Body dysmorphic disorder: the ongoing effects of lockdown on mental health

The lockdown imposed as a result of the COVID-19 pandemic has seen a rise in body dysmorphic disorder cases

Being in lockdown as a result of the coronavirus pandemic stoked fears in everyone. For some, it was the fear of losing loved ones or of contracting the virus themselves and becoming sick. Others feared the financial implications of being in lockdown: redundancy or their business failing, or finding a way to adapt while working from home and adequately homeschooling their children, while others feared a combination of all the above. Being contained at home with no escape from the stress and uncertainty of the worldwide situation made it easy to become transfixed on various hobbies, and lockdown saw a surge in DIY projects and home improvements as a corner of the home or garden became the focus during all those empty hours. Unfortunately for some people, it was not an area of their home or garden that became the transfixion during lockdown, but rather, an aspect of themselves that they believed needed to change—perhaps their weight or a facet of their appearance, such as the shape of their nose or skin texture. It has been reported that lockdown not only saw cases of those already suffering with body dysmorphic disorder (BDD) (Box 1) experience their symptoms worsen, but it also saw a rise in people developing the disorder as a result of the imposed restrictions. Before going into lockdown, it was estimated that 2% of the population in the UK suffered from BDD, which equates to one in every 50 people worldwide (2013). However, this number is expected to be higher, as many sufferers of BDD do not realise that it is a psychological disorder and are often too embarrassed or ashamed by their obsession with their appearance to report their symptoms to a doctor (Phillips, 2007). If all people with BDD were to be properly diagnosed, it is thought that the disorder would be more common than conditions such as anorexia nervosa and schizophrenia (Bjornsson et al, 2010). At the moment, it is too early to know the true rise in people with BDD following lockdown but reports from organisations such as the International OCD Foundation and the BDD Foundation indicate that it is staggering. A study conducted before lockdown revealed that 70% of patients with BDD seek some sort of cosmetic or aesthetic procedure, with under 10% of whom being satisfied with the results (Sarwar, 2002). It is because of this that BDD patients have always been problematic for the aesthetics sector. Cosmetic practitioners need to be aware not just of new clients coming into clinic expecting treatments for imagined flaws, but also of regular patients returning following lockdown and seeking advice and treatment for concerns that they have never mentioned or presented before.