Transtorno dismórfico corporal sob a perspectiva da análise do comportamento

Abstract

O Transtorno Dismórfico Corporal (TDC) é diagnosticado quando há uma preocupação tão exagerada com algum defeito mínimo ou imaginado na aparência, que traz prejuízos significativos à vida da pessoa. Buscou-se investigar o desenvolvimento e manutenção de comportamentos do TDC através de análises funcionais e do conceito de esquiva experencial proposto por Hayes, Wilson, Gifford e Follette (1996). Participaram do estudo sete pessoas com comportamentos característicos do TDC, seus familiares e quatro cirurgiões plásticos. Foram utilizados como instrumentos: roteiros para orientar cirurgiões sobre comportamentos do TDC, possibilitando-os identificar e convidar pacientes seus para participarem da pesquisa; uma ficha de identificação dos participantes, para selecionar a amostra; roteiros de entrevistas semi-estruturadas para os participantes e seus familiares, com questões relativas à história de vida dos participantes, relações familiares, início das preocupações com a aparência, comportamentos do TDC e contingências atuais que os mantinham. Dez pacientes responderam à ficha de identificação e sete foram selecionados. Entrevistas individuais foram feitas com cada participante e com seus familiares, de acordo com a necessidade de se coletar dados complementares. A partir da gravação e transcrição das entrevistas foi feito um estudo sistemático clínico em que os comportamentos foram descritos e analisados de acordo com prováveis processos de origem e funcionamento atual. Além de comportamentos relacionados às preocupações com a aparência, foram encontrados comportamentos típicos de outros transtornos (como: Transtorno Obsessivo Compulsivo, Depressão, Fobia Social, Hipocondria) e padrões de comportamento conhecidos como traços de personalidade (como: vaidade, perfeccionismo, agressividade). Os resultados apontaram processos funcionais semelhantes, entre todos os participantes.

The Body Dysmorphic Disorder (BDD) is diagnosed when there is an exaggerated preoccupation with some minimal or imagined defect in the appearance, which brings significative impairments to the person s life. It has been sought to investigate the development and maintenance of the BDD behaviors through the functional analysis and the concept of experential avoidance proposed by Hayes, Wilson, Gifford and Follette (1996). Seven people with characteristic behaviors of the BDD, their families and four plastic surgeons participated in this study. It has been used as instruments: instructions to orient surgeons about behaviors of the BDD, enabling them to identify and invite patients to participate in the research; an identification questionnaire with the purpose to select the sample; semi-structured interviews for the participant and their families, containing questions relating to the history of the participants life, families relationship, the beginning of the concern with the appearance, behaviors of the BDD and actual contingencies which maintains them. Ten patients responded to the identification questionnaire and seven of them were selected. Individual interviews were made with each of the participants and their families, according to the necessity of collecting complementary data. From the recording and transcription of the interviews, it has been made a clinic systematical study, in which, the behaviors were described and analyzed according to probable origin and actual functioning processes. Beyond the behaviors related to the preoccupations with the appearance, typical behaviors of other disorders were found (such as: Obsessive Compulsive Disorder, Depression, Social Phobia, Hypochondria) and standards of behavior known as personality features (such as: vanity, perfectionism, aggressiveness). The results pointed similar functional processes, among all the participants. Among the origin processes there were: the cohersitive education with few positive reinforcements in the childhood, past occurrence like accidents, comparisons and comments relating to the part of the body which they worried about. These contingencies, probably, influenced the strong emphasis on discriminative stimuli related to the appearance. Among the actual processes there have been identified: negative reinforcement, lack of positive reinforcements, secondary gains and strong cultural influences of the valorization of the appearance. As particular variables to each case there have been found: low development of skilful socially behaviors, models in the childhood, extremely critical mother concerning to the appearance, among others. It has been concluded that the actual functioning of the BDD is marked by experiential avoidance where the individuals start avoiding the private aversive stimuli, like the anxiety, thoughts about their appearance and about the reaction of the people against their appearance. This avoidance prevents them from exposing themselves to the social situations, resulting in consequences such as social isolation and depressive behaviors. Functional resemblances were demonstrated for all seven cases studied although some topographic behaviors were different, indicating the necessity in considering the functionality of the behaviors and not only the arbitrariness of the psychiatric classification based on symptoms.