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Houve diferenca signifcante entre os escores totais de pacientes com e sem sintomas (P < 0 prostate 101 generic 60 ml rogaine 5 free shipping,001) prostate cancer uk buy rogaine 5 60 ml without a prescription. Observou-se forte correlacao (r = 0 androgen female hormones order rogaine 5 australia,841; P < 0 prostate 32 60 ml rogaine 5 visa,001) entre a Yale-Brown Obsessive Compulsive Scale para transtorno dismorfco corporal e a Body Dysmorphic Symptoms Scale. It causes clinically signifcant compulsive symptoms among patients seeking esthetic surgery. Body dysmorphic symptoms may be associated was conducted in accordance with the Brazilian Ethical Review with muscle dysmorphia. Typical candidates include people with ethni was obtained from all patients or their parents or legal represen cally characteristic noses, teenagers and individuals with body tatives afer the procedures had been fully explained to them and dysmorphic disorder,3-5,7-11 which thus shows the social aspect of prior to their inclusion in the study; anonymity was assured. Rhinoplasty improves appearance through enhanc Patients of both sexes at any age, seeking rhinoplasty and ing facial harmony. The inherent risks associated with the sur showing physical appearance associated with clinically signif gical process include respiratory problems, visible or palpa cant subjective distress, were recruited at the plastic surgery out ble irregularities and dissatisfaction with the fnal outcome. A psychologist with expertise are more likely to show dissatisfaction with the surgical results, in body dysmorphic disorder, who was also one of the authors of because their perception of the physical defect may be a symptom this study, performed the clinical assessment on all patients, in or contributory factor for development of a mental disorder. The overall score is the sum of posi A sample size of at least 50 and not more than 100 subjects is ade tive responses. High scores indicate the presence of psychopatho quate for representing and evaluating the psychometric properties logical factors associated with dissatisfaction with body image and of social construct measurements. Perugi, the main ticipated in the cultural adaptation of the scale; 20 were included author of the original version of the Body Dysmorphic Symptoms in the reliability analysis on the fnal version of the instrument; Scale,23 granted us permission to translate, culturally adapt and and these 20, together with 30 diferent patients, participated in validate the instrument for Brazilian Portuguese. The Body Dysmorphic Symptoms Scale was translated from The cultural adaptation, reliability and validity phases of English into Brazilian Portuguese by two independent transla the study followed the methodology of Guillemin et al. Both translations were evaluated by a multi also applied the cross-culturally validated Brazilian-Portuguese disciplinary committee formed by two plastic surgeons, a psychi version of the Yale-Brown Obsessive Compulsive Scale for Body atrist and two psychologists with extensive experience of body Dysmorphic Disorder to patients participating in the construct image disorder and selection of candidates for cosmetic surgery. A consensus Brazilian-Portuguese ver rated instrument that is designed to measure severity of body sion of the instrument was then obtained by combining elements dysmorphic disorder symptoms among individuals showing from both translations. Both back-trans assess excessive preoccupation, obsessions and compulsive lated versions were evaluated and compared with the original behavior associated with dissatisfaction with physical appear one by the same multidisciplinary committee, in order to cor ance. The frst three items are based on the body dysmorphic dis rect possible errors or discrepancies made during back-transla order diagnostic criteria and assess preoccupation, impairment tion. Items Portuguese, which was appropriately adapted to the linguistic 11 and 12 assess insight and avoidance, respectively. The total score and cultural context of the target population, while maintain is calculated as the sum of ratings for the 12 items, thus yielding a ing all the essential characteristics of the original instrument maximum score of 48. Construct validity was assessed among 50 patients 30 patients to test possible failures of the respondents to compre (20 patients who participated in the reliability analysis together hend the items. Afer providing informed consent, the partici with 30 diferent patients) using convergent and discriminant pants each had the opportunity to express their comprehension validity analyses. Convergent validity was tested by correlat of the scale and suggest any changes that they considered nec ing the Body Dysmorphic Symptoms Scale with the Yale-Brown essary. All of the patients understood that the scale items were Obsessive Compulsive Scale for Body Dysmorphic Disorder related to concerns and dissatisfaction with physical appearance. Discriminant validity was determined by comparing the In this phase, the face and content validity of the instrument mean Body Dysmorphic Symptoms Scale scores of patients with were determined through a consensus reached by the multidis and without body dysmorphic disorder symptoms. Face validity evaluates whether the instru A cutof point for symptom severity and the correspond ment measures what it was designed to measure and content ing sensitivity and specifcity values were estimated through the validity relates to the degree to which each item is relevant in receiver operating characteristic curve, which was constructed measuring the target content. The kappa coefcient was ments refects real diferences rather than random fuctuation. The instrument was assessed by means of test-retest proce The Statistical Package for the Social Sciences version 20. All statis interviewed by psychologist #1 and the interview was repeated tical tests were performed at a signifcance level of 5% (P < 0. This phase of testing was used to verify the pre The Brazilian-Portuguese version of the Body Dysmorphic cision of the instrument for measuring the properties for which Symptoms Scale (Appendix 1) was administered to 80 patients. The patients did not Validity have any doubts about the items, which were considered easy Construct validity is the process in which the correlation of a to understand and clearly formulated. The mean time taken to measurement with other variables is tested for theoretical con respond to the questionnaire was fve minutes. In determining the construct validity, hypothesis test Tirty-seven patients (37/80; 46%) met the diagnostic cri ing indicates the direction and strength of the expected relation teria for body dysmorphic disorder, according to the Body ship. The Body Dysmorphic Symptoms Scale demonstrated excel The corrected item-total correlation was greater than 0. Tere were signifcant diferences in Body Dysmorphic According to the Body Dysmorphic Symptoms Scale, 56 Symptoms Scale scores between patients with and without body patients (70%) reported that they compulsively checked their dysmorphic symptoms (P < 0. Eligible participants n = 80 Excluded n = 0 Included in the study n = 80 Cultural adaptation Reliability analysis Construct validity assessment n = 20 n = 20 + 30 = 50 n = 30 Dropout Dropout Dropout n = 0 n = 0 n = 0 Final sample Final sample Final sampleFinal sample n = 30 n = 20 n = 50 Figure 1. Do you try to hide the part of your body that concerns you by using makeup, clothing or 5 0. Do you believe that esthetic surgery can dramatically change your life, correcting the defect 6 0. Have you neglected or felt discouraged about performing your usual activities because of the 7 0. Have you previously received any treatments or undergone any surgery to correct this defect 8 0. Does this defect make you angry, impatient or aggressive, especially towards your relatives, 9 0. Are there are times when you feel so distressed with the defect that you see no meaning in life 10 0. Inter and intra-rater reliability for the Body Dysmorphic Symptoms Scale Reliability Intraclass correlation 95% confdence interval P-value Intra-rater 0. The Body Dysmorphic Symptoms Scale was translated into Brazilian Portuguese, culturally adapted and tested for reliabil ity and construct validity. The general guidelines for cross-cul a similar tool, so as to evaluate the relationships of compara tural adaptation of instruments were followed in order to ensure ble constructs with similar operational concepts. Healthcare cross-culturally validated Brazilian-Portuguese version of the professionals who were experienced in managing patients with Yale-Brown Obsessive Compulsive Scale for Body Dysmorphic body dysmorphic disorder and rhinoplasty patients participated Disorder, which measures the degree of dissatisfaction with in the evaluation on this instrument. However, it was not and that both instruments are able to detect patterns of neuro possible to compare these results with those of the original scale or cognitive defcits (obsessive thoughts and compulsive behavior) with the scientifc literature because the psychometric properties that are present in body dysmorphic symptoms. However, the of the scale were not assessed by the authors of the instrument,23 Yale-Brown Obsessive Compulsive Scale for Body Dysmorphic or by Muhlbauer et al. A cutof score of 6, which was determined using the receiver easy-to-administer scale that also captures specifc information operating characteristic curve, was able to discriminate between about body dysmorphic symptoms. The cutof score of 6 was associated with sensitivity was a signifcant diference in mean Body Dysmorphic Symptoms of 1. A larger number of patients reported high scores for ment for identifying body dysmorphic symptoms. This tool may items 1, 2, 4, 5 and 6, thus showing dissatisfaction with their body be used preoperatively, in screening the candidates for esthetic sur image with regard to compulsive behavior. This belief study was conducted on a clinical population that usually has appeared to be related to exaggeration of the defect rather than greater disease severity, given that higher rates of disease sever to a delusional perception, but in 70% of the patients it enhanced ity have been observed in clinical samples than in the general self-referential ideas (item 4). Further studies with a larger number of patients which suggested that these items had a weak correlation with the and involving multiple centers are necessary in order to evalu other items of the scale. This may have related to the presence ate and compare the prevalence of body dysmorphic symptoms of body dysmorphic symptoms (as described in the Diagnostic among patients seeking plastic surgery, so as to enable develop and Statistical Manual of Mental Disorders, Fifh Edition, in the ment of care and treatment strategies for this population. In fact, 70% of the patients responded positively the Body Dysmorphic Symptoms Scale is a reliable instrument to item 2 and only 7. It is a useful tool and 10, respectively, which were the items with the lowest scores that can contribute towards screening candidates with body dys in the instrument. The prevalence of moder The prevalence of body dysmorphic symptoms was 46% in ate to severe body dysmorphic and appearance-related obsessive the study sample (according to the Body Dysmorphic Symptoms compulsive symptoms is high among patients seeking esthetic Scale), and 54% of the patients had moderate to severe appear rhinoplasty. Patients with mild to moderate Compulsive Scale Modifed for Body Dysmorphic Disorder. J Plast high prevalence of body dysmorphic symptoms found in the pres Reconstr Aesth Surg.

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The threat to prostate miracle buy genuine rogaine 5 your health might be real or imag ined and may be from the past (for example prostate oncology specialist in nashville tn purchase rogaine 5 now, a memory) or what you think could happen in the future prostate qigong buy generic rogaine 5 60 ml on line. When anxiety dominates the picture prostate normal size order rogaine 5 online now, you may be overestimating the degree of danger to yourself or others. Your mind will want to know for certain or have a guarantee that you will not die or suffer from a severe illness. This leads to worrying about how to solve non-existent problems and to control as much of your bodily functions or to plan ahead to deal with all the possible problems that do not arise. One of prob lems is that your thoughts become fused with past experi ences and accepted as facts in the here and now. As a consequence, you develop a pattern of thinking that is like holding a prejudice against information that does not fit with your fears. We?ll be emphasizing the importance of recognizing that thoughts about your health are just that thoughts, not reality. Learning to accept these negative thoughts and images willingly as just thoughts? and not buying into them is an important part of overcoming health anxiety. Worry Some people cope with health anxiety by trying to control their thoughts or suppressing them, which can mean the thoughts enter your mind more frequently. Brooding You may be trying to put right? or make sense of past events by brooding on them, perhaps mulling over them constantly. Alternatively, you may be constantly comparing yourself unfavourably with others and making judgements and criticizing your self. Brooding invariably makes you feel worse because you never resolve the existing questions and may even generate new questions that cannot be answered. Attentional processes When you are worried about your health, you become more self-focused on your physical sensations and feelings and at the same time discarding negative test results. This tends to make you more aware of how you feel and makes you more likely to assume that your thoughts or pictures in your mind (such as an image of yourself being ill) are realities. This, in turn, interferes with your ability to make simple decisions, pay attention to or concentrate on your normal tasks or what people around you are saying. Your view of the world now depends on your thoughts and the way these chatter away inside your mind rather than your experience. In other situations you may be so focused on monitoring your physical sensations that you fail to take in the context and find it difficult to concentrate on what others are saying. Effect on feelings Experiencing health anxiety is often a mixture of different emotions. The problem is not that you are just anxious, but that your anxiety is either particularly severe or persistent. Anxiety can produce a variety of physical sensations too, including feeling hot and sweaty, having a racing heart, feeling faint, wobbly or shaky, experiencing muscle tension (for example, headaches), having stomach upsets or diarrhoea, to list a few. If, however, you are becoming despondent and hopeless about the future, you may feel down or emotionally numb?, feeling that life has lost its fun. In addition you might start to experience sleep problems, lose your appetite and sexual interests. You might be brooding about the past, feel more irritable, and have difficulty concentrating. With depression, people can react by becoming withdrawn and inactive and wanting to avoid situations or activities that are painful. When the fear is high, you may either try to distract yourself from your thoughts and feelings or to escape from or avoid situations that remind you of illness or death. For example, you might avoid going to the doctor because you are convinced you will be given bad news. In this respect you may have so-called magical thinking?, where you believe that simply thinking about bad events will make them happen. When your doubt is high, you may make excessive checks? in the form of self-examination. Examples include checking whether:??you have a lump??your heart rate is too fast or blood pressure is too high??you are losing excessive weight??your nervous system is still normal??you are losing your memory??you can still swallow. Checking is an example of a safety behavior? that aims to prevent harm, increase certainty and reduce anxiety. People with health anxiety try to adopt ways to improve the way they feel but unfor tunately the solutions usually leave them feeling worse and prevent them from testing out their fears. Safety behaviors are a way of trying too hard? to prevent bad consequences but often the solutions become the problem. We shall explore this further in Chapter 2 when we look at a psychological understanding of health anxiety. Needless to say, you have to stop all your safety behaviors if you are to overcome your health anxiety successfully. You may be seeking repeated reassurance from friends or your doctor to find out the cause of your symptoms. When you are dissatisfied by one doctor, you may seek a second and third opinion and so on. Interestingly, doctors can become frustrated with people with health anxiety and may prefer to refer you on to another doctor (rather than a mental health professional). Health anxiety has an effect on your friends and family, too, since when you are preoccupied with your health you may appear uninterested in anything else and distant. The content of worries, safety behaviors and avoidance behavior are closely related. You may then try to avoid thinking about it by distracting yourself or suppressing the thought. Extra problems with health anxiety People with health anxiety often have other problems, which may make health anxiety harder to treat or to separate out. Everybody feels down from time to time, but in normal circumstances the feeling usually passes fairly quickly and doesn?t interfere too much with the way we live our lives. When most people say I?m depressed? they mean that they are feeling low or sad, or perhaps stressed, which are normal facets of human experience. However, when health professionals talk of depression, they are using the term in a different way. They are referring to a condition that is different from the normal ups and downs of everyday life. This is the type of depression we will be discussing: it is more painful than a normal low, lasts longer and interferes with life in all sorts of ways. Often, individuals with health anxiety do not have full-blown clinical de pression but experience a fluctuating mood, a sense of frustration and irritability. After years of preoc cupation and social isolation, individuals with health anxiety often have a low self-esteem which relates to areas other than their health. If this is a problem, then we would also recommend another book in this series, Overcoming Low Self-Esteem by Melanie Fennell. So how can you tell if you are experiencing depression or just going through a period of feeling low? Depression can only be diagnosed by a health professional, but to meet the criteria for a diagnosis you must have been feeling persistently down or lost your ability to enjoy your normal pleasures or interests for at least two weeks. In addition, you should have at least two to four of the following symptoms persistently. Tick off how many of the following symptoms of depression you?ve experienced in the past week. Your lowered mood will vary little from day to day, and will not usually change even if your circumstances do. Individuals? experience of depression varies enormously, especially among adolescents. In some cases, you may feel more anxious or agitated than depressed, or your depression may be masked by irritability, excessive use of alcohol, or a preoccupation with your health. Very rarely, people with health anxiety and severe depression may experience What is health anxiety? More inform ation on depression can be found in Overcoming Depression by Paul Gilbert. Panic disorder A person with panic disorder may also experience a number of worrying physical sensations such as palpitations, feeling short of breath or dizziness. The difference between health anxiety and panic disorder is that the symptoms of panic disorder can be easier to spot. Symptoms usually occur within 10 minutes and are often misinterpreted as evidence of an immediate catastrophe for example death, suffoca tion, having a heart attack, or going mad now, rather than of a slow lingering illness such as cancer. When panic attacks persist they may lead you to avoid situations or activities where you believe you may have a panic attack, this is called agoraphobia.


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