Key points
- Body dysmorphic disorder is a mental health condition in which a person is excessively preoccupied with slight or perceived flaws in their appearance, to the point that it interferes with daily life [1].
- In a systematic review that pooled many studies, the estimated prevalence was 1.9% among adults in the general population, 13.2% in cosmetic surgery settings, and 20.1% in rhinoplasty settings [2].
- It has been reported that when people with body dysmorphic disorder have surgery, the results are usually poor and symptoms can actually get worse [1, 3].
- Mental health treatment, such as cognitive behavioral therapy, is at the center of care, and it is described as helpful for most patients [1].
What is body dysmorphic disorder?
Body dysmorphic disorder (BDD) is a mental health condition that mainly appears in adolescents and young adults, regardless of gender [1]. People with this condition perceive their own appearance in a distorted way and become preoccupied with a minor flaw, or one that is not actually there, in any part of the body, such as the face, nose, skin, or hair, and this ends up interfering with daily life [1].
People with this condition often visit several doctors for examinations and request cosmetic procedures because of the flaws they perceive [1]. In plastic surgery, the condition is identified in some patients who request multiple cosmetic operations [4]. Although it is relatively common, it has long been poorly recognized [1].
How common is it?
A 2016 systematic review estimated its prevalence in various settings as weighted averages [2]. The figures were 1.9% among adults in the general population, 2.2% among adolescents, and 3.3% among student populations [2]. In contrast, the estimates were higher in general cosmetic surgery settings (13.2%), rhinoplasty settings (20.1%), orthognathic (jaw correction) surgery settings (11.2%), and dermatology outpatient clinics (11.3%) [2].
In most settings, women outnumbered men, but this was not the case in cosmetic surgery and dermatology settings [2]. The researchers concluded that body dysmorphic disorder is common in some psychiatric and cosmetic settings but often goes unrecognized [2]. These figures are estimates pooled from studies in many countries, so they cannot be assumed to match the situation in Korea.
Why surgery may not help
A literature review in facial plastic surgery considered that body dysmorphic disorder and borderline personality disorder are common in cosmetic practice, appearing in up to 15% of patients [3]. It explained that surgery for these patients not only ends in dissatisfaction but can also worsen their existing condition [3]. It therefore stressed that it is essential to steer these patients away from surgery and connect them with cognitive therapy [3].
A 2014 literature review also considered that because surgical results are usually poor and can lead to worsening symptoms and anger, early intervention is needed to prevent a cycle of repeated surgery [1]. Body dysmorphic disorder is also a condition that can lead to severe depression and suicidal thoughts [1].
How is a concern about appearance different from the condition?
Dissatisfaction with one's appearance is in itself a common psychological experience, and it occurs not only in people with a higher body weight but also in people of normal weight [5]. People who have body contouring procedures generally focus their attention on the areas they want to change, and it has been reported that their body image often improves after the procedure [5]. However, this literature is based on Western societies [5].
The concern arises when dissatisfaction becomes extreme. Extreme dissatisfaction with body image can be a symptom of a mental health condition such as anorexia nervosa, bulimia nervosa, or body dysmorphic disorder, and these conditions can be a reason not to perform cosmetic procedures [5].
A 2022 literature review of the psychological effects of cosmetic surgery summarized that surgery appears to improve body image, but that researchers disagree about its effects on self-esteem, anxiety, and depression [6]. Mental health before surgery, education level, type of surgery, length of recovery, gender, and age influenced the direction and size of psychological changes after surgery [6].
Signs to check for yourself
A 2020 literature review described signs that medical staff should watch for carefully [3]. If several of the following apply to you, it may help to look after your emotional well-being before considering surgery.
- Placing an unrealistically large emotional meaning on a single facial feature
- A history of multiple procedures or operations
- Wanting to change a nose that was close to normal to begin with
- Emotional wounds from childhood
- Living with several mental health concerns at the same time
- Difficulties in social life or relationships
How to get help
Treatment for body dysmorphic disorder centers on medications in the selective serotonin reuptake inhibitor (SSRI) class and cognitive behavioral therapy, and it is described as helpful for most patients [1]. An approach in which professionals from several fields work together is strongly recommended [1].
If thoughts about your appearance take up much of your day and make daily life difficult, it is a good idea to see a mental health specialist first. If you feel depressed or have thoughts of harming yourself, do not try to cope alone; reach out right away to a nearby mental health service or to the people around you for help. Talking honestly about these concerns during a plastic surgery consultation also allows you and your surgeon to decide together whether surgery is the right choice for you right now.
Frequently asked questions
- If I want cosmetic surgery several times, does that mean I have body dysmorphic disorder?
- Not necessarily. A history of multiple procedures is mentioned as one of the signs that should be looked at carefully [3]. However, a diagnosis is made through an assessment by a professional. An important criterion is whether thoughts about your appearance interfere with your daily life [1].
- If I have body dysmorphic disorder, does that mean I cannot have surgery?
- The literature notes that body dysmorphic disorder can be a reason not to perform cosmetic procedures [5]. Because surgery can lead to dissatisfaction and worsening symptoms, connecting with mental health treatment first is recommended [3]. It is best to discuss surgery again after receiving treatment and seeing how you are doing.
- Will cosmetic surgery give me more confidence?
- In a 2022 literature review, cosmetic surgery appeared to improve body image, but opinions were divided about its effects on self-esteem, anxiety, and depression [6]. Many factors, including mental health before surgery, affect the outcome, so it can differ from person to person [6].
References
- Husain Z, Janniger EJ, Krysicka JA, et al. Body dysmorphic disorder: beyond skin deep. G Ital Dermatol Venereol. 2014.PubMed 25068234
- Veale D, Gledhill LJ, Christodoulou P, et al. Body dysmorphic disorder in different settings: A systematic review and estimated weighted prevalence. Body Image. 2016.PubMed 27498379DOI
- Wever CCC, Wever AMEA, Constantian M. Psychiatric Disorders in Facial Plastic Surgery. Facial Plast Surg Clin North Am. 2020.PubMed 33010863DOI
- Chan JK, Jones SM, Heywood AJ. Body dysmorphia, self-mutilation and the reconstructive surgeon. J Plast Reconstr Aesthet Surg. 2011.PubMed 20392680DOI
- Sarwer DB, Polonsky HM. Body Image and Body Contouring Procedures. Aesthet Surg J. 2016.PubMed 27634782DOI
- Kam O, Na S, La Sala M, et al. The Psychological Benefits of Cosmetic Surgery. J Nerv Ment Dis. 2022.PubMed 35766540DOI
This article is an English translation of general health information that DOY JUN Plastic Surgery compiled in Korean from the summaries (abstracts) of papers in international academic journals. Treatment methods and results vary depending on each person's condition, so please consult a specialist for an accurate diagnosis and treatment plan.
