The contribution of embarrassment to phobic dental anxiety: a qualitative research study

BACKGROUND: Embarrassment is emphasized, yet scantily described as a factor in extreme dental anxiety or phobia. Present study aimed to describe details of social aspects of anxiety in dental situations, especially focusing on embarrassment phenomena. METHODS: Subjects (Ss) were consecutive specialist clinic patients, 16 men, 14 women, 20–65 yr, who avoided treatment mean 12.7 yr due to anxiety. Electronic patient records and transcribed initial assessment and exit interviews were analyzed using QSR"N4" software to aid in exploring contexts related to social aspects of dental anxiety and embarrassment phenomena. Qualitative findings were co-validated with tests of association between embarrassment intensity ratings, years of treatment avoidance, and mouth-hiding behavioral ratings. RESULTS: Embarrassment was a complaint in all but three cases. Chief complaints in the sample: 30% had fear of pain; 47% cited powerlessness in relation to dental social situations, some specific to embarrassment and 23% named co-morbid psychosocial dysfunction due to effects of sexual abuse, general anxiety, gagging, fainting or panic attacks. Intense embarrassment was manifested in both clinical and non-clinical situations due to poor dental status or perceived neglect, often (n = 9) with fear of negative social evaluation as chief complaint. These nine cases were qualitatively different from other cases with chief complaints of social powerlessness associated with conditioned distrust of dentists and their negative behaviors. The majority of embarrassed Ss to some degree inhibited smiling/laughing by hiding with lips, hands or changed head position. Secrecy, taboo-thinking, and mouth-hiding were associated with intense embarrassment. Especially after many years of avoidance, embarrassment phenomena lead to feelings of self-punishment, poor self-image/esteem and in some cases personality changes in a vicious circle of anxiety and avoidance. Embarrassment intensity ratings were positively correlated with years of avoidance and degree of mouth-hiding behaviors. CONCLUSIONS: Embarrassment is a complex dental anxiety manifestation with qualitative differences by complaint characteristics and perceived intensity. Some cases exhibited manifestations similar to psychiatric criteria for social anxiety disorder as chief complaint, while most manifested embarrassment as a side effect

Dismorfia muscular: análise comparativa entre um critério antropométrico e um instrumento psicológico Muscle dysmorfia: a comparative analysis between the antropometric criteria and a psychometric scale

Os transtornos psiquiátricos relacionados à distorção da auto-imagem corporal são marcados por elevado grau de sofrimento físico e psíquico, associado a perdas sociais e ocupacionais significativas, além de produzirem comportamentos danosos para a saúde física do paciente. A dismorfia muscular (DISMUS) é um subtipo do transtorno dismórfico corporal, que se caracteriza por uma preocupação específica com o tamanho do corpo e com o desenvolvimento dos músculos. É um transtorno presente quase exclusivamente em homens que, apesar da visível hipertrofia, procuram ativamente aumentar sua massa muscular, através de exercícios excessivos, do uso de substâncias ergogênicas e de dietas hiperprotéicas. O presente estudo teve como objetivo avaliar a validade de constructo de um critério antropométrico (Índice B/P - relação entre a perimetria do braço contraído e da perna), anteriormente proposto, para suspeita diagnóstica de DISMUS. Uma amostra (n = 100) de homens, praticantes de treinamento de força, com idade entre 18 e 35 anos, teve suas medidas antropométricas comparadas os os escores obtidos em uma escala usada para o diagnóstico da DISMUS (MASS - Muscle Appearance Satisfaction Scale) e também com as medidas de um grupo de indívíduos de características semelhantes, avaliados com o objetivo de obter orientação para a prática de exercícios físicos (n = 313). A análise dos resultados indica que um indivíduo com índice B/P > 1 possuem alta probabilidade de apresentar um escore indicativo de DISMUS no instrumento MASS e sugere ser coerente a aplicação do índice B/P como um indicador antropométrico válido para o diagnóstico de DISMUS. O critério B/P pode ser um potente instrumento usado por profissionais da área de exercício para auxiliar no diagnóstico e tratamento precoce desses indivíduos.<br>Psychiatric disorders related to body image distortions are highly associated with physical and psychological distress and significant social and ocupacional disfunction. Also, they are caracterized for inducing behaviors that can be harmful for the patient's health. Muscle Dysmorfia (MD) is a subtype of Body Dysmorfic Disorder, marked by specific and recurrent worring about muscle appearance and hipertrophy. This disorder is significantly more prevalent in men and, despite the actual level of muscle hipertrophy, the subjects seek increasing their body mass by excessive weight lifting, engaging in hiperproteic diets and using anabolic substances. The present study aimed to evaluate the construct validity of an antropometric criteria (The B/P index - the ratio between the perimeter of the contracted arm and the perimeter of the leg), previously proposed, as an antropometric indicator to suspect of MD in weight lifters. A sample (n = 100) of male body builders, between 18 and 35 years old, were measured and responded the Muscle Appearance Satisfaction Scale (MASS). Their cineantropometric measures were also compared to the ones from another sample (n = 313), with similar demografic caracteristics, evaluated to start an exercise program. Data analysis sugest that a subjetc with B/P > 1 have a higher probability of presenting a score that would indicate MD in the MASS. This results indicate that the B/P index can be used as a valid antropometric criteria to help exercise professionals suspect of MD in individuals with B/P > 1 and reffer them to especialized professionals for diagnose and treatment