Many of us can identify something about our face or body that we do not like. Maybe we can even identify a few things. In the majority of people these perceived flaws do not fit the notion of physical beauty and, if they were corrected with cosmetic surgery, may actually make the patient look more attractive. Most of us have a reasonable self image or body image. When we see a feature that could be improved or enhanced we either have surgery to change it, wish to have surgery some day or simply live with the less-than-ideal feature. Some people, however, do not have the self-esteem or positive self image to rationally consider a flaw and move on.
Body dysmorphic disorder (BDD) is a psychiatric disorder in which the sufferer is exceedingly preoccupied with minor or even nonexistent “flaws” in their appearance. They seek out the services of cosmetic surgeons, dermatologists and other specialists in a never-ending pursuit of perfection. Sadly perfection is rarely achieved, either because the “flaw” was not “corrected” or one surgery reveals to the patient’s mind another “imperfection” that must be addressed.
In BDD, appearance becomes an obsession. People with BDD avoid social interactions because they are ashamed of their appearance or fear ridicule. They constantly seek reassurance from others about their appearance, which put strain on relationships. Patients with BDD will commonly worry about their appearance for hours each day.
Shrewd plastic surgeons can identify people with presumed or borderline BDD and require that these patients seek psychiatric treatment before surgery. This saves the patient from potentially disfiguring surgery and from multiple procedures. Unfortunately people with severe BDD may ignore this advice and shop around for a surgeon that will perform surgery without therapy.
Patients with BDD often request many cosmetic procedures. They frequently change surgeons and physicians either because they feel that they are not getting the results that they desire or the medical professional identifies BDD and refuses to operate until psychiatric evaluation and treatment are performed. In extreme cases of BDD the patient is left scarred, disfigured and penniless.
How do you know if you have body dysmorphic disorder? It is sometimes difficult to tell. Because a person with BDD has a distorted self image, it is first necessary for the patient to realize that what they are seeing in the mirror and what they believe about their appearance is actually wrong; a difficult task for anyone. There are objective tests that can be used to screen for BDD. One test that has been validated is the Multidimensional Body-Self Relations Questionnaire. This questionnaire has about 70 questions and can detect problems in self-esteem and self image.
If you feel that you may be suffering from BDD or may be at risk, it is important to postpone cosmetic surgery until you can speak with a mental health professional. While plastic surgeons and dermatologists are beauty specialists, psychiatrists and clinical psychologists are the experts of the mind. BDD is a disorder of the mind—not the body—and needs to be evaluated and treated by the proper specialist.
References
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Yanover T, Thompson JK. Self-reported interference with academic functioning and eating disordered symptoms: associations with multiple dimensions of body image. Body Image 2008;5:326-328.
Thoma A, Sprague S, Veltri K, Duku E, Furlong W. Methodology and measurement properties of health-related quality of life instruments: a prospective study of patients undergoing breast reduction surgery. Health Qual Life Outcomes 2005;3:44.
Sarwer DB, Wadden TA, Pertschuk MJ, Whitaker LA. Body image dissatisfaction and body dysmorphic disorder in 100 cosmetic surgery patients. Plast Reconstr Surg 1998;101:1644-1649.