How should plastic surgeons handle patients with Dysmorphic Disorder?

A plastic surgeon's perspective in dealing with patients who have body dysmorphic disorder

Patients with Body Dysmorphic Disorder (BDD) feel excessive concern and anxiety when they think about one or more of the perceived flaws in their appearance. Their insecurities have become an obsession and source of their incessant worry and distress. (Photo Designed by Pexels)

Feeling self-conscious about certain parts of your body – whether it is a crooked nose, blemished skin, or extra belly fat—is a normal emotion we all experience at times. Most of us have something we wish to change about ourselves and this allows us to continually strive for improvement. However, for people who have body dysmorphic disorder, insecurities can become an obsession and a source of incessant worry and distress.

What is Body Dysmorphic Disorder?

Body Dysmorphic Disorder (BDD) is a mental illness in which an individual is unable to stop thinking about one or more perceived flaws in his or her appearance. To others, these imperfections may seem insignificant or unobservable, but to the affected individual, they cause excessive concern and anxiety.

The following are some of the symptoms which affect persons with BDD:

  • Dedicating a significant amount of time examining oneself in front of a mirror (>1 hour a day)
  • Repetitive behaviors involving one’s appearance (can be physical or mental)
  • Feeling shameful and depressed because of one’s physical appearance
  • Constantly comparing one’s body to others
  • Excessive grooming
  • Hiding imperfections through “camouflaging” (with makeup, hats, clothing, etc.)
  • Social anxiety
  • Refusing to appear in pictures
  • Always seeking reassurance from other people
  • A desire to fix flaws through plastic surgery

Of note, not everyone with BDD will exhibit all of the listed symptoms, and it is important to consult a physician in order to discuss a possible diagnosis.

Is plastic surgery the solution?

Since BDD essentially involves a perceived cosmetic concern, it is natural to assume that undergoing plastic surgery will easily solve the problem. On the contrary, undergoing surgery will not ensure that the patient’s insecurities will be resolved. In most cases, surgery may even exacerbate a patient’s symptoms.

Generally, plastic surgeons do not operate on patients who are diagnosed with BDD. This is because plastic surgery does not effectively address the underlying psychological problem. After surgery, a patient with BDD can feel like another part of their body also needs to be “fixed,” which results in a continuous and endless cycle of frustration both for the patient as well as for the surgeon.

In order to avoid this, plastic surgeons screen their patients for BDD during the initial consultation. By thoroughly reviewing your history, your plastic surgeon will assess your desired procedures and expectations. If your surgeon decides that surgery is not right for you, they may refer you to other health professionals to help provide the appropriate care.

What are the best treatment options?

The most ideal way of treating BDD is by seeking psychiatric and psychological help, first and foremost. The treatment may involve Cognitive Behavioral Therapy (CBT) and medications which include Selective Serotonin Reuptake Inhibitors (SSRIs). These treatments are meant to help reduce symptoms of BDD and eventually improve mental health.

Although plastic surgery might seem like a quick fix for personal insecurities, it is not the correct treatment option for a patient with BDD.

Addressing BDD requires cooperation from both the patient and physicians who are certified to help. When attempting to undergo treatment—whether that may be by a board-certified plastic surgeon to assess plastic surgery needs or by a mental health professional—honesty and open-mindedness are important in addressing such issues.

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