As global awareness of mental health continues to grow, the spotlight is increasingly shining on Body Dysmorphic Disorder (BDD), a mental health condition that can significantly distort self-perception.
Recent studies indicate that approximately 1 in 50 individuals worldwide suffer from BDD, a figure that underscores the widespread nature of this disorder.
For individuals seeking cosmetic or minimally invasive treatments, especially those driven by the pursuit of aesthetic perfection, BDD is even more prevalent.
This article unpacks the complexities of BDD in aesthetic patients, the warning signs and the ethical responsibilities of practitioners in the field.
What is Body Dysmorphic Disorder (BDD)?
Body Dysmorphic Disorder is a mental health condition categorised by an obsessive focus on perceived flaws or defects in one's appearance - flaws that are often imperceptible to others.
People with BDD may spend hours fixating on or trying to "correct" these perceived imperfections, leading to social withdrawal, depression and even suicidal ideation.
Societal pressures and the rise of BDD
In a world increasingly dominated by social media and unrealistic beauty standards, many individuals feel pressure to conform to these ideals.
According to Dr Alek Nikolic, an expert in aesthetic medicine, societal beauty standards and trends exert immense pressure on people to fit unrealistic ideals, which can lead to feelings of inadequacy and contribute to mental health issues like BDD.
"However, when approached with care and professionalism, cosmetic enhancements can play a positive role in improving self-esteem and overall well-being," Nikolic notes.
But the line between a healthy desire for self-improvement and the compulsions driven by BDD can be perilously thin.
Prevalence of BDD in cosmetic patients
While BDD affects up to 2.9% of the general population, this rate skyrockets among those seeking cosmetic procedures.
Recent studies indicate that 11-13% of patients in dermatology settings and up to 20% of rhinoplasty patients meet the diagnostic criteria for BDD. This suggests that individuals seeking aesthetic treatments are at a significantly higher risk of struggling with this mental health condition.
According to Nikolic, the distress caused by BDD can be so severe that it impacts patients’ ability to function socially, often leaving them feeling embarrassed and ashamed.
"They tend to feel that everyone is looking at their flaws," he explains. This pervasive sense of inadequacy frequently drives individuals to seek out cosmetic procedures in a misguided attempt to "fix" the problem, yet satisfaction remains elusive.
One of the most concerning aspects of BDD in aesthetic patients is the endless cycle of dissatisfaction. Even after undergoing cosmetic procedures, many individuals with BDD find themselves fixating on a new flaw, leading to a pursuit of additional treatments.
Nikolic emphasises, “Patients with BDD often shift their focus from one perceived flaw to another after treatment, and this should already ring an alarm for practitioners.”
This cycle can be emotionally draining for patients and burdensome for practitioners, who may feel conflicted about whether to proceed with further treatments.
Recognising the signs of BDD
Recognising the signs of BDD is critical, especially for aesthetic practitioners and those close to the patient. Some key warning signs include:
Excessive focus on flaws: Patients may spend hours obsessing over minor or imagined imperfections.
Compulsive checking: Frequently checking mirrors, taking selfies, or asking for reassurance about their appearance.
Social withdrawal: Avoiding social situations for fear of being judged or scrutinised.
Repeated procedures: Seeking multiple cosmetic interventions yet remaining dissatisfied.
Self-harm thoughts: Expressing feelings of hopelessness or suicidal ideation related to their appearance.
“Many patients with BDD may not openly discuss their concerns due to feelings of shame or embarrassment, making it essential for practitioners to be vigilant during consultations,” says Nikolic.
Ethical responsibilities in aesthetic practice
The ethical responsibilities of aesthetic practitioners cannot be overstated. While cosmetic treatments can boost confidence and help individuals feel better about their appearance, practitioners must be cautious of treating patients with underlying mental health conditions like BDD.
Nikolic stresses the importance of thorough consultations, saying, "As a health practitioner, I must understand why someone wants a certain procedure done and thoroughly explore their background before prescribing treatments."
He emphasises the need for mental health evaluations to be integrated into cosmetic consultations.
By understanding the motivations behind a patient’s desire for treatment, practitioners can better support their overall health and ensure they make informed decisions.
For practitioners, the first step may be identifying BDD in a patient. This involves not only recognizing the warning signs but also engaging in open, non-judgmental dialogue with the patient about their expectations and mental health.
In some cases, it may be necessary to refer the patient to a mental health professional before proceeding with any cosmetic treatment.
"Patients with BDD often seek cosmetic procedures as a 'quick fix' for deeper emotional or psychological issues," Nikolic notes.
"It is our responsibility to ensure that we don’t perpetuate their cycle of dissatisfaction by offering treatments that won't address the root of their concerns."