Body Dysmorphic Disorder and its effect on humans

By Nilma DOLE

Everybody wants to be beautiful and people have long-suffered to make themselves perfect as society expects. Striving to be beautiful has been many people's life's goals including young girls who yearn for model-perfect curves but what happens when it becomes a deadly obsession? "When I see the many cases of deformities and compare it with my specialty skin clinic where people want to be fairer or want glossy hair, I can't believe that people who have everything are not happy," said Dr. Jayasiri Jayawardena, one of Sri Lanka's leading Ayurvedha specialists and consultant at the National Hospital.

Low self-esteem contributes to body dysmorphic disorder

He said that it becomes difficult to 'cure' these so-called patients when they are not happy with how they look even after the prescribed course.

"As a doctor, I generally see three or four cases of deformities a week but I have at least 10 cases of people who want to look beautiful.

It is difficult that doctors like us have to think of the lucrative side of making people beautiful but for me, it's talking to patients and telling them to be happy with what they have," he said.

The condition of not being happy with one's image and the obsession of being beautiful is known as Body Dysmorphic Disorder (BDD) which is also called dysmorphophobia.

"A person affected by this condition is extremely worried about physical appearance and have low self-esteem. They are also very worried about what others think of their image," he said.

Often in cases where people come to see him for beauty purposes, Dr. Jayawardena often has a side counselling session where he helps people talk about their emotions and their perception of their looks.

"Most don't have anything wrong in their body but they want to change it.

I'm not a plastic surgeon so I feel it's my duty to educate people to be happy with themselves," he said.

Usually the sufferer complains of many specific features or a single feature which they are not happy with. This even leads to them not being happy with their lives, their family and it can even lead to suicidal behaviour.

"I have noticed depression in certain cases where they have anxiety and really want to look beautiful or else nothing good will happen.

For example, a rather plump young girl asked me to make her look slim in a month just because she thought she could have a better suitor for a marriage proposal," said the doctor.

According to the Psychological Medicine survey, about 1-2% of the world's population meet all the diagnostic criteria for BDD.

There is no known cause of BDD but it can stem from abuse, neglect or hidden factors that the sufferer is greatly affected by. Personal criticism to one's appearance might start as something small or something someone said but it could cause severe mental strain to the sufferer.

Common symptoms include loneliness, compulsive behaviour, depression, anxiety, distance from loved ones, panic attacks, difficult temper, inability to focus on work or study, comparing with others and low feelings about themselves.

"We can help patients with BDD by just talking to them and showing them how beautiful they are. Changes in the environment and how their loved ones perceive them is important," said the doctor.

In addition to this, psychotherapy, medication, or a combination of both might help heal the patient. According to research, it has been proved that Cognitive Behavioural Therapy (CBT) and Selective Serotonin Reuptake Inhibitors (SSRIs) are effective in treating BDD.

"No matter what we look like, we should be happy with what we have. Most people don't have arms, legs or even their vital organs intact so we as healthy individuals should be happy with ourselves," said the doctor.

Preventing the spread of HIV/AIDS

A new study further validates the use of humanized BLT mice in the fight to block HIV transmission. The more than 2.7 million new HIV infections recorded per year leave little doubt that the HIV/AIDS epidemic continues to spread globally.

That's why there's the need for safe, inexpensive and effective drugs to successfully block HIV transmission.

The "BLT" name is derived from the fact that these designer mice are created one at a time by introducing human bone marrow, liver and thymus tissues into animals without an immune system of their own. Humanized BLT mice have a fully functioning human immune system and can be infected with HIV in the same manner as humans.

The pioneering developers of the humanized BLT mouse model are Paul Denton, PhD, instructor of medicine and J. Victor Garcia-Martinez, PhD, professor of medicine in the UNC Center for Infectious Diseases and the UNC Center for AIDS Research.

In the study published May 18 in the Journal of Virology, Denton and colleagues provide data that validates humanized BLT mice as a preclinical experimental system that potentially can be used to develop and test the effectiveness of experimental HIV prevention approaches and topical microbicides.

The animal study reproduced the design and methods of a recent double-blind clinical study in 889 women of the topical microbicide tenofovir.

That study, the CAPRISA 004 trial, tested topical pre-exposure prophylaxis (PrEP) with 1 percent tenofovir which participants were instructed to apply vaginally twice daily. The 2.5 year trial resulted in an overall 39 percent reduction in instances of vaginal HIV transmission. Among women who self-reported as strongly adhered to the recommended instructions the protection figure climbed to 54 percent.

The new topical PrEP study by Denton and coauthors in humanized BLT mice reproduced the CAPRISA experimental design with tenofovir. The researchers say they "observed "88 percent protection of vaginal HIV-1 transmission," which was further confirmed by lack of detectable virus anywhere in the animals.

The researchers then tested six additional microbicide drug candidates for their ability to prevent vaginal HIV transmission. These experimental compounds, not yet tested in people, interfere with the virus' ability to reproduce. Partial or complete protection was shown by all but one of these drug candidates. Based on these positive results, Denton said these inhibitor drugs warrant serious consideration for future testing in people.

"This animal model has great potential value for testing and predicting the HIV preventive benefits of the second generation of microbicide candidates that are aimed at preventing viral replication," Garcia said. "The results of these studies will help provide important information for current and future clinical trials." (Source: Les Lang University of North Carolina School of Medicine)

New and recurring cancers differ from tumours

When women with a history of breast cancer learn they have breast cancer again, one of the first questions they and their doctors ask is: Has my cancer come back, or is this a new case? Now, new data from Fox Chase Cancer Center suggest that both new and recurring cancers will differ significantly from the original tumors, regardless of how many months or years women spent cancer-free, and doctors should tailor treatment to the specific qualities of the second tumor, regardless of whether it's old or new.

Anita Patt, MD, surgical oncology fellow at Fox Chase and lead author on the study, will be presenting the findings at the 2011 Annual Meeting of the American Society of Clinical Oncology on Monday, June 6. "There tends to be a stigma and a lot of anxiety about the word 'recurrence,'" says Richard J. Bleicher, MD, FACS, attending surgeon at Fox Chase and senior author on the study. "Sometimes women will worry more if they believe their original cancer is back, meaning they didn't 'beat it' the first time around.

These findings suggest they should not get hung up on that idea, because any subsequent diagnosis - whether it's a recurrence or a new tumor - will look significantly different from their first cancer."

In women with a history of breast cancer, doctors often approach new tumors differently depending on whether they believe it's a recurrence of the first tumor, or a totally new one, Bleicher explains. But there are no official ways to distinguish between the two types, so doctors typically rely on a few criteria, then form their own opinion based on an "overall gestalt," he says.

One of the criteria doctors have used to distinguish between new and recurring cancers is the amount of time women spent cancer-free, reasoning that the longer the time between the two tumors, the more likely the second one is to be an entirely new case. To investigate if this and other criteria indeed distinguish new and recurring tumors, Bleicher, Patt, and their colleagues looked at data collected from 4,420 women with a history of breast cancer.

Two-hundred and thirty five women were eventually diagnosed with another tumor in the same breast, suggesting it could be a recurrence.

However, when the researchers compared the first and second tumors, they saw that 89% differed in at least one key characteristic that could potentially affect treatment or prognosis, regardless of whether the second tumors were new cases or a recurrence of the original cancer. Sixty percent of the second tumors differed from the first by at least 2 or more criteria, including whether or not it would respond to hormones, how it was diagnosed, and whether at least 25 percent of the tumor was confined to the ducts, and therefore less able to spread throughout the body.

Half of the women experienced a second tumor within 60.5 months of their first. And, importantly, the amount of time they spent cancer-free appeared to have no bearing on whether the two tumors differed in any key characteristics.

The findings suggest that patients and doctors shouldn't spend much time determining if the second tumor is a recurrence of the first, or a totally new entity, says Bleicher, and should instead tailor treatment to the specific qualities of the second tumor, regardless of whether it's old or new.

"When a patient comes back with a relapse, whether it's a new tumor or a recurrence, it really doesn't make a difference," he says. "We treat them both as potentially curable."

(Source: Diana Quattrone Fox Chase Cancer Centre)

Simple fitness test could predict long-term risk for heart attack

How fast can you run a mile?

If you're middle-aged, the answer could provide a strong predictor of your risk of heart attack or stroke over the next decade or more.

In two separate studies, UT Southwestern Medical Centre researchers have found that how fast a middle-age person can run a mile can help predict the risk of dying of heart attack or stroke decades later for men and could be an early indicator of cardiovascular disease for women.

In one recent study in the Journal of the American College of Cardiology, researchers analyzed the heart disease risk of 45-, 55- and 65-year-old men based on their fitness level and traditional risk factors, such as age, systolic blood pressure, diabetes, total cholesterol and smoking habits. The scientists found that low levels of midlife fitness are associated with marked differences in the lifetime risk for cardiovascular disease.

For example, a 55-year-old man who needs 15 minutes to run a mile has a 30 percent lifetime risk of developing heart disease. In contrast, a 55-year-old who can run a mile in eight minutes has a lifetime risk of less than 10 percent.

"Heart disease tends to cluster at older ages, but if you want to prevent it, our research suggests that the prescription for prevention needs to occur earlier - when a person is in his 40s and 50s," said Dr. Jarett Berry, assistant professor of internal medicine and a corresponding author on both studies.

Researchers in this study found that a higher fitness level lowered the lifetime risk of heart disease even in people with other risk factors.

In a separate study in Circulation, UT Southwestern researchers found that the same treadmill test predicts how likely a person is to die of heart disease or stroke more accurately than assessing the risk using only typical prediction tools such as blood pressure and cholesterol levels.

Heart disease is a leading killer in industrialized nations and the No. 1 killer of women in the U.S. Women younger than 50 are particularly difficult to assess for long-term cardiovascular risk.

"Nearly all women under 50 years of age are at low risk for heart disease," Dr. Berry said. "However, as women get older, their risk increases dramatically. In our study, we found that low levels of fitness were particularly helpful in identifying women at risk for heart disease over the long term."

For decades, scientists have tried to improve their ability to determine which patients are at highest cardiovascular disease risk.

Blood-based and imaging techniques have been used to try to improve risk prediction, but fitness has not been examined until now, Dr. Berry said.

For both studies, researchers collected information from thousands of participants who underwent a comprehensive clinical exam and a treadmill exercise test at the Cooper Clinic in Dallas between 1970 and 2006.

In the JACC study, researchers evaluated more than 11,000 men tested before 1990 - women were excluded because of the low number of participants and cardiovascular death rates - and found 1,106 who died of heart attack or stroke during the study period. They measured participant fitness levels and traditional risk factors for heart disease. Within each age group, higher levels of fitness were associated with lower levels of traditional risk factors.

For the Circulation study, researchers examined more than 66,000 participants without cardiovascular disease, ages 20 to 90. They were then followed until death or the end of the study period; follow-up lasted up to 36 years. There were 1,621 cardiovascular deaths during the study. The researchers found that by adding fitness to the traditional risk factors, they significantly improved their ability to classify participants' short-term (10 years) and long-term (25 years) risk.