areas faces.

For the questionnaire, one of the many methods of preliminary survey of patients was used - the HAD (Hospital Anxiety Depression) scale (see Appendix), an accessible and quick screening method for assessing anxiety and depression in hospital and outpatient settings. The scale form is easy to fill out and contains seven questions each for separately assessing anxiety and depression. Scale items were selected so that responses were not influenced by concomitant medical illness. For each condition, a score of less than eight is normal, 8–10 is “borderline,” and more than 10 indicates a corresponding possible mood disorder.

As a result of the survey, the following data were obtained: 15 people (50%) gave 8–10 points, of which 10 people (33.33%) for anxiety and 5 people (16.67%) for depression, which is a “borderline state” "between normal and mood disorders. 7 people (23.3%) showed more than 10 points: 4 people (13.3%) for anxiety and 3 people (10%) for depression, indicating a corresponding possible mood disorder.

Clinical case 1

Patient K., 19 years old, complained of rashes on the skin of the face for four years with periodic exacerbations, which were accompanied by the appearance of sporadic redness, worsening with excitement.

Examination data: sufficient amounts of comedones on the skin of the cheeks, nasolabial triangle, five inflammatory papules and three pustules, single foci of post-inflammatory pigmentation. Nodulocystic elements and scars were not found.

Diagnosis: acne, mild severity. Local treatment is recommended in accordance with acne treatment standards, facial skin care products based on azelaic acid, and consultation with a gastroenterologist.

At one of the follow-up consultations, the patient said that he was feeling depressed due to inflammatory elements on the skin of his face, which made him avoid meeting with friends and youth events, traveling on the metro during rush hour, etc. The reason for this, according to the patient, is: “close attention from relatives, friends, carriage passengers” to the condition of his skin, which leads to depressed mood, attempts to avoid any society and an irresistible desire to get rid of rashes by any means, and sometimes even to suicidal thoughts. Moreover, the patient did not follow the recommendations for local treatment and considered the only way out of the current situation to be the appointment of systemic isotretinoin at the maximum course dose.

The patient was referred to a psychotherapist.

Diagnosis: social phobia.

Appropriate psychotherapeutic treatment is carried out.

Clinical case 2

Patient M., 49 years old, complained of periodic redness, burning sensation, tingling and heat of the skin in the eyelids and lips. These complaints appeared several years ago, periodic exacerbations are associated with work stress and business trips. During this time, the patient randomly used topical steroids, which brought temporary relief followed by an indefinite period of remission.

The results of the examination: the skin of the moving and fixed parts of the eyelids is flesh-colored, normal moisture and temperature (to the touch), there are no elements of a rash, the skin pattern is smoothed.

During repeated visits “during an exacerbation” during examination, the “localis” status remained unchanged.

The patient was referred to a psychotherapist.

Diagnosis: hypochondriacal disorder.

Appropriate psychotherapeutic treatment is carried out.

Discussion

The results obtained from the survey are noteworthy in that more than half of the patients surveyed have a borderline state or anxiety disorders. When collecting complaints about altered mood, attention is drawn to mentions of feelings of unreasonable fear, anxiety in various areas of life, without particular reference to any situation; increased attention to one’s own appearance, which, according to respondents, should be ideal.

Patients with a HAD score of 8 points or higher were referred for consultation to a psychologist.

conclusions

To identify psycho-emotional disorders among patients visiting an aesthetic medicine specialist, it makes sense to use special questionnaires ( HAD scale ). The presence of a borderline state or mood disorders with a predominance of anxiety in two-thirds of the patients we surveyed who applied for the correction of aesthetic defects in the facial area indicates a high level of borderline disorders and psycho-emotional disorders among patients of doctors working in the field of aesthetic medicine. In this regard, it is necessary to attract the attention of doctors of all specialties to the problem of the high prevalence of psycho-emotional disorders in these patients with the aim of their timely diagnosis and qualified treatment with the involvement of specialized specialists (psychiatrist, psychologist, psychotherapist) within the framework of using an individual interdisciplinary approach in the management of such patients.

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First published: Les Nouvelles Esthetiques 2015/№2