ANXIETY DISORDERS IN PLASTIC-SURGERY

Surgery is a stressful event, with the potential for profound disturba nce to the patient's psychological and physiologic homeostasis. Cosmet ic surgery is a particularly in tense psychological experience because , in addition to the usual concerns about surgical side effects, cosme tic patients bring their hopes and expectations for improved self-imag e, putting them at risk for the added anxiety of disappointment. High levels of anxiety coupled with the perception of vulnerability or thre at to self can cause significant psychological reactions complicating care for the plastic surgical patient. This paper outlines the diagnos tic features of the common types of anxiety, disorders seen in plastic surgical patients, and it offers treatment strategies for the practit ioner, delineating when referral to a mental health expert is advised. Specific clinical case studies of panic attack, posttraumatic stress disorder, and acute stress disorder are presented to illustrate the va riety of abnormal anxiety responses that may be encountered in the per ioperative setting. Interventions for the anxious patient are part sci ence and part art. Careful questioning and psychosocial assessment can identify those patients who are at greater risk for psychological pro blems after surgery. However, some patients may mask or keep secret th eir concerns, which can be manifested with resulting anger and hostili ty. Plastic surgeons must use appropriate indicators of psychological anxiety and measure a specific patient's reactions to surgery to make the diagnosis of abnormal anxiety. Close follow-up by the plastic surg ical team is an essential part of the anxiety disorder patient's psych ological treatment, but it is imperative that these problematic patien ts be referred promptly to a qualified mental health professional to l imit their adverse experience and promote their well-being Patients wh o are less anxious during the perioperative period report less emotion al distress and fewer defensive behaviors and are likely to be more sa tisfied with the outcome of their surgery.