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Body Dysmorphic Disorder May Be Overlooked In Those Seeking Cosmetic Surgery

A new survey suggests body dysmorphic disorder (BDD) may be underdiagnosed by cosmetic professionals. Inattention to the condition can lead to patient dissatisfaction with the cosmetic procedure as well as failure to receive appropriate care for mental health problems including anxiety and depression.

Researchers found that although plastic surgeons and other cosmetic professionals are familiar with the challenges posed by patients with body dysmorphic disorder (BDD), the condition may not be receiving as much attention as it should.

Lead researcher, Theo Bouman, Ph.D., of University of Groningen, the Netherlands, and colleagues contend that “Body image problems should become a standard topic during cosmetic consultations.”

Their study appears in Plastic and Reconstructive Surgery®, the official medical journal of the American Society of Plastic Surgeons (ASPS).

The researchers surveyed three groups of Dutch cosmetic professionals — plastic surgeons, dermatologists, and others — regarding their knowledge of and experience with BDD.

Responses were received from 173 professionals who perform cosmetic procedures; not only surgery but also minimally invasive procedures, such as botulinum toxin or filler injections.

Body dysmorphic disorder refers to perceived flaws in appearance that lead to personal, social or occupational impairment. Patients with such extreme dissatisfaction with body image have high rates of mental health problems, including depression and suicide risk.

Most of the cosmetic professionals surveyed said they were familiar with BDD and the criteria used to diagnose it. About two-thirds of said they had encountered one to five patients with BDD in their practice over the past years.

By comparison, studies have reported that BDD is present in about two percent of the general population, and in up to 10 percent of patients seeking cosmetic procedures.

Most respondents said they sometimes or often addressed body image problems while consulting with patients, but only seven percent routinely did so. Just under half said they collaborated with psychologists or psychiatrists.

Most patients with BDD seek plastic surgery or other cosmetic procedures. However, they are generally dissatisfied with the results, often causing them to desire further procedures. As a result, BDD is contraindicated for cosmetic procedures.

About 70 percent of survey respondents said they would refuse to perform cosmetic procedures in a patient they suspected of having BDD.

Plastic surgeons were more likely to refer patients to a psychiatrist or psychologist and to refuse treatment in a patient with BDD, compared to the other groups of cosmetic professionals. About 16 percent of cosmetic professionals reported verbal altercations, while six percent received legal threats.

“Most of the cosmetic professionals in our sample reported to have a considerable degree of awareness of BDD and to use this knowledge in their decision whether or not to perform a cosmetic procedure,” Bouman and coauthors write.

While generally consistent with previous studies, the results indicate an “apparent underdiagnosis” of BDD.

This suggests that cosmetic professionals should receive education about recognition and management psychological contra-indications to cosmetic procedures.

Bouman and colleagues concluded, “This would make the exploration of body image problems (such as BDD) a standard topic in every patient encounter in a cosmetic clinic.”

Source: Wolters Kluwer Health/EurekAlert

Body Dysmorphic Disorder May Be Overlooked In Those Seeking Cosmetic Surgery

Rick Nauert PhD

Rick Nauert, PhDDr. Rick Nauert has over 25 years experience in clinical, administrative and academic healthcare. He is currently an associate professor for Rocky Mountain University of Health Professionals doctoral program in health promotion and wellness. Dr. Nauert began his career as a clinical physical therapist and served as a regional manager for a publicly traded multidisciplinary rehabilitation agency for 12 years. He has masters degrees in health-fitness management and healthcare administration and a doctoral degree from The University of Texas at Austin focused on health care informatics, health administration, health education and health policy. His research efforts included the area of telehealth with a specialty in disease management.

APA Reference
Nauert PhD, R. (2018). Body Dysmorphic Disorder May Be Overlooked In Those Seeking Cosmetic Surgery. Psych Central. Retrieved on November 24, 2020, from
Scientifically Reviewed
Last updated: 8 Aug 2018 (Originally: 7 Feb 2017)
Last reviewed: By a member of our scientific advisory board on 8 Aug 2018
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