Body dysmorphic disorder and aesthetic procedures
Aesthetic practitioners treat all kinds of people, and each one is motivated to seek treatment for different reasons. In some cases, patients may have underlying issues that encourage them to seek aesthetic procedures. In this comment piece, Eda Gorbis explores the issue of body dysmorphic disorder in aesthetic patients, and provides recommendations on how to identify and treat this psychiatric disorder
There can be multiple reasons why a patient is seeking aesthetic procedures. A recent study, published in JAMA Dermatology, found that patient motivations consisted of seeking improvements in the following: aesthetic appearance (e.g. looking younger), physical health (e.g. preventing worsening of physical conditions), and psychosocial wellbeing (e.g. feeling more confident about onesself) (Maisel et al, 2018). However, in some cases, a serious psychological disorder, body dysmorphic disorder (BDD), may be the primary reason why a patient is seeking aesthetic treatment. Dey et al (2015) showed that around 13.1% of patients seeking cosmetic surgery had BDD. Due to this prevalence and the potential negative effects of aesthetic treatment on patients with BDD, practitioners must be able to catch this disorder and refer patients to mental health professionals for proper diagnosis.
BDD, or the disease of self-perceived ugliness, is a psychiatric disorder in which afflicted individuals have a pervasive distortion of their self-image, usually by having persistent preoccupations, or obsessions, with a particular part of their body (American Psychiatric Association (APA), 2013). Common obsessions of appearance include the nose, mouth, eyelids, muscles, breasts, and penile size in males. Research has suggested that compared to individuals without BDD, individuals with BDD show abnormal brain activity when processing visual information, and this suggests that these individuals have a distorted self-image in their minds (Feusner et al., 2010). The greatest challenge for BDD patients is to learn to accept that their physical defect does not exist, or if it does, to accept it without the all-consuming desire to change it.
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