Body dysmorphic disorder,mental health and cosmetic surgery

Plastic surgery Addiction Disorder

Disorders / February 28, 2023

Plastic surgeons are trained to perform procedures that correct physical deformities and those intended solely to improve a patient’s appearance. But here’s another skill plastic surgeons should have: the ability to identify cosmetic surgery patients who are never satisfied with the way they look and, in extreme cases, may develop cosmetic surgery addictions.

Body Dysmorphic Disorder as the Root of Cosmetic Surgery Addiction

Can you become physically addicted to surgery? “It’s more of a psychological issue than a physical addiction, ” explains Canice E. Crerand, PhD, psychologist in the division of plastic surgery at the Children’s Hospital of Philadelphia.

And the underlying psychologic problem has a name: body dysmorphic disorder, or BDD, a condition that can lead to a cosmetic surgery addiction. A person with BDD may be preoccupied with a slight, or even an imagined, defect, usually in a facial feature. Focusing on the “defect” becomes obsessive and seriously disrupts daily activities and responsibilities. In fact, one study suggests that as many as one-third of nose-job patients have symptoms of BDD.

People with body dysmorphic disorder may spend hours every day trying to hide their displeasing physical features with makeup, clothing, or accessories, or even try some form of do-it-yourself “surgery” to disguise the feature. People with BDD also have unusually high suicide attempt rates.

Patients with this disorder are unlikely to be satisfied with the results of cosmetic surgery, and some people have even attempted to take out their frustration on their plastic surgeon.

How does a doctor determine whether body dysmorphic disorder is behind a cosmetic surgery addiction? Besides being unhappy with the surgical outcomes, patients with BDD:

  • May have very unrealistic expectations about surgery, thinking it will lead to a better relationship or a higher paying job
  • May be satisfied with the requested procedure, but then “suddenly realize” another feature is unacceptable, says Crerand, and desire additional surgeries

The Role of the Plastic Surgeon in Cosmetic Surgery Addiction

Most plastic surgeons are aware that they may see patients who have body dysmorphic disorder. A responsible plastic surgeon should try to identify a patient with this condition before agreeing to perform a surgical procedure.

“There are some challenges in determining if someone has BDD, ” Crerand says. “Individuals with body dysmorphic disorder tend to have low self-esteem.” Self-esteem has many different components — besides one’s appearance it can be linked to personal or work-related accomplishments, intellectual ability, or personality traits such as friendliness or honesty. However, people with body dysmorphic disorder place a disproportionate amount of emphasis on their physical appearance.

Cosmetic surgeries are almost always elective procedures, so a cosmetic surgeon has an ethical responsibility to weigh the risks and potential benefits of surgery.

To rule out BDD, a plastic surgeon should interview the patient to try to understand the patient’s perspective. The plastic surgeon may ask:

  • How much does the flaw that you want to have corrected bother you?
  • How often do you think about it?
  • Have you had any previous surgery on the feature? A repeat surgery on a particular feature may indicate BDD.

If a plastic surgeon suspects that a patient may have body dysmorphic disorder, the doctor should refer the patient to a consulting psychologist or psychiatrist for a more in-depth interview and psychiatric history. People who have body dysmorphic disorder are likely to have another psychiatric disorder such as depression, anxiety, or substance abuse, that may require treatment.