Sofia Martinez
Body dysmorphic disorder (BDD) is a mental health condition characterised by distress arising from self-perceived physical imperfections. Individuals with BDD often seek cosmetic procedures to address their perceived flaws, leading to a high prevalence of BDD among patients seeking plastic surgery. Plastic surgeons play a crucial role in recognising and managing BDD, as performing surgical procedures without prior psychological treatment can have dangerous or even deadly consequences. While some surgeons refuse treatment or refer patients with suspected BDD to mental health professionals, others may inadvertently enable self-destructive behaviour by performing cosmetic procedures that do not address the underlying psychiatric disorder.
| Characteristics | Values |
|---|---|
| Prevalence of BDD in the general population | 1% to 2% |
| Prevalence of BDD in rhinoplasty patients | 21% |
| Prevalence of BDD in patients undergoing cosmetic procedures | 2% to 10% |
| Prevalence of BDD in plastic surgery patients | 0.1% |
| Comorbid psychiatric conditions in BDD patients undergoing cosmetic procedures | Depression, Anxiety, Attention-Deficit Hyperactivity Disorder |
| BDD as a contraindication for cosmetic surgery | Yes |
| BDD patients' likelihood of seeking further treatments | High |
| BDD patients' likelihood of threatening legal action | High |
| BDD patients' likelihood of threatening physical violence | High |
| BDD patients' likelihood of committing homicide | Possible |
| BDD patients' likelihood of suicide | High |
| BDD patients' likelihood of being satisfied with cosmetic treatment | Low |
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What You'll Learn
- Plastic surgeons are more likely to refer BDD patients to psychiatrists or psychologists and refuse treatment
- Body Dysmorphic Disorder (BDD) is a prevalent mental health condition characterised by distress arising from self-perceived physical imperfections
- BDD patients often seek cosmetic solutions, leading to a cycle of excessive treatments and worsening mental states
- BDD can be treated with psychological therapies and medications
- Surgeons must carefully screen patients to avoid exacerbating BDD
Plastic surgeons are more likely to refer BDD patients to psychiatrists or psychologists and refuse treatment
Body dysmorphic disorder (BDD) is a mental health condition characterised by an obsession with and constant focus on perceived flaws in one's appearance, leading to personal, social, or occupational impairment. People with BDD often seek cosmetic procedures to alter their physical appearance, with the highest rates of BDD found among those seeking help from cosmetic surgeons and dermatologists. However, surgery does not address the underlying disorder and can even contribute to its worsening. Plastic surgeons play a crucial role in recognising and managing BDD in their patients to ensure they receive appropriate care.
Plastic surgeons are often the first point of contact for individuals with BDD seeking cosmetic procedures. While BDD may be under-diagnosed in this population, surgeons are becoming increasingly aware of the challenges posed by BDD. A survey of Dutch cosmetic professionals, including plastic surgeons, found that most respondents were familiar with BDD and its diagnostic criteria. The survey also revealed that plastic surgeons were more likely to refer patients with suspected BDD to psychiatrists or psychologists and to refuse treatment compared to other cosmetic professionals.
The decision to refer patients with BDD to mental health specialists is an important ethical responsibility of plastic surgeons. By recognising the signs of BDD and referring these patients for appropriate psychiatric or psychological care, surgeons can help prevent unnecessary and potentially harmful procedures. This is crucial, as patients with BDD are generally dissatisfied with the results of cosmetic procedures, often leading to a cycle of repeated interventions that fail to address their underlying disorder.
While most cosmetic professionals in the survey reported a good degree of awareness of BDD, there is still a need for improved recognition and management of BDD in clinical practice. This includes incorporating routine screening for BDD during cosmetic consultations and providing cosmetic specialists with the necessary tools and education to identify and manage BDD effectively. By addressing these issues, plastic surgeons can play a vital role in ensuring that patients with BDD receive the specialised care they need while also minimising potential harm.
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Body Dysmorphic Disorder (BDD) is a prevalent mental health condition characterised by distress arising from self-perceived physical imperfections
Body Dysmorphic Disorder (BDD) is a prevalent mental health condition characterised by distress stemming from self-perceived physical imperfections. Individuals with BDD often seek cosmetic treatments, believing that their problems are rooted in their physical appearance. However, cosmetic surgery is generally contraindicated for this population, as it rarely resolves BDD symptoms and can sometimes worsen them. The highest rates of BDD are found among people seeking cosmetic interventions, with the highest incidence in those seeking rhinoplasty, at 21%.
BDD is associated with a range of psychiatric comorbidities, including major depression, anxiety, and Attention-Deficit Hyperactivity Disorder (ADHD). It is also linked to higher rates of suicidality and violent behaviour towards physicians providing cosmetic treatments. Therefore, accurate identification and appropriate selection for procedures are crucial. While cosmetic surgeons typically treat patients with reasonable goals and see high patient satisfaction, they must be aware of the potential for underlying BDD.
Plastic surgeons and other cosmetic professionals are familiar with the challenges posed by patients with BDD seeking cosmetic procedures. However, BDD may be under-diagnosed in this population, with rates of 2-10% reported in previous studies. This highlights the need for more awareness and identification of BDD among cosmetic professionals. While some surgeons are vigilant in screening for BDD, others may inadvertently enable patients' self-destructive behaviour by performing cosmetic procedures without addressing the underlying psychiatric disorder.
To fulfil their ethical obligations and adhere to the principle of "first, do no harm", cosmetic specialists should routinely screen for BDD. Several screening tools are available, such as the Body Dysmorphic Disorder Questionnaire (BDDQ), which has been validated in facial plastic surgery patients. If BDD is suspected, careful further questioning and referral to a BDD specialist are recommended. Treatment for BDD typically involves psychological therapies, such as cognitive-behavioural therapy, and medications like serotonin reuptake inhibitors (SRIs).
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BDD patients often seek cosmetic solutions, leading to a cycle of excessive treatments and worsening mental states
Body Dysmorphic Disorder (BDD) is a mental health condition that causes a person to have a persistent and obsessive focus on minor or non-existent flaws in their physical appearance. This preoccupation is disproportionate to the actual defect, if any, and can cause significant emotional distress and impaired functioning in social and work settings. BDD is found at higher rates among people seeking cosmetic procedures, with the highest rates among those seeking rhinoplasty, where up to 21% of patients met the criteria for BDD.
BDD patients often seek cosmetic solutions because they believe that altering their physical appearance will address their insecurities and improve their emotional well-being and psychosocial functioning. However, this can lead to a cycle of excessive treatments and worsening mental states. The underlying issues driving their dissatisfaction are not addressed through cosmetic procedures, and the patients' expectations often do not align with the reality of the outcomes, leading to further dissatisfaction and an increased preoccupation with their physical flaws. This can result in requests for additional treatments, which can worsen the patient's mental state and increase frustration for the cosmetic specialist.
In some cases, individuals with BDD may become depressed following cosmetic treatments, as they may feel that the procedure did not improve their appearance or may even believe that it made them look worse. Research has shown that cosmetic treatments for individuals with BDD are often associated with poor outcomes and can negatively impact their mental health. Studies have found higher rates of suicidality and suicide attempts among individuals with BDD who have undergone cosmetic procedures, particularly among those seeking breast augmentation.
The cycle of excessive treatments and worsening mental states can have negative consequences for both patients and healthcare providers. Patients may experience financial burdens from continuously seeking cosmetic services, and providers may incur increased costs from offering refunds or redo procedures to appease dissatisfied patients. In some severe cases, patients with BDD have responded with aggression, violence, or legal action towards healthcare providers.
To break this cycle, it is crucial for cosmetic professionals to be aware of BDD and to screen patients for potential red flags during consultations. While BDD may be under-diagnosed in cosmetic settings, plastic surgeons are more likely to refer patients exhibiting signs of BDD to mental health specialists and refuse treatment compared to other cosmetic professionals. Proper screening and referral to BDD specialists can help ensure that patients receive appropriate psychological treatment and that cosmetic procedures are only performed when they are in the patient's best interest.
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BDD can be treated with psychological therapies and medications
Body Dysmorphic Disorder (BDD) is a mental health problem that affects an individual's ability to function normally. People with BDD may become obsessed with any part of their body, but the most common areas are the face, hair, skin, chest, and stomach. They may spend hours each day worrying about how they look and may even consider suicide. BDD is associated with other mental health disorders such as obsessive-compulsive disorder, social anxiety, depression, and eating disorders.
BDD can be effectively treated with psychological therapies and medications. Cognitive Behavioural Therapy (CBT) is the most effective form of talk therapy for BDD. CBT involves identifying and evaluating maladaptive thoughts and generating alternative, more positive thoughts. For example, a therapist might introduce common cognitive errors in BDD, such as "all-or-nothing thinking" ("This scar makes me completely disgusting") or "mindreading" ("I know my girlfriend wishes I had better skin"). Patients are then encouraged to monitor their appearance-based thoughts and identify cognitive errors.
Another therapeutic technique is motivational interviewing (MI), which involves empathizing with the patient's body image-related distress and addressing the usefulness of their beliefs, rather than directly questioning their validity. For example, a therapist might say, "I see that you really suffer because you are so worried about the way you look. Let's try to reduce this distress." Non-judgmental Socratic questioning can also be employed, such as asking, "What might be the advantages of trying CBT for BDD?".
In addition to psychotherapy, medications, typically antidepressants, can be used to treat the underlying problems associated with BDD. It is important to note that treatment for BDD may be a long-term commitment, and it is crucial to follow the recommendations of healthcare providers and seek help early to prevent the condition from worsening.
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Surgeons must carefully screen patients to avoid exacerbating BDD
Body dysmorphic disorder (BDD) is associated with major depression, with 60% of patients experiencing clinical depression. It is important to note that the highest rates of BDD are found among people seeking cosmetic procedures. This presents a challenge for plastic surgeons, as BDD may be under-diagnosed in this patient group. Surgeons must carefully screen patients to avoid exacerbating BDD.
Plastic surgery may even worsen BDD if the disorder is not properly addressed before surgery. It is crucial for plastic surgeons to screen for BDD in their patients and refer them for appropriate treatment before proceeding with surgery. Surgeons have an ethical responsibility to identify BDD and not perform the patient's desired procedure. This is because surgery almost never improves BDD symptoms and can often worsen them.
To screen for BDD, surgeons should ask patients questions such as:
- Is this your first surgery?
- How many surgeries have you had in total?
- Have you had surgery on the same body part more than once?
- What was your level of satisfaction with the previous surgery (on a scale from 1-10)?
- Were your concerns resolved after the first surgery?
- How did your self-image change after the first surgery?
- How upset are you with the body part you want to modify now (on a scale from 1-10)?
- How many hours per day do you look at or check that body part?
Surgeons should also listen carefully to how patients describe their physical problems and their impression of the consequences. They should consider whether the patient's expectations of treatment are realistic and ensure a comfortable and private space for these discussions. It is also important for surgeons to be aware of how marketing and advertising for cosmetic services might influence patients' expectations.
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Frequently asked questions
BDD is a mental health condition characterised by distress arising from self-perceived physical imperfections. People with BDD often misperceive and are dissatisfied with the sizes and shapes of their body parts.
Plastic surgeons are familiar with the challenges posed by patients with BDD seeking cosmetic procedures. However, plastic surgeons are more likely to refer patients with BDD to a psychiatrist or psychologist and refuse treatment compared to other cosmetic professionals.
Surgical treatment without prior psychological treatment can result in dangerous or deadly consequences for the patient and surgeon. There is an increased likelihood that dissatisfied patients will turn to litigation, physical threats, and even homicide.
