Body Dysmorphic Disorder and Cosmetic Surgery

Body dysmorphic disorder is a psychiatric condition in which patients will have an unhealthy occupation with either minor or nonexistent physical flaws, and will obsess on their appearance for numerous hours a day. Perhaps of greatest concern for cosmetic surgeons is that these patients may also seek out numerous cosmetic surgical procedures in order to fix these perceived flaws, but will never be satisfied with the results from their many procedures. It is important for cosmetic surgeons to understand body dysmorphic disorder, so that they know how to screen for such patients during the consultation visit.

What Are the Symptoms of Body Dysmorphic Disorder?

Patients with body dysmorphic disorder can be obsessed about one or more parts of their body, including face, stomach, breasts, or buttocks. They will generally spend an excessive amount of time attempting to hide their perceived physical flaws with clothing, facial hair, or makeup. They may also need constant reassurance from friends and family about their appearance.

How Common Is Body Dysmorphic Disorder?

Studies estimate that body dysmorphic disorder affects anywhere from 1 percent to 2 percent of the general population. However, the disorder is often underreported to physicians due to intense shame, so the estimated prevalence may actually be somewhat higher. Dermatological procedures are most commonly requested by patients with body dysmorphic disorder. Studies that have looked specifically at patients undergoing cosmetic surgical procedures have found a higher prevalence rate, ranging from 7 to 15 percent.

What Are Standard Treatments for Body Dysmorphic Disorder?

The condition can be difficult to treat, both because patients may also have other psychiatric conditions and, as mentioned previously, they will often not volunteer information to their doctor about their dissatisfaction with their appearance. However, there has been some success with a mixture of anti-anxiety medications, antidepressants, and cognitive-behavioral therapy.

How Can Cosmetic Surgeons Screen for Patients with Body Dysmorphic Disorder?

An article in the July-August 2000 issue of the American Journal of Clinical Dermatology notes that dermatologists and cosmetic surgeons who do facial procedures may be the most likely to see patients with body dysmorphic disorder, as they will repeatedly request procedures to treat their perceived skin and facial flaws. The researchers suggest that dermatologists recommend non-surgical treatments, such as dermatological washes or creams, along with patient education on the benefits of non-surgical treatment. It may also be a good idea for the patient to be referred to a psychiatrist specializing in treating body dysmorphic disorder.

A 2013 article from the Archives of Clinical and Experimental Surgery cautions cosmetic surgeons not to attempt to diagnose patients with body dysmorphic disorder. However, there are some questions that can be kept in mind during the consultation visit:

  • Do they have unreasonable expectations from cosmetic surgery?
  • Are they spending money beyond their means?
  • Do patients have significant social problems due to this imagined defect?
  • Were they dissatisfied with previous surgical procedures?
  • Are they excessively concerned with a nonexistent deformity?
  • Which parts of their body are they happy with?
  • Do they hide the imagined defect?
  • How much time does the patient spend thinking about the defect? Is it more than an hour?

Patients with body dysmorphic disorder who undergo cosmetic surgical procedures are often unhappy with the results. Their symptoms may even worsen following the procedure. With a bit of careful questioning, cosmetic surgeons can hopefully steer such patients toward proper help.

About the Author:

Dr. Vince Marin is a San Diego board-certified plastic surgeon specializes in cosmetic surgery of the face, nose, breast and body. If you wish to contact Dr. Marin, write to [email protected] or you can follow him on Twitter!