Patient emotional and psychological safety

This guidance document proposes actions that JCCP registrants might seek to undertake to assure themselves that someone is not experiencing Body Dysmorphic Disorder (BDD) before they undertake treatment. The JCCP recognises that BDD forms a discreet aspect of the psychological wellness and morbidity spectrum, and practitioners should review this paper in that context. However, the JCCP's increasing understanding of the vulnerable nature of many individuals seeking cosmetic procedures necessitates a renewed focus on this specific area of concern.

BDD is characterised by a preoccupation with an imagined defect in one's appearance, or in the case of a slight physical anomaly, the person's concern is markedly excessive. BDD is characterised by time-consuming behaviours such as mirror gazing, comparing particular features to those of others, excessive camouflaging tactics to hide the defect, skin picking and reassurance seeking. Experience in the cosmetic sector shows that individuals with possible BDD may be less risk-averse, being prepared to accept a level of procedural risk that is disproportionate to the concern at hand when viewed objectively. They are more likely to be ‘cosmetic shoppers’ with a history of seeking interventions from a range of practices or training organisations locally or nationally. The effort expended by such users of cosmetic services is typically characterised by diminishing satisfaction in how they look. These are ‘red flag’ features that can be readily identified through the provision of sufficient questioning of the person's medical and cosmetic history.