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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 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 the 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 the 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 be somewhat higher. Patients with body dysmorphic disorder most commonly request dermatological procedures. 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 challenging 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 as 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, some questions 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.

*The content in this blog is developed to spread the awareness towards plastic surgery. Our blog is not intended to serve as a replacement for an actual in-office consultation with Dr. Marin. As such, the information within this blog reflects the unique cases of our individual patients.

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TO OUR MARIN AESTHETICS PATIENTS:

In light of the state wide restrictions on non-essential businesses to help reduce the spread of COVID-19, we are rescheduling all of our elective appointments until the global circumstances improve. Our necessary post-operative appointments will be made, as needed, to address immediate surgical concerns such as suture removal and acute postoperative issues. All non-acute follow up appointments, fillers and Botox will need to be postponed until after the quarantine period mid April. Our office will reach out to all patients who need to be rescheduled.

We will be offering new patient virtual consultations online and via Skype that can be scheduled through our website or by emailing info@marinaesthetics.com. Also, we will offer follow-up appointments in the same manner to help manage our patients’ concerns while still respecting the need for social distancing.

We appreciate all of your understanding during these difficult times for all of us.

Stay safe,

Dr. Main and the Marin Aesthetics Team