Psychological portrait of the patient of the clinic of aesthetic medicine

Tarasova Sof'ya Yur'evna ORCID: 0000-0002-5621-2999 PhD in Psychology Senior Researcher at the Psychological Institute of RAO 125009, Russia, g. Moscow, ul. Mokhovaya, 9 str. 4 syutarasov@yandex.ru Other publications by this author

Novikov Kirill Aleksandrovich ORCID: 0000-0002-8127-8113 PhD in Medicine Director, Laser Dermatocosmetology Clinic “Doclaser” 123104, Russia, Moscow, lane Bogoslovsky, 16/6 building 1 dr.novikov.ka@mail.ru

Introduction

Today, people often turn to cosmetology medical organizations in order to improve their own appearance, remove any objective or apparent defects, "rejuvenate", etc. Technological advances offer new opportunities for the treatment and prevention of diseases and defects of the skin and subcutaneous fat (Novikov, 2021). Researchers of the psychological aspects of people's appeals to aesthetic medicine clinics agree on the presence of various psychological difficulties in such patients. Difficulties of a wide scale: from minor neurotic manifestations to severe forms of dysmorphic phobia. Body dysmorphic disorder is a mental disorder in which a person suffers from anxiety due to perceived defects in their appearance and may experience significant impairments in social, professional and interpersonal adaptation. Here are the results of a comprehensive study in 2022 on the problem of accepting one's own body, dysmorphic phobia and visits to a cosmetic surgeon. The authors conducted a meta-analysis of the prevalence of such anxiety in people seeking help with cosmetic surgery. This review study searched the international databases Scopus, PubMed and Web of Science over the past 30 years. According to the results of the meta-analysis, the prevalence of dysmorphic phobia among people who applied for cosmetic surgery, in 48 articles with a sample size of 14,913 people, was 19.2%. It is concluded that people who resort to cosmetic surgery often suffer from dysmorphic phobia (Salari, 2022). Domestic researchers describe similar results and come to similar conclusions. E.T. Sokolova and L.T. Baranskaya associate the appeal to aesthetic surgery with borderline personality disorder, namely, narcissism. The purpose of L.T. Baranskaya's dissertation research is to identify risk factors for personality adjustment disorders in aesthetic surgery patients who turn to a plastic surgeon. The battery of methods included: analysis of the request of patients presented during the initial appointment of a plastic surgeon (sometimes taking into account the opinion of a psychiatrist); the method of M. Lusher's color preferences; assessment of the neurotic status of study participants before and after surgery (questionnaire of neurotic disorders in adaptation by L.I. Wasserman); test of humorous phrases by A.G. Shmelev; the methodology of M. Rokich's value orientations; Dembo-Rubinstein self-assessment scales; thematic apperceptive test. According to the results of a study by Sokolova and Baranskaya, persons with borderline personality disorder among patients of an aesthetic surgeon range from 17 to 37%. The authors conclude that a borderline narcissistic personality can abuse modern medical technologies, changing his bodily appearance to meet a "perfectionist need" (Baranskaya, 2007; Baranskaya, Sokolova, 2007; Baranskaya, 2008).

It should be borne in mind that most of these studies are aimed at studying the psychological factors of appeals to a plastic aesthetic surgeon. However, modern cosmetology as a field of medicine has a wide range of diverse methods and techniques (hardware, laser technologies, etc.).   The possibilities of aesthetic medicine are very wide today. There is an opinion that clinical cosmetology, aimed at the prevention and rehabilitation of diseases of the skin and subcutaneous fat, as well as the correction of cosmetic defects, has "displaced" plastic surgery. Therefore, regarding the manifestations of dysmorphic phobia, not everything is so unambiguous and obvious. There is an alternative point of view. For example, in the 2022 article, the authors presented a psychological portrait of a patient at a private aesthetic medicine clinic in Gdansk, Poland. The aim of the study was to evaluate the main motives and clinical features of dysmorphic disorder among people seeking cosmetic procedures. A typical client of an aesthetic clinic is a 40-50–year-old woman with higher education who undergoes aesthetic procedures more than twice a year, mainly with botulinum toxin injections. The most common motives are the desire to get a fresh look, the desire to reduce the signs of aging and invest in yourself (Dobosz, 2022). Also, a number of researchers on this issue note the difficulties of selecting adequate psychological tools (Houschyar, 2017; Pereira, 2023).

Focusing on the Russian classical scientific school in clinical psychology, we drew attention to the idea of perfectionism, the desire to improve oneself. Today, it is customary to separate adaptive "healthy" perfectionism and maladaptive neurotic perfectionism. Maladaptive perfectionism is associated with destructive manifestations of personality up to suicidal attempts (Yasnaya, Enikolopov, 2013). Eating disorders, anorexia and bulimia, which are accompanied by strong dissatisfaction with their appearance, have long been associated with high maladaptive perfectionism; in this study, perfectionism correlates with anxiety and hostility (Manara, 2005). A recent meta-analysis has shown that neurotic perfectionism is associated with various destructions: from self-esteem difficulties to anxiety and depression (Morgan-Lowes, 2019; Thomas, 2020). Perfectionism may correlate with emotional aggression as the downside of anxiety (?orluka ?erkez, 2021). Many experts believe that perfectionism acts as a transdiagnostic factor in anxiety and depressive personality tendencies (Bardone-Cone, 2017; Drieberg, 2018). For example, it has been shown that maladaptive perfectionism combined with high hostility leads a person to social anxiety and devaluation of their social achievements (Barahmand, 2023).  A detailed review of modern research on perfectionism is made in the article "Psychological risks of a successful student" (Tarasov, 2023).

In this paper, we focus on R. Slaney's model of perfectionism (Slaney, 2001). This study is a contribution to the further validation of the Slaney model and the questionnaire in the Slaney model in the Russian sample. The key factor, according to Slaney, is the Discrepancy – fear-anxiety of not meeting the ultra-high requirements set for oneself.

The aim of the study is to study the manifestations of adaptive and maladaptive perfectionism, anxiety and aggressiveness of the patient of the clinic of aesthetic medicine.

Methods

The ARS-R perfectionism scale in S.N. Enikolopov's adaptation. Adaptive perfectionism scales: Standards – striving for high personal standards. Order is a tendency towards order and neatness, "friendship" with time. Maladaptive perfectionism: Incongruity is a feeling of inability to meet the high standards set for oneself. Relationships are difficulties in interpersonal relationships due to constant distress. Procrastination/Anxiety. Procrastination is a tendency to procrastinate, an inability to take action. The anxiety here is caused by the inability to meet the high standards set for oneself. The factor reveals a tendency to procrastination caused by excessive dependence on the opinions of other people.

The Bass-Perry Aggression Questionnaire (adaptation on the Russian-language sample by S.N. Enikolopov and N.P. Tsybulsky). Scales: Physical aggression – self–report on the tendency to physical aggression in behavior; Anger – self-report on the tendency to irritability; Hostility - self-report on the willingness to behave aggressively.

Spielberger's Personal Anxiety Questionnaire. Individuals classified as highly anxious tend to perceive a threat to their self-esteem and vital functions in a wide range of situations and react with a very pronounced state of anxiety. If the psychological test expresses a high indicator of personal anxiety in the subject, then this gives reason to assume that he has a state of anxiety in various situations, especially when they relate to the assessment of his competence and prestige. 

The "Unfinished sentences" technique. They were used to identify personal characteristics, motives, and personality conflicts of the study participants. Identifies personal problems related to self-esteem and Self-Image, including the bodily Self.

A clinical conversation in order to find out from the patient the reason for the treatment. Collecting a medical history. The conversation, in particular, is aimed at the aesthetic component, dissatisfaction with appearance. A dermatologist must intuitively assess the patient's mental state. Not being a psychiatrist, he tries not to hire people with an obviously unstable, labile psyche.

Data analysis methods

Methods of descriptive statistics and correlation analysis were used.

Selection

Study participants: 39 patients of a private dermatocosmetology clinic (38 women, 1 man). The average age is 40 years.

There were two control groups in the study. Group 1: 48 psychology students and adult professional psychologists (37 women, 11 men). The average age is 29 years. Group 2: 43 biology students and adult biology professionals (38 women, 5 men). The average age is 27 years.

Results and their discussion

We describe the results obtained for a group of patients and two control groups. In the control group (combined biologists and psychologists), procrastination was statistically significantly higher (p = 0.007). Since procrastination/anxiety according to Slaney is a tendency to procrastination, an inability to start acting, it can be assumed that many people would do cosmetic procedures similar to how they regularly visit a dentist. According to self-report, they do some procedures: peeling, massage, laser hair removal. However, many are afraid to trust new technologies. Today, people have not yet developed a tradition of such cosmetic self-care. If we analyze the statements in the comments on the Internet to an article about the popularity of plastic surgery in South Korea, we can see the following picture. The main message of the text of the article is that technology is getting cheaper, and in the foreseeable future there will technically be no problem "to be beautiful and forever young." About 40% of commentators strongly opposed such a prospect, the same number reacted neutrally ("we'll wait and see"), and about 20% of commentators approved of such a possibility, recognized it as likely and attractive.

Next, the patients were divided into three groups. When selecting the groups, they were guided by the perception of skin features such as acne and scars, as well as the degree of invasiveness of the procedure. There were three groups of patients:

1.      Patients with acne, scarring and rosacea (16 people)

2.      Patients who applied for injection procedures, fillers (10 people)

3.      Patients who applied for hardware techniques (rejuvenation, increased skin turgor, microneedle therapy) (13 people).

Tables 1-3 show the average values of the scales of the Bass-Perry aggression questionnaire for the selected groups of patients.

Table 1. Results of descriptive statistics of the Bass-Perry aggression questionnaire for group 1 patients.

Table 2. The results of descriptive statistics of the Bass-Perry aggression questionnaire for group 2 patients.

Table 3. Results of descriptive statistics of the Bass-Perry aggression questionnaire for group 3 patients.

As you can see, there are differences between the anger groups. In patients with acne, scarring and rosacea, anger indicators are lower.

Next, we decided to look at the difference in the average values of non-compliance with the standards set for ourselves (the key factor according to Slaney) for the selected groups of patients (Table 4).

Table 4. Results of descriptive statistics of the discrepancy scale for selected groups of patients.

Analyzing the differences between patient groups, taking into account Bonferroni's correction, we can mainly talk about trends. In the group of patients with a request for injection procedures, there is a higher discrepancy with their requirements than in the other two groups: than in the group with hardware procedures (p = 0.04), than in the group with acne and rosacea (p = 0.07). There are no statistically significant differences in the discrepancy between patients with acne and rosacea and patients with a request for hardware techniques. It can be assumed that people with higher non-compliance with the standards set for themselves go for more invasive procedures (injections, fillers). They are more determined to change their appearance, expect a more noticeable and quick result, and are ready to suffer the pain of injections. It should be noted that, agreeing to an invasive procedure, patients nevertheless experience fear and anxiety. Differences in anxiety according to Spielberger were found: those undergoing injections have higher anxiety than those undergoing hardware procedures (p = 0.05). Spielberger anxiety is also much higher when requesting injections than when treating acne (p = 0.006). The last fact is logically understandable and understandable: people are traditionally afraid of injections. In the present study, this is not related to the age of the patients.

Further, the obtained differences in the mean values in the anger groups were analyzed. The group of patients with acne, scarring and rosacea has the lowest anger rates.  In patient group 1, anger is lower than in the other two groups: than in the group with a request for injections (p = 0.05), than in the group with a request for hardware procedures (p = 0.05). There are no differences between patients with a request for injections and patients with a request for hardware anger techniques. It should be noted that in the group of patients with acne, scars and rosacea, the average values of anger are abnormally low. According to the "unfinished sentences" method, it is in this group that the theme of dissatisfaction with one's appearance is strongly expressed. Here are examples of answers in "unfinished sentences": "I'm afraid of how I look", "I'm afraid that I scare people". Similar responses were not found in other patient groups. It can probably be concluded that acne, scarring and rosacea are psychosomatic symptoms. A person does not know how to express anger in a socially adequate, acceptable form, and the emotion of anger "goes away" into physicality. There is an opinion that in our Slavic culture they do not teach in childhood to express their anger, but banally forbid it. After all, a child is usually angry, feels anger at a parent, so anger is often simply suppressed, prohibited in the family through punishment (deprivation of something, prohibition, etc.). Over time, in adolescence, dissatisfaction with his skin, the experience of ugliness, and the symptoms of anger increase ("why am I so unlucky?!"). A classic neurotic vicious circle is forming. Interestingly, it was in patient group 1 that the relationship between anger and nonconformity was found (r = 0.57, p < 0.05). In patient groups 2 and 3, anger was not statistically significantly associated with non-compliance with standards.   

Psychological symptoms have a biological, physiological cause. In group 1, 80% of patients have endocrine disorders that may have a psychogenic cause. According to available data, stress can lead to the manifestation of rosacea in 79% of cases in people predisposed to it (Takci, 2015; Novikov, 2021). Such disorders are traditionally considered as psychosomatic symptom complexes, the physiological cause of which is the depletion of the hypothalamic-pituitary axis of the body due to intense or prolonged stress, a traumatic situation.

A correlation analysis was performed, which showed that in the sample of patients as a whole, the indicators of the aggression questionnaire are interrelated with the ARS-R perfectionism scales (from r = 0.38 at p < 0.05 to r = 0.54 at p < 0.05). Similar correlations were obtained in the combined control group, which confirms the relationship between perfectionism and aggression. 

Conclusions

1.      An empirical study found one statistically significant difference between the patient group and the control group. Procrastination as a tendency to procrastination, inability to start acting higher in the control group. No other differences were found. Oral care traditions have already developed in society, and perhaps in the future similar traditions will arise regarding new cosmetic technologies and procedures.

2.      In the group of patients with a request for invasive, injectable procedures, there is a higher discrepancy with their requirements than in patients with other requests. Patients with an injection request also experience greater fear and anxiety (the results are statistically significant).

3.      In the group of patients with acne, scarring and rosacea the lowest rates of anger among patients (the results are statistically significant).  At the same time, in the group of patients with acne, scars and rosacea, the average values of anger are abnormally low. In the same patients, endocrine disorders were found in 80% of cases, which may have a psychogenic cause. The cause of psychosomatic symptoms is unexpressed anger.

Conclusion

Let's draw a parallel with dentistry. They have been taught to take care of the oral cavity and to visit a dentist at least once a year since childhood. According to the results of an empirical study, the frequency of brushing teeth once a day and less often is observed in people with low levels of self-acceptance, body care, body protection and adaptive perfectionism (Dumitrescu, 2009).  An analysis of oral health behaviors revealed a link between self-acceptance, self-esteem, and investments in bodily health. The authors conclude that self-acceptance and the desire to invest in bodily health can be markers of both psychosocial risk and social success. In the future, we may come to what we have partly come to in dentistry. Thanks to new technologies, people will be less afraid to take care of themselves with the help of modern aesthetic medicine and cosmetology procedures.  

Do not forget that the manifestations of perfectionism are different, it can be "determined" not only by appearance, but also by many other factors of success of a modern person. Our control group consisted of students and teachers, and how mentally harmonious are they? Seventy percent of the surveyed university students showed, according to self-report, an average and high level of perfectionism (Visvalingam, 2022). The results of other recent studies of perfectionism have shown that adaptive perfectionism is positively associated with student academic performance (Siah, 2022). But if students have high values of maladaptive perfectionism, then mental health suffers (Lin, 2017). Perfectionism needs to be studied further.