Feb. 18, 2011 -- Sheyla Hershey, the Brazilian model famous for her size triple-K breasts she got after undergoing 18 surgeries, is reportedly comatose after she attempted suicide for the second time, according to British media reports.
The Sun newspaper said Hershey was distraught after doctors had to remove her implants several months ago after a life-threatening infection.
Her husband, Derek, who lives with his wife and their two children near Houston, told the paper doctors don't know when she'll wake from her coma.
After her implants were removed, Hershey told Houston's Fox affiliate she was trying to accept her body without her famous bosom, but still longs for her bombshell body.
"I'm ready to get my breasts back and take my life back," she said. On her website, there was even a call for donations so she could get her implants again.
Although they don't know Hershey and didn't evaluate her, medical experts told ABC News that a person's preoccupation with what he or she sees as a flaw in physical appearance is a hallmark of body dysmorphic disorder, or BDD.
"BDD patients are extremely distressed by these flaws that others can't see or are very minor," said Sabine Wilhelm, director of the Body Dysmorphic Disorder Program at Massachusetts General Hospital in Boston. "This preoccupation gets in the way of having a good life. It gets in the way of social functioning, working -- all areas of functioning can be affected."
They typically obsess over more than one body part and ruminate over their perceived flaws for several hours a day. They also tend to ritualistically look at themselves in the mirror.
People with BDD will often seek treatment not from a mental health professional but from a different type of practitioner.
"They very often go to cosmetic surgeons or dermatologists because they are convinced there is something wrong with the way they look. They don't see that they have an internal problem," said Wilhelm.
"We've found in our research in two different studies that about three-quarters of people with BDD seek cosmetic treatment and about two-thirds of them actually get it, and they may go to many doctors to try and get it," said Dr. Katharine Phillips, a professor of psychiatry and human behavior at Brown University's Alpert School of Medicine in Providence, R.I.
"Studies have shown that as many as 48 percent of people with BDD seek cosmetic treatments," she said.
Wilhelm added that many plastic surgeons, cosmetic surgeons and dermatologists still don't recognize the signs of BDD because the disorder may mask itself as something else.
"Patients may present with symptoms of depression or social anxiety," she said. "The very first thing people should look for is the extreme distress BDD patients often have."
Plastic Surgeon: Spot Signs and Suggest Counseling
"Patients might suggest in either their demeanor or the way they speak that there may be some other underlying psychological issues," said Dr. Malcolm Roth, director of plastic surgery at Maimonides Medical Center in Brooklyn, N.Y. "It's important to be sensitive to that and consider having the patient talk to a psychologist or psychiatrist and find out if there may be something else going on that may be part of the reason why the patient is coming to the plastic surgeon's office."
One of the most important issues to consider, Roth said, is whether a patient's expectations are realistic.
"When a cosmetic surgeon is in a consultation, the surgeon really needs to listen carefully to what it is that the patient is unhappy about, and a critical question that I always ask is, 'Why are you here now? How long has this problem or issue been bothering you?" Roth said.
Often, people with BDD expect surgery or medical treatments to make them happy about themselves and because of this unrealistic expecation, they are often dissatisfied and go back for repeated procedures.
Suicidal Tendencies More Common in BDD Patients
BDD occurs in about 2 percent of the population, and is slighly more common in women. It usually starts in adolescence. Studies have shown that the majority of people with BDD show suicidal tendencies.
"There's also an association between cosmetic surgery and suicide, but it's not clear how many people in those studies had BDD," said Phillips.
One of the most effective treatments for BDD is cognitive-behavioral therapy, or CBT.
"The cognitive element helps people have more accurate beliefs about their appearance and and the behavioral component helps stop the obsessive behaviors," said Phillips.
Selective serotonin reuptake inhibitors, or SSRIs, often used to treat depression, can also be effective, although they are not approved by the U.S. Food and Drug Administration for treatment of BDD. In fact, experts say there are no approved medications for BDD.
Phillips said it's important to emphasize that BDD is treatable, but it's also a very serious illness that requires mental health intervention.
"It's not vanity. Don't try to talk people out of cosmetic surgery, because they won't believe ... there's nothing wrong wtih them. Instead," said Phillips, "encourage them to seek mental health treatment rather than cosmetic treatment."