健康与遗传心理学研究室知识库

随着社会经济的迅速发展，人们对美的观念日益增强，通过整形手术人们的外表得到很大的改善，但在整形外科手术中有一部分躯体变形障碍患者，他们过度关注自身的外表，造成严重的心理痛苦和社会功能的障碍，这种疾病并不为医生和患者所认识，国外从上世纪80年代开始研究，而国内的相关研究很少。

为了调查躯体变形障碍在整形外科手术中的临床特征、心理状况和治疗方案，本研究通过3个实验来实现。实验一采用访谈问卷、躯体变形障碍自评量表、SCL-90量表对21名躯体变形障碍患者及对照组进行的测试，以探讨躯体变形障碍患者的临床特征、体像问题及心身症状。实验二采用David Veale的手术满意度问卷对21名躯体变形障碍患者及对照组进行手术满意程度的调查。实验三将64名躯体变形障碍患者分为研究组与对照组，对研究组进行3个月的认知一行为一社会模式的干预，采用自评抑郁量表(SDS)、焦虑自评量表(SAS)、生活质量综合评定问卷(GROLI-7})评定患者的情绪和生活质量。探讨心理干预对研究组的情绪状态以及生活质量的影响。

实验结果如下:

1.在134名整形外科求术者中，躯体变形障碍的发生率为15. 7%，他们关注的 部位有皮肤、鼻部、眼部、乳房、头发等，每天关注的时间平均为61. 4士24. 7分钟，都存在重复性行为(如照镜子)以及掩饰行为(如过度化妆、用帽子 衣物掩盖等)，有2个患者试图用硬币和刀片刮掉脸上的斑点。

2.躯体变形障碍患者的SCL-90各因子分与对照组有显著性差异，总体心理健康 状况很差，在抑郁、焦虑、人际关系、精神病因子上更为明显。和正常的整 形求术者相比，他们都有自身外表缺陷的观念，但躯体变形障碍患者存在错 误的认知，过度的关注，看重别人的评价，情绪和社会交往更容易受影响， 更倾向于不断寻求改变体貌的方法(如整形手术或自我矫正)。而且他们的 躯体变形障碍症状的严重程度与心身症状严重程度成正相关。

3.躯体变形障碍患者手术后在体貌改善程度、痛苦的改善程度、关注时间的改善程度以及社会交往改善程度方面变化不显著，对手术治疗的满意度低，反 复的手术导致更低的满意程度。

4。躯体变形障碍患者在认知一行为一社会模式的心理干预后SDS} SAS和生活质量问卷中的躯体功能、心理功能、社会功能三个维度上的评分与治疗前及对照组有显著性差异。认知一行为一社会模式的心理干预可改善躯体变形障碍患者的抑郁、焦虑情绪，提高其的生活质量。

Cosmetic concerns are increasingly pervading in China. heople's appearance were improved by cosmetic surgery. In many cosmetic surgery or dermatologic treatment we can found some individuals have Body Dysmorphic Disorder (BDD), who are preoccupied with an imagined or slight defect in appearance; the appearance concerns are excessive and the preoccupation cause clinically significant distress or functional impairment. Body dysmorphic disorder (BDD) is relatively common in cosmetic practice, yet it remains under-recognized. Since the 1980s, western scholars have been carrying out systematic research on this disorder. In China, the related research is still very few.

In order to explore the clinical characteristicsq mental state and treatment of body dysmorphic disorder in cosmetic surgery, three experiments were conducted. Experiment 1:SCL-90 and SIZSBI were used to evaluate 21 patients with BDD and control group。To investigate clinical features, body image problems and mental health of patients with BDD in cosmetic surgery. Experiment 2e 21 patients with BDD and the normal controls were examined by using a interview questionnaire(David Veale) to explore the satisfaction of cosmetic surgery that the patients with body dysmorphic disorder(BDD)received. Experiment 3:64 patients with BDD were randomly divided into intervention group and control group. The intervention group received cognitive-behavioral-social intervention for 3 months, in order to study the effect of psychological intervention on emotion and the quality of lift in patients with body dysmorphic disorder.

Main results as follows:

found the prevalence rates of body dysmorphic disorder among cosmetic surgery patients is 15.7%. 1'reoccupations usually involve the skin, nose, eye, breast and hair etc. They think about their perceived flaws by average one hours per day. They perform repetitive, timerconsuming behaviors and camouflaging. Two patients had skin picking.

2. The patients with BDD had bad mental health. They showed significantly higherpsychiatric symptoms of depression, anxiety, intcrpcrsonal relationship,psychoticism than controls. They have poor insight, and their concerns about appearance are excessive.They think a lot of other people's opinion. Their emotion and social functioning are easily impaired. They prefer to seek surgical treatment to improve perceived defects. Their mental health were positively related to the severity of their BDD symptoms.

3.There have no any change in appearance, social function, the time they took and distress they experienced after the operation. The result showed that the patients with BDD dissatisfied with the outcome of cosmetic surgery, and the more procedures had the lower satisfaction.

4. Affter cognitive-behavioral-social intervention, the SDS，SAS value，the quality of life in the BDD group were significantly differ from the before-intervention group and the control group. The result showed that psychological intervention can decrease anxiety，depression and improve the quality of life in patients with ADD.