The relationships between social media, cosmetic surgery and body image create an uncertain future as technology becomes more advanced, creating more ways to change one's body as well as market it. As rates of suicide and self-harm go up, so do different ways to fix the way we look. Social media has become highly addictive. Mike Featherstone has helped to articulate the shits in body image and its connection to consumer culture, exploring a utopian world of unrealistic images. Creators of social media apps and algorithms make sure we are on these apps for as long as possible, so they make as much money as possible. There is no concern for how manipulating people to stay on an app might affect their life. Cosmetic surgeons have also discovered social media as a space that they can advertise their work, normalising making changes to one's body. Posting toxic before and after images on social media accounts, they collaborate with celebrities exchanging a product for a shout-out via Instagram. As the influence of fame is so prominent, the middle class on the app as well as young children, turn to cosmetic procedures as a quick fix to the bigger picture. The body image of young people on the internet is seriously harmed as they become obsessed with how they look and the number of likes, follows, shares and comments they receive on their latest selfie.

This thesis is a study of the correlation between cosmetic surgery and body image and how social media has played a role in this relationship. As we analyse the latest trends in cosmetic surgery, the role of social media and Instagram influences and guides the current movements

in the beauty industry. We begin to see both the positive and negative effects of cosmetic surgery on body image with a broader focus on the negative aspects.
Firstly, the thesis will deconstruct body image in all of its forms and the way that it affects people, in particular, young social media users. Mike Featherstone helps deconstruct the connections between body image, consumer culture and the medias influence (Featherstone, M). Featherstone also talks through cosmetic surgery and the connection to body image. 'Before and after photos', is a topic discussed by Featherstone that is very relevant in today's media trends. Cosmetic surgeon, Dr Simon Ourian, shares before and after photos to his following of over 3.5 million create a sense that anything can be done and should be done if one looks like that average and natural before picture.

Moving into cosmetic surgery and injectables, we discover an industry with an estimated worth of 50.5 billion dollars and an increase of 5% from 2019 (Danziger, P 2019). Lip fillers, in particular, are one of the biggest trends of the past 20 years with a 43% increase since 2000 (Danziger, P 2019). These procedures have become trendy caused by celebrity patients, Dr Anita Patel explains in an interview, posting pictures and videos of the procedures gloating about how easy and pain-free their experience was. "Patients do not understand the risks even on a non-invasive procedure" (Lebsack, L 2018). Dr Patel explains the high risks of blindness, loss of skin and reactions to the product that is not shared by their favourite influencers when showing off their new lips and smooth face. Society has a habit of thinking that celebrity means authority, thinking that just because someone has a following on Instagram, they are qualified to give advice or recommend a product (Lebsack, L 2018). However, the information presented by these celebrities is unreliable and often over glamorised as a way to endorse the product. Sponsorships are an excellent way for companies to get a product out there, but scarily enough some influencers are sponsored and paid to endorse companies that conduct cosmetic procedures. Joanna Yoo, also known as 'Joanna the nurse' on her socials, is a practising Aesthetic Nurse, although she has a Master's in nursing, she is not board certified. Joanna is famous for injecting the likes of YouTube stars such as Tana Mongeau and James Charles, often appearing in their videos and 'vlogs' glamorising the procedures. Tana Mongeau shares and documents her experiences for the public dubbing these medical procedures as "the norm" and "chill" influencing her younger teenage audience to "check out Joanna, link in bio" (Mongeau, T 2019).

Exploring the unusual connection between Cosmetic surgery, body image and social media the word 'trends' pop up a lot. With it now being more straightforward than ever to share what we are doing, eating, feeling, watching, really anything, creates a society of young adults that have an obsession with checking their phones, comparing and always trying to look their best. "FOMO" (fear of missing out) (Jones, M 2012) is also created around products or experiences that generate the user to become obsessed with achieving a specific look or experience. The obsession can then create body image and identity issues in the users. Taking a positive approach to the experience that social media provides in terms of cosmetic procedures and body image we find that if we are strong enough to curate our feeds and monitor what we 'follow', 'subscribe' and 'like', people and influencers are spreading a positive message. Through images, videos or text, influencers can express their own experiences and journeys with body image and cosmetic procedures without the use of things like 'Facetune'. As these editing apps that give a false perception of the human body, become more popular, some influencers join a movement focusing on a message that anyone can be beautiful.


One in five adults feels shame about their bodies when they look themselves in the mirror (Featherstone, M). Body image is an issue that has been around since the beginning of time, with the influence of our 21st-century media and technology, it is as ripe as ever. "Body image is generally understood as a mental image of one's body as it appears" (Featherstone, M). Those who suffer from body image issues such as Body Dysmorphic Disorder, where patients are "preoccupied with a perceived defect in appearance" (Rossell, S), are much more sensitive to highly edited social media posts. For example, a patient with Body Dysmorphic Disorder might have an obsession with their hair, how it looks and the style. They will spend

hours in front of a mirror perfecting that part of the body (the hair), commonly making them late to things throughout the day. (Wittchen, H 2002) Continuously throughout the day, the patient will avoid mirrors as well as shiny surfaces to avoid seeing the part of their body that they feel self-conscious about seeing. Being diagnosed with body dysmorphia is an extreme example of body image issues, which can be life hindering. Body dissatisfaction is much more common and less detrimental to one's life, but still affects people's moods and behaviours daily. Body dissatisfaction is also becoming more and more common as society is continuously comparing every aspect of life to that of our friends as well as celebrities through social media platforms, such as Instagram. This dissatisfaction leads to toxic perceptions of our bodies that trigger individuals to go to extreme lengths to create the perfect look.

Some scholars believe that there is a "status and social accountability depending on how a person looks" (Featherstone, M), a toxic view based on popular "physiognomic assumptions that the body especially the face is a reflection of the self" (Featherstone, M). These ideas sit with us even if we are unaware of it, as every day in television and media, there are links between beauty and perceived moral goodness. Beauty is often equated to success, "Pretty privilege does exist" (Mock, J), as being 'beautiful' can get you to the front of the line in a club or that job at that fancy clothing store where you always wanted to work. With these factors of privilege being prominent and widely recognised in modern society, it is easy to believe that a high number of people are suffering from issues with their body image and appearance. With the rise of social media and the accessibility of cosmetic surgery, it creates a whole new platform and experience for people to share their bodies, as well as change them.

As someone that has had my struggles with body image and learning and growing from my experience, I can say that it is a process that is not easy and should not be taken lightly. As a teenage girl, I was always bigger than my friends; I was a size fourteen at the age of sixteen surrounded by my size six friends causing me to hate my body. My weight brought me to develop a harmful mentality causing me to lose a large 20kg in around four months, something changed in me, and I thought I needed to 'fix' myself. As the weight began to drop, I never felt any better. Friends at school and work consistently told me how good I

looked, of course, they thought that was a nice thing to say, but they did not know their words were encouraging unhealthy behaviours. The idea of complimenting people when they lose weight can be very harmful, as you do not know if they are healthily losing weight. A compliment can make them think that what they are doing is right, which makes them want to keep going. One morning when I had not eaten hardly anything for a few days, I fainted, split my chin open which required five stitches as well all my back teeth being broken teeth. It was, unfortunately, the wakeup call that made me realise I needed to fix the way I thought about my own body. After leaving high school and learning a lot about myself, I can finally live a life where I am confident in who I am and do not have to worry about what I eat or the way I dress to hide my body. Having an experience like this and knowing the way I felt during this time with zero communication with my friends and family, I can only imagine all the young girls that have had a similar experience to me. An experience like this although so horrible has helped shape the way I am today and has allowed me to connect with a topic that I feel holds so much importance to the world we are living in today.

Social media was starting to become popular around this time in which I was suffering from body image issues. The number of young girls that were admitted to hospital for self-harm was very stable and consistent with very few patients. The number of patients rose in 2010 when social media became more common amongst the younger generation. Self-harm was up 62% amongst teenagers and a whopping 189% amongst pre-teens as well as suicide rates being up 70% amongst teens and 151% amongst pre-teens (Simpson, K, T 2019). These super concerning stats are only going up as generations are now being raised on social media from younger and younger ages. Gen Z was the first generation to be raised on social media and have suffered the consequences of it the most because of its addictive nature. Being addicted to checking in on others' lives is a scary pattern that is only going up as technologies continue to advance and people create more and more ways to keep one engaged with their phone for as long as possible. Spending hours a day looking into the highlights of others' lives is almost life-threatening at this point, particularly to young adults, teenagers and even kids. Unrealistic ideas of body image begin to form in young people's heads, sending them down a scary path to an uncertain future.

Although social media is filled with toxic perceptions of what a person should look like we also do have somewhat of control of what we see and consume on our phones and televisions. Influencers that showcase who they are with no filters or makeup such as @AshleyGraham on Instagram showcasing her 'big' body to her audience in all its glory. Also becoming a new mum, she has shown the trials and tribulations of pregnancy and becoming a mother. With so much judgment on the internet, she is determined to remain real and remind people that it is not all sunshine, like other mothers on the internet might portray it to be. People such as Ashley with millions of followers that put out such a beautiful message are the ones that we should be following so that our feeds are curated to be more positive.


As the world becomes more advanced in technologies and recourses, cosmetic surgery procedures become more and more common and accessible. The cosmetic surgery industry is worth an estimated 50.5 billion dollars, and the cosmetic/beauty industry as a whole is valued at a massive 532 billion dollars in the year 2020 (Lebsack, L 2018). A vast and rapidly growing industry with an abundance of products and techniques that are pushed into the market everyday people around the world are shown and pushed to buy what is new and what is 'best'. With every part of the body that one may not like comes many different procedures designed to target the area. From filler to plasma facials to implants, the beauty industry has it all. "Who Benefits from the chase of perfection"(Lebsack, L 2018) is it us as the consumers who can enjoy a product or the industry that is racking up billions of dollars in revenue and pumping out more and more new products to make sure that we keep coming

back. When "everything can be fixed or faked" (Lebsack, L 2018) as soon as we have a problem with ourselves or bodies, a lot of young women and sometimes men consider what a cosmetic surgeon can do. Dr Simon Ourian, a Los Angeles, Cosmetic Surgeon, has been dubbed the "Dr of Instagram" (Lebsack, L 2018). He has an astounding 3.5 million Instagram followers to which he posts videos and photos of before and after shots taken of his clients showcasing the procedures. This type of content brings in hundreds of customers and new clients, as people see these photos and think that if they look like the before picture, then they probably need to fix how they look. Dr Ourian also uses celebrities such as Kim Kardashian to help endorse his services and bring customers to his office. And everyone wants to look like a Kardashian, don't they? He was also famous for injecting Kylie Jenner's lips when she was only 17 years old. A fascinating part about this substantial high paying doctor is that he never actually finished his degree, meaning that he is only a certified GP and not a surgeon, trained to only do procedures such as filler, Botox and different laser procedures. Which he does, but there are no regulations for his chosen title of 'Cosmetic Dermatologist' in the US or the UK. As well as not being a real cosmetic surgeon, in 2009, Dr Ourian was placed on probation for five years, required to practice under another doctor. Dr Ourian was accused of the 'Tenth cause of discipline' (patient SB) (gross negligence), 'Twenty- Fifth cause of Discipline (false Advertising or Dishonest and corrupt Acts) and the 'Thirty-third cause of Discipline' (patient LK) (Inadequate Records) (Lebsack, L 2018). Even with these big claims against his name, no one is worried, or do they even know about it? One does not see that on his Instagram feed or website. The probation never really lasted the whole of the five years, and Dr Ourian was back to practising as usual. Although all the types of procedures the Dr Ourian offers are non-invasive, procedures such as fat transfers also known as a Brazilian butt lift, which is one of his more popular procedures, draw a fine line between what is invasive and non-invasive. Fat transfers require one to go under local anaesthetic and takes between 2-3 hours, depending on the focused area, to complete the procedure. Fat is then sucked out of one area and injected into another, which is extremely uncomfortable and painful. Looking into the world of Dr Ourian and his army of nurses, we see a very fine line between legal and illegal practice. Nevertheless, with his extensive list of celebrity clients, anything that he has done in the past or how qualified he is for the job is wholly disregarded as people only care about how they can look closer and closer to that fictional idea of perfection by getting the latest and best procedure.

Although there is an increasingly high risk when undergoing cosmetic surgery, why do people allow themselves to take that risk? Ole Martin Moen answers this question in his work titled 'Cosmetic Surgery'. He talks about the idea of more attractive people having a more straightforward and better life. "An attractive worker in the United States will on average earn $230,000 more than a quite ordinary one" (Moen, O 2012). They can climb the industry ladder easier and use their charming good looks to get what they want. So, does this make a life-risking surgery worth it to work one's way up their job potentially? Maybe a new set of boobs can get one that promotion they were after, or add a little bit of Botox to give them that more youthful look. With this being the case may be a little bit of Botox in ones face is worth it if done correctly by a qualified and experienced cosmetic surgeon. Looking at what is considered 'beautiful' may also keep you out of prison or leave you with a shorter sentence. The halo effect of attractiveness is a phenomenon where we view someone more attractive than the average to be smarter, kinder and an all-round better person. Ted Bundy is an excellent example of good looks getting him out of trouble and gaining trust for the longest time. Because of his appearance, it made it easier to commit the crimes in the first place, explicitly luring women into his car and towards him in general. His looks and charm also caused his court hearing to be drawn out and created a lot of media attention. He wanted to represent himself in court which seemed charming to young viewers at the time, although he had killed more than 30 young women. Without the forensic evidence-making Bundy Guilty he may not have gone to prison or maybe come off with a shorter sentence because of his charming looks and personality that everyone loved so much. Although he did not have cosmetic surgery, he possesses the standardised ideas of beauty and has the appealing personality to back that up. His looks and personality made him irresistible to the American audience.

By having cosmetic surgery and improving our looks in whichever way that might be, we can have a better shot in life. Paul Bloom, an American - Canadian psychologist, argues that whilst most things that we might spend money on like a new handbag make us feel better for a short period, cosmetic surgery has a long-term positive impact on our wellbeing and lives. The argument of it being unnatural and kind of cheating life comes up very often in discussions surrounding cosmetic surgery. If cosmetic surgery is all about changing and enhancing our appearance, then what is the difference from someone who changes their hair

colour and gets their nails done. Nevertheless, such negative connotations are associated with cosmetic surgery, what is so wrong with making ourselves feel a bit better? Mike Featherstone also suggests in the piece 'Body Image and the Affect in Consumer Culture' that a body can become an "artistic medium" (Featherstone, M 2010). If surgery is done correctly by a qualified and experienced doctor, fixing something about one's body that hinders their life can have a mostly positive impact. Many people have suffered permanent damages to their bodies caused by accidents, resulting in maybe a burn, severe acne, or even being born in the wrong body. For transgender individuals, cosmetic surgery can help them show on the outside how they feel on the inside, which is incredibly life-changing.

Although there are negatives to cosmetic surgery which can be large and scary if things go wrong, there are things to consider when we think about why people get cosmetic surgery. If one is doing it because that girl they follow in Instagram did it then maybe some more thought should go into changing their body forever. If one is doing it to help make the inside match the out or fix the damage that has been made to one's body, then it can bring some incredibly positive effects to one's life for years to come, as long as it's done right.


The relationship between social media and body image brings up areas of both concerns, as well as, liberating perspective. With the idea of anything is possible, when do we stop? Is a bit of filler in ones face and a new set of boobs a quick fix for what is going on inside one's head? Or just a way to make the outside match the inside? Meredith Jones helps us understand all

sides of the story, trends and the culture of the consumer. In the article 'Cosmetic Surgery and the fashionable face'. Jones talks through the idea of the struggle between 2D and 3D, how we make that a reality and desperation to look like a "2D photoshopped product" (Jones, M 2012). Jones also talks about the effect of the celebrity and the trends that they set in terms of cosmetic surgery, for example, The stretched out, tight facelift, glassy skin and overdone Botox is "so last year"(Jones, M 2012), the newest trend in cosmetic surgery is being dubbed the "pillow face"(Jones, M). The idea of a face being in or out of fashion is a very uneasy feeling as our face is our "most important communication tool" (Jones, M 2012) do we try and match the outside to trends and how we want to look or learn to love our bodies for what we were given. When we undergo cosmetic surgery to change our face for whatever reason that might be, it is often to make our faces look more like everyone else or the majority of the media. We strive to look like the majority of people that we see in magazines, not real life.

People that undergo cosmetic procedures desire to look like a 2D and most likely photoshopped image that they see on their phone. However, the middle class can most likely not afford to undergo these unnecessary procedures that we see on everyone's favourite celebrities. Like fashion, there are many different levels of procedures, depending on the money that one is willing to spend. If one spends more, it can get them a certain level of quality of the product, then maybe someone with less money. We imagine a world where there are "middle streams" (Jones, M 2012) available in local shopping centres, which has become a reality, we can now get a new set of lips before we get tonight's dinner sorted. Some may consider people such as Dr Ourian to be the "avant-garde" (Jones, M 2012) of cosmetic surgery and injectables who offers a "new look" (Jones, M 2012). We could eventually take the same creative approach to our faces as we do to fashion, at the comfort of or local Shopping centre.

When seeing our favourite supermodels on our screens, we most likely compare ourselves to them, but what happens when we start comparing our looks and lives to our peers and colleagues. Social media documents the "highlights" (Simpson, K) of one's life and enhances it, making everything look better than it may seem. We do not post the breakdown we just had or the bad hair day. With the growing connection between social media and cosmetic surgery, trends become more and more apparent. The integrity of the app is questioned and

how the role of the app might play on one's self-esteem. Jia Tolenentino, in an article, 'The Age of the Instagram Face' for 'The New Yorker' talks through the influence that social media plays in the cosmetic surgery industry and the secret on everyone phone 'Face Tune'. "FaceTuning your jawline is the Instagram equivalent of checking your eyeliner in the bathroom of a bar" (Tolenentino, J 2019). She also talks about the power of the celebrity and how influential they have become. Tolenentino took a trip to LA, the home of cosmetic surgery and injectables, on a mission to discover the reason for these "professionally beautiful women" (Tolenentino, J 2019) that all consume this same "Cyborgian" (Tolenentino, J 2019) look that has taken over our feeds, TVs and even traditional print media.

The look is made up of "poreless plump skin, high cheekbones", "catlike eyes" with "long cartoonish lashes" a "small neat nose and full, lush lips" (Tolenentino, J 2019). The look is very racially ambiguous; which has many people feeling very uneasy as they have faced so much discrimination for the skin that they were born in for generations after generations because of the features that they possess from their origin of birth or family background. Now, these things that they were once turned down from opportunities or just merely an equal life are on-trend! "We are talking an overly tan skin tone, a South Asian influence with the brows and eye shape, an African-American influence with the lips, a Caucasian influence with the nose, a cheek structure that is predominantly Native American and Middle Eastern." (Tolenentino, J 2019) These features are unrealistic for apparent reasons unless one's decedents were a mixture of all of these ethnicities. Not everyone can afford the work that is put into achieving the idea of beauty, and let us be real nobody naturally looks like that, the introduction of face filters happened. Snapchat, soon followed by Instagram, introduced the face filter that made us look "conventionally more attractive" (Tolenentino, J 2019). These filters have taken over. It is more common than not now to post a picture with a face filter than without; this does nothing for the confidence of young women. They think that their favourite influencer on Instagram is flawless and naturally beautiful when, in reality, they have a filter on their face. With the introduction of video filters on apps like face tune, we begin to lose perception of reality and how we look. When we say, "professionally beautiful women" (Tolenentino, J 2019), we do mean it. Being beautiful can get one millions of followers and opportunities on apps like Instagram, making them much money. Depending on the following size of someone on Instagram, they could make upwards of $20,000 for a

brand deal with a company to make a post in a pair of bikinis. When Kylie Jenner advertises something like 'Hi smile' (a teeth whitening company) imagine how much business she is pulling in with her following of over 196 million on Instagram alone. "Social media has supercharged the propensity to regard one's identity as a potential source of profit" (Tolenentino, J 2019). Thinking of ones face as a business; change the underperforming aspects, then they can bring in more revenue to maximise profits. It is a difficult way of thinking about one's face, but unfortunately, that is what this world has become.

As we understand the world of the internet and the rise in cosmetic surgery trends, a scary path is paved. With the age of Instagram and an attitude of I want it, I got it, the lengths that people are willing to go to get that "filtered look" (Lebsack, L) is extreme. We have discovered some positives to cosmetic surgery's and injectables as we live in a world where "pretty privilege" exists as well as the ease of changing our appearance. With the ease of one quick session and $1000, we can potentially guarantee more opportunities for ourselves in this crazy world—a society where beautiful people dominate how does that affect the brain and how we view our bodies. Generation Z is a generation of kids who have been raised on the internet, and this idea of everything is fixable as well as a "chase for perfection" (Lebsack, L). Social media has become a marketplace for advertisers to reach women and even young kids seeking that "perfect look" (Lebsack, L) that they see on their phones. As Instagram only shows the highlights of one's life, we are made to believe that everyone is always looking and feeling their best when, in reality, they are not. An individual posting a picture in full glam makeup might be sitting in bed with a box of tissues looking for validation from their friends, which becomes exceptionally unhealthy. When a like and comment means more than a

conversation with a friend, we have created a generation of kids who are more depressed than ever. Rates of self-harm and suicide are enormous, yet people are still addicted to these apps, and the reason for that being algorithms. Algorithms are made to keep us on the app and for a long as possible. They track what we like and what we want to see then recommend more and more content to keep us on their app. Knowing what we want to see makes us addicted and spending more and more time obsessing over the content that is fed to us. When communication through message and image grows so high, being addicted to phones makes things such as dating and making connections with people harder.
Social media and the influence of the celebrity has eased the stigma around cosmetic surgery. Before and after photos have become widely popular amongst surgeons on Instagram that have accounts. With celebrities sharing their results and before and after shots, the shame of getting work done has gone down. Women turn to filler to make themselves feel better and have that quick fix because everyone else is doing it; it does not feel as bad. With a mentality that if a celebrity can do it, so can I, they have become an authority when it comes to trends and specifically cosmetic surgery. People trust what they have to say just based on their following and appearance without researching themselves about the product that is being put in their face. In a world where social media rules and technologies continue to become more advanced, humans remain trying to work and navigate their ways through this new world.


Andsager, L 2014, 'Research directions in social media and body image', Feminist Forum Commentary, Vol.71(11), pp.407-413, viewed 05 March

Danziger, P 2019, '6 Trends Shaping The Future Of The $532B Beauty Business', Forbes, 01 September, viewed 11 August, beauty-business/#4a04d055588d

Featherstone, M 2010, 'Body image and Affect in Consumer Culture', Body and Society Copyright, vol.16, no. 1, pp. 193-221, viewed 10 March 2020, Sage Journals

Jones, M 2012, 'Cosmetic surgery and the Fashionable Face', The Journal of dress body and culture, vol.16:2, pp. 193-209, viewed 10 March 2020

Lebsack, L 2018, 'The Truth Behind Instagram-Famous Plastic Surgeons', YouTube, 24 June, viewed 10 August,

Mock, J 2017, 'Being Pretty Is a Privilege, But We Refuse to Acknowledge It, Allure, 28 June, viewed 01 September,

Moen, O 2012, 'Cosmetic Surgery', The Royal Institute of Philosophy, Think 31, Vol. 11, viewed 04 May 2020 Mongeau, T 2019, 'GET A FACE FULL OF FILLER WITH ME (graphic)', YouTube, 02 April, viewed 10 August,

Oranges, C 2016, 'the impact of aesthetic Surgery on Body Image and its implications on mental health, vol.36, viewed 06 March

Ourian, S 2020, 'Treatment: Body contouring', Instagram, viewed 09 August,

Prieler, M, Choi, J 2014, 'Broadening the scope of Social media Effect research on body image Concerns', Feminist Forum Commentary, Vol.71(11), pp.378-388

Rocamore, A 2017, 'Mediatization and Digital Media in the field of fashion', The Jornal of Dress, Body and Culture, vol. 25, pp.505-522

Rossell, S 2019, 'Body dysmorphic disorder patients actually see faces differently', YouTube, 28 October, viewed 01September,

Sigall, H, Ostrove, N 1975, Beautiful but Dangerous: Effects of Offender Attractiveness and Nature of the Crime on Juridic Judgment, Journal of Personality and Social Psychology, Vol. 31, No. 3, 410-414
Simpson, K, T 2019, 'Our Body Image and Social Media: Live Life Unfiltered | Keisha & Teagan Simpson Simpson | TEDxOttawa', YouTube, 09 December, 01 September,

Sloan, L, Quan-Haase, A 2017, 'The Sage Handbook of Social Media Research Methods', SAGE Publications, 1st edition, London, UK

Tolentino, J 2019, 'The Age of the Instagram Face', The New Yorker, 12 December, viewed 14 March 2020, https://www.newyo- cade-in-re- view/the-age-of-Instagram-face

Wittchen, H 2002, Generalised anxiety disorder: prevalence, burden and cost to society, Depression and Anxiety, Volume 16, issue 4