Page 7 - The Motivation Question Continued

There is substantial and growing literature regarding the life adjustment of short adults. Men tend to be more concerned with short stature than women; being a petite female is less stigmatizing and more culturally acceptable than being a short male.27,29 Consequently, more men present for consideration for stature lengthening. Short individuals who have been sensitized to height issues in childhood tend to be more troubled by their stature as adults.30 Those who seek stature lengthening almost always report a family concern with their height in childhood, evidenced by visits to multiple specialists and a sense of despair at the close of puberty. Stature exerts a genuine influence in several life areas, including dating relationships, 31 mate selection,29,32 salary,33 occupational opportunity, and career success.34–37

Paley and Windisch21 named this condition “stature dysphoria.” It is likely that persons suffering from stature dysphoria become aware of their short stature in childhood, often as a result of negative parental or peer appraisals. Over time, they come to attribute various adverse experiences with family, peers, school, and sports to their short stature. As adults, their continuing negative experiences in the social and occupational realms accentuate feelings of alienation and personal failure. Their selective attention, expectancies, and attributional biases convince themselves their short stature has irreparably damaged their lives. As a consequence, they are prone to social anxiety, awkwardness, depression, low self-esteem, and interpersonal difficulties, often despite substantial success in various areas. In conclusion, patients seeking SSL are primarily motivated by a psychological preoccupation with their stature.

The Selection Question

Various factors play a significant role in a prospective patient’s ability to participate in and benefit from SSL. Persons seeking care should be sufficiently motivated to undergo the lengthening process with its attendant discomfort and inconvenience. They should possess sufficient information to give meaningful informed consent, including a solid understanding of treatment procedures, possible complications, and the need to participate in daily physical therapy. They should have realistic expectations about treatment outcomes, including any limitations on physical activity in the future. They should have the ability to collaborate over time with their surgeon and rehabilitative care staff. To the extent a prospective patient has a flexible and mature personality structure, good emotional regulation, self-awareness, and good interpersonal skills, he or she will have greater resources to contend with the challenges inherent in SSL. When a prospective patient presents for a radical and protracted elective procedure, it is essential to evaluate his or her fitness for such a treatment. It is important to gauge motivation and rule out psychiatric disorders (eg, body dysmorphic disorder). Coping skills and the ability to tolerate procedural stresses and pain must be determined, and there is a need to evaluate treatment response and outcome.

In the Paley and Windisch study, to assess fitness for lengthening surgery, prospective patients underwent a presurgical psychological evaluation by W.W., that included the Minnesota Multiphasic Personality Inventory-2 (MMPI-2), Millon Behavioral Health Inventory, and Rorschach Inkblot Test. These assessment tools were used to formulate a comprehensive evaluation of the patient’s perception of well-being, preoccupation with health issues, emotionality, coping styles and psychogenic attitudes, and his or her suitability for adapting to the rigor of the surgery and rehabilitation.

Patients accepted for SSL were more conventional in their response style on the MMPI-2 F Scale (P = 0.005), less likely to report symptoms of depression on the MMPI-2 D Scale (P = 0.056), less likely to report a history of antisocial behaviors on the MMPI-2 Pd Scale (P = 0.077), less likely to report symptoms of thought disturbance on the MMPI-2 Sc Scale (P = 0.050), less likely to report anxiety symptoms on the MMPI-2 ANX Scale (P = 0.088), and more likely to report supportive family relations on the MMPI-2 FAM Scale (P = 0.033).

On the Millon Behavioral Health Inventory, declined patients had a greater sense of future despair than accepted patients (P = 0.058). The 2 groups did not otherwise differ in personality attributes assessed by this measure. No detectible differences were observed in introversion-extroversion, inhibition, cooperation, sociability, confidence, forcefulness, respectfulness, sensitivity, tension, stress, pessimism, social anxiety, and vulnerability to emotional disruption under conditions of stress.