every morning holding the ears flat against the
head then letting go to see whether they’ve
changed, repeating this behavior to the extent of
missing school or work. The person may go out in
public only if wearing a hat regardless of whether
a hat is appropriate and may refuse to get haircuts
for fear that the hair stylist will see his or her ears.
The person may have multiple cosmetic surgery
operations to obtain a more satisfactory appear-
ance but is never happy with the results.
Because body image is highly subjective and
most people do have minor imperfections or
asymmetries in appearance, a first or even second
cosmetic surgery procedure may not seem out of
the ordinary. It is when the person persists in
attempts to “fix” the “problem” that the dysfunc-
tion becomes apparent. The plastic surgeon or der-
matologist the person consults for cosmetic
surgery may be the first to raise a red flag about
the person’s obsession. The most successful treat-
ment approach is medication therapy with a selec-
tive serotonin reuptake inhibitor (SSRI), a class of
ANTIDEPRESSANT MEDICATIONS. Most people experi-
ence marked improvement within three months
and have long-term improvement after six
months to a year of medication. Combining SSRI
therapy with COGNITIVE THERAPY has more rapid
effectiveness for many people, though cognitive
therapy alone is far less effective than SSRI ther-
apy alone. Most people are able to reach a level of
normal perspective about body image and return
to full function within daily life.
See also DEPRESSION; EATING DISORDERS; GENERAL
ANXIETY DISORDER(GAD); OBSESSIVE–COMPULSIVE DIS-
ORDER; PLASTIC SURGERY; SOMATIZATION DISORDER.brief reactive psychosis A trauma- or stress-
induced psychotic episode (break with reality)
that lasts longer than one day but less than one
month. Symptoms may include HALLUCINATION,
DELUSION, disordered speech, nonsensical expres-
sions or thought processes, and strange or bizarre
behavior such as outbursts of laughing without
provocation or sitting motionless for hours and
then returning to normal activities as though
nothing out of the ordinary had happened. Often
the episode is more apparent to others than to the
person and may end before there is enough con-
cern for family, friends, or co-workers to seek
medical attention for the person. When symptoms
result in a doctor’s evaluation, treatment may be a
combination of short-term ANTIPSYCHOTIC MEDICA-
TIONSand PSYCHOTHERAPYto address the underlying
trauma or stress. Treatment usually resolves the
psychotic episode.
See also ACUTE STRESS DISORDER; COGNITIVE FUNC-
TION AND DYSFUNCTION; STRESS AND STRESS MANAGE-
MENT.368 Psychiatric Disorders and Psychologic Conditions