Desperately Seeking Surgery: The truth behind Body Dysmorphic Disorder and Plastic Surgery

Written by Ashley Shaw

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For some people with appearance concerns, cosmetic surgery can be a good option, and the majority of those who receive cosmetic surgery are satisfied. However, for individuals suffering from body dysmorphic disorder (BDD), cosmetic surgery rarely leads to satisfaction or improvement in symptoms and can even be harmful.
 
Not everyone who seeks out or receives plastic surgery has BDD. Research suggests that about 3-53% of patients in cosmetic surgery settings and about 9-12% of patients in dermatology settings may be suffering from BDD (Castle et al., 2004; Ishigooka et al., 1998; Phillips et al., 2000; Sarwer et al., 1998; Uzun et al., 2003; Vargel et al., 2001; Vindigni et al., 2002). Conversely, about 75% of individuals with BDD seek cosmetic treatment for their appearance concerns (Crerand et al., 2005; Phillips et al., 2001). 
 
Signs of Body Dysmorphic Disorder:

1. Do you find yourself excessively concerned or distressed by appearance flaws that friends, family members, or doctors tell you are minor or nonexistent?

2. Do your appearance concerns interfere with your ability to work, take care of things at home, or socialize?

3. Have you undergone multiple cosmetic procedures (but still feel unsatisfied with your appearance)?

4. Do you believe that receiving plastic surgery will transform your life or fix all of your problems?

 
What are the risks of having plastic surgery if you have BDD?
 
In most cases, cosmetic surgery is not beneficial for patients with BDD, and many plastic surgeons consider a diagnosis of BDD to be a contraindication for surgery (Sarwer et al., 2006). Often individuals with BDD feel disappointed after receiving plastic surgery because they have very high expectations about the impact of cosmetic surgery on their life (e.g. thinking that the surgery will dramatically improve their social life or make all their problems go away). Unfortunately, there is no evidence that plastic surgery improves social relationships (Sarwer et al., 2006). Moreover, one study revealed that most individuals with BDD (81%) are dissatisfied with the results of cosmetic treatments (Veale et al., 1996). A second study revealed that 68.7% of cosmetic treatments led to no change or a worsening of symptoms among individuals with BDD (Phillips et al., 2001). In cases in which the individual with BDD is satisfied with the procedure, he or she will often then become dissatisfied with a different body part (Phillips et al., 2001).
 
If you are considering cosmetic surgery, but think you may have BDD, consider seeking out a psychological evaluation before deciding to undergo a cosmetic procedure. If you do have BDD, psychological treatments are a more effective option for decreasing preoccupation and dissatisfaction with your appearance.
 
What are alternative treatments besides plastic surgery for BDD?
If you suspect that you or someone you know may be suffering from body dysmorphic disorder, we strongly encourage you to call our clinic at (617) 726-6766 or e-mail bdd@partners.org.
 
References:
  • Castle DJ, Molton M, Hoffman K, Preston NJ, Phillips KA. Correlates of dysmorphic concern in people seeking cosmetic enhancement. Australian and New Zealand Journal of Psychiatry 2004;38:439-444.
  • Crerand CE, Phillips KA, Menard W, Fay C. Nonpsychiatric medical treatment of body dysmorphic disorder. Psychosomatics: Journal of Consultation Liaison Psychiatry 2005;46:549-555.
  • Ishigooka J, Iwao M, Suzuki M, Fukuyama Y, Murasaki M, Miura S. Demographic features of patients seeking cosmetic surgery. Psychiatry and Clinical Neurosciences 1998;52:283-287.
  • Phillips KA, Dufresne RG, Jr., Wilkel CS, Vittorio CC. Rate of body dysmorphic disorder in dermatology patients. Journal of the American Academy of Dermatology 2000;42:436-441.
  • Phillips KA, Grant J, Siniscalchi J, Albertini RS. Surgical and nonpsychiatric medical treatment of patients with body dysmorphic disorder. Psychosomatics 2001;42:504-510.
  • Phillips KA. The Broken Mirror: Understanding and Treating Body Dysmorphic Disorder (revised and expanded edition). New York, NY: Oxford University Press; 2005.
  • Sarwer DB, Pruzinsky T, Cash TF, Goldwyn RM, Persing JA, Whitaker LA, eds. Psychological Aspects of Resconstructive and Cosmetic Plastic Surgery: Clinical, Empirical, and Ethical Perspectives. Philadelphia, PA: Lippincott Williams & Wilkins; 2006.
  • Sarwer DB, Wadden TA, Pertschuk MJ, Whitaker LA. Body image dissatisfaction and body dysmorphic disorder in 100 cosmetic surgery patients. Plastic and Reconstructive Surgery 1998;101:1644-1649.
  • Uzun O, Basoglu C, Akar A, Cansever A, Ozsahin A, Cetin M, Ebrinc S. Body dysmorphic disorder in patients with acne. Comprehensive Psychiatry 2003;44:415-419.
  • Vargel S, Ulusahin A. Psychopathology and body image in cosmetic surgery patients. Aesthetic Plastic Surgery 2001;25:474-478.
  • Veale D, Boocock A, Gournay K, Dryden W. Body dysmorphic disorder: a survey of fifty cases. The British Journal of Psychiatry 1996;169:196-201.
  • Vindigni V, Pavan C, Semenzin M, Grana S, Gambaro F, Marini M, Bassetto F, Mazzoleni F. The importance of recognizing body dysmorphic disorder in cosmetic surgery patients: Do our patients need a preoperative psychiatric evaluation? European Journal of Plastic Surgery 2002;25:305-308.

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