Is this a good thing?  One of the most common issues we see in our clients with Body Dysmorphic Disorder (BDD) is excessive focus on the appearance of their eyes, including their eyelashes.  Latisse plays right into this common BDD concern.

Body Image Issues and Body Dysmorphic Disorder (BDD)

A recent British study found that the average woman has negative thoughts about her body 36 times a day.  While many might reasonably assume that other body parts (breast, lips, skin) are generally the focus of these thoughts, negative thinking about eyelashes is a fairly common body image issue for many women.  The huge market for eyeliners, mascara and other eye makeup products confirms how much attention many women already pay to their eye appearance. Marketing a drug that promotes eyelash growth reinforces the idea that women’s natural eyelashes are not good enough, and has the potential to lead to even more body image and BDD issues related to the appearance of the eyes.

Risks of Latisse

While discussing Latisse, it is important that we not overlook that this is a serious drug with potentially serious side-effects.  Among the reported side effects are:

• Redness and irritation of the eyes
• Eye pain and itchiness
• Bacterial infections
• Unwanted hair growth near the application area
• Darkening of the eyelid skin around the application area
• Change in eye color, especially in those with brown eyes

In fact, on September 10, 2009, the FDA reprimanded the drug’s manufacturer, Allergan Inc. of Irvine, California, noting that the firm’s advertising failed to appropriately note the side effects noted above.

Are longer, fuller eyelashes worth these risks? Apparently many women think so.  Latisse generated approximately $60 million in sales in 2009, and Allergan’s CEO reportedly expects the company to sell over $500 million of the drug in the next few years.  While there have been no studies investigating possible long-term consequences of using Latisse, that’s not stopping women from spending $120 a month to use it.

Treatment for BDD and Body Image Concerns Related to Eyes

While Latisse may provide a short-term benefit of enhanced lashes, the long-term outcome is a continuation of the belief that one’s natural lashes are not acceptable.  With each application of Latisse, a woman reinforces her belief that her lashes are not good enough…that she is not good enough.

A more effective solution to these types of body image and BDD issues would be for people to become more accepting of themselves, and to reject potentially dangerous drugs that chemically alter their bodies.  Four recent research studies have found that Cognitive Behavioral Therapy (CBT) is an effective means of addressing these types of body image and BDD concerns.  The cognitive component of CBT helps people learn to challenge the negative thoughts they have about themselves, while the behavioral component helps people change behaviors that reinforce that negative thinking.

While I may sound like a bit of a zealot on this issue, my main concern is that Latisse exploits the negative self image and BDD issues experienced by so many women.  Of course, Latisse is hardly the only product on the market that feeds into women’s body image issues.  But don’t we all deserve to go through life with a feeling of self-worth?  While Latisse and other products may provide hope of a quick fix for the negative thoughts people have about their bodies, it is only through acceptance of our bodies that we can truly feel good about ourselves in the long term.

•Tom Corboy, MFT, is the director of the OCD Center of Los Angeles, a private, outpatient clinic specializing in Cognitive-Behavioral Therapy (CBT) for the treatment of Obsessive-Compulsive Disorder (OCD) and related conditions. He can be contacted director@ocdla.com.

BDD and Changing Cultural Views of Cosmetic Surgery

While dissatisfaction with one’s body is fairly common (and probably has been throughout history), one significant cultural shift that has occurred in recent years is that many are now willing, and financially able, to have surgeries and other procedures that were very rare just a generation ago. A mere 30 years ago, cosmetic procedures were uncommon – both the cost of the procedures and the cultural attitudes of the day were strong disincentives against having one’s appearance altered. Now, parents give their teenaged daughters nose jobs for birthday presents, and housewives have botox parties. And while cosmetic procedures used to be an almost exclusively female phenomenon, more and more men are now having work done as well.

Exploitation of Patients with BDD

While the easiest culprit to blame for this cultural shift is “the media” (surgically enhanced celebrities, airbrushed models, etc.) there is also a significant financial aspect to this issue. Not only are these procedures now less expensive, they are also being heavily marketed by big pharma. And many cosmetic surgeons are not above providing – and sometimes pushing – procedures that their patients simply do not need. We treated one man with Body Dysmorphic Disorder whose obsessions were with the appearance of his teeth and gums. He had a dentist who performed multiple, very expensive, totally unnecessary, procedures on our client’s perfectly nice looking mouth. I ultimately had to call his dentist and forcefully tell him he was harming our client and that he had to stop performing these unnecessary procedures. We also treated a client with BDD who was scheduled to have one minor cosmetic procedure for a legitimate skin problem. But on the morning of her surgery, as she lay on the gurney being prepped, her cosmetic surgeon talked her onto adding two additional (very expensive, totally unnecessary) procedures.

Finally, here is a personal story. In 1990 I had to have a nose job. Not a cosmetic nose job, but a long-delayed functional fixing of my nose which had been broken since high school. The doctor with whom I initially consulted kept telling me that he could do a (very expensive, totally unnecessary) cosmetic nose job at the same time. I repeatedly told him I had no interest in changing my appearance, but he kept revisiting the topic. The message was very clear – my nose, which I had heretofore considered aesthetically just fine, was unacceptable and worthy of a (very expensive, totally unnecessary) surgery. I ultimately dropped him and elected to have my nose fixed by an MD who willing to do the required surgery without trying to increase his revenue at my expense.

BDD and the Ethics of Cosmetic Surgery

One of guiding principles of medical ethics is “first, do no harm”. But, as we discussed in an earlier posting, two studies have found that cosmetic surgery in patients with Body Dysmorphic Disorder frequently results in increased BDD symptoms. Studies have also found that these surgeries are less effective than Cognitive-Behavioral Therapy in reducing the distress experienced by those with BDD.

Despite these findings, there is no shortage of unethical cosmetic surgeons, dentists, and other medical professionals quite willing to financially exploit the insecurities of people with Body Dysmorphic Disorder. Perhaps the most egregious example of this is the case of the late Michael Jackson, who by all accounts appeared to have BDD. Unfortunately, he was in the position of being able to afford numerous (very expensive, totally unnecessary) cosmetic procedures designed to alleviate his insecurities about his appearance. The result was a face that, in the end, scarcely looked human.

It is time the issue of unethical cosmetic surgeons came under scrutiny by state medical boards and the media so that the public is protected from doctors willing to exploit those with BDD.

•Tom Corboy, MFT, is the director of the OCD Center of Los Angeles, a private, outpatient clinic specializing in Cognitive-Behavioral Therapy (CBT) for the treatment of Obsessive-Compulsive Disorder (OCD) and related conditions.  He can be contacted director@ocdla.com.

Of course, anyone who has been paying attention knew that Jackson was troubled.  Over the past twenty-five years, his physical appearance radically changed.  The glaringly obvious alterations of his nose, chin, facial structure, and skin tone indicate that he had multiple cosmetic procedures, and suggest  that he suffered from a significant case of Body Dysmorphic Disorder (BDD).  Recent reports have also suggested that he experienced clinical Hypochondria (health anxiety), as well as an eating disorder (possibly Anorexia).  There have also been reports of serious prescription drug problems, and severe insomnia that may have led to some of his alleged drug use.  All of these issues are of course in addition to the very public charges of child molestation that resulted in his earlier arrest, indictment, and subsequent acquittal on sex charges.

Perhaps the saddest part of this dreary tale is that this talented man appeared to become overwhelmed by his personal demons, and had the power and money to indulge those demons.  Like Elvis before him, Jackson was catapulted to fame at a young age, and appeared unable to handle its pressures.  And like Elvis, he appeared to have no shortage of people willing to accommodate and enable his various psychiatric issues.  When Jackson sought repeated cosmetic surgeries that ultimately disfigured him, he apparently had no difficulty finding surgeons willing to perform procedures that were arguably unethical.

The coming year will likely see an onslaught of tell-all books that provide details of Jackson’s psychiatric issues.  And while we’ll never know the full and accurate story, it seems safe to say that his most enduring legacy may be not just his music, but his psychiatric downfall.

•Tom Corboy, MFT, is the director of the OCD Center of Los Angeles, a private, outpatient clinic specializing in Cognitive-Behavioral Therapy (CBT) for the treatment of Obsessive-Compulsive Disorder (OCD) and related conditions.  He can be contacted director@ocdla.com.