Cosmetic Surgery and Body Dysmorphic Disorder: Should Surgeons Assess Patients’ Mental Health?

December 21, 2015

It’s only natural for people to have insecurities. The majority of individuals will admit to wanting to change one or two physical features if they could. However, for those with Body Dysmorphic Disorder (BDD), a psychological condition that sees sufferers obsess over their physical appearance, there’s no escaping their insecurities. Many sufferers are convinced they’re ugly and in some cases they can battle loneliness, depression and even suicidal thoughts.

With many sufferers spending the majority of their day-to-day lives worrying about how they look, many people with BDD turn to cosmetic surgery to alter their appearance. In fact, it’s believed that up to 40% of individuals with the condition turn to plastic surgery.

Can cosmetic surgery help?

Up to 15% of cosmetic surgery patients are thought to have BDD and while some people feel that their looks improved after a procedure, others worry about the same issue they wanted to correct. A 2010 study revealed that just 2% of cosmetic surgery procedures conducted on patients with Body Dysmorphic Disorder resulted in satisfaction. Eight out of 30 patients reported to feel worse.

If a cosmetic surgery procedure was to go wrong at the hands of a negligent surgeon, the impact on the victim’s mental health could be devastating. However, since BDD causes sufferers to have a distorted view of how they look, patients may feel worse even if the surgeon acted professionally and the procedure went as promised. In some cases, patients may start to obsess over other aspects of their appearance. For example, a person who was originally dissatisfied with the shape of their nose, may start to obsess over their chin or lips after undergoing a rhinoplasty.

Can BDD be treated?

Although studies suggest that people with BDD don’t usually benefit from cosmetic surgery procedures, pharmacotherapy and cognitive-behavioral psychotherapy treatments can have a more positive impact on the sufferer’s mental health. Unfortunately, many BDD sufferers are unaware that these types of treatment are available to them. They’re often so consumed in their negative thoughts that they believe changing their appearance physically is their only option.

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The benefits of mental health screenings

When an individual meets with a cosmetic surgeon for a consultation, they’re unlikely to be questioned about their motives for seeking surgery, nor are they likely to be referred for a mental health examination. As a result, it’s only too easy for a BDD sufferer to access cosmetic surgery without trying less-drastic treatments first.

Reid Ewing, an actor from ABC’s Modern Family, recently wrote about how he’d had numerous cosmetic surgery procedures in a bid to overcome Body Dysmorphic Disorder. Riddled with negative feelings and a lack of confidence, he first started having surgery at the age of 19. However, after having several procedures from a variety of surgeons, he regrets his choice to repeatedly go under the knife.

In an article for The Huffington Post, Ewing wrote about how his first surgeon failed to prepare him for the after-effects of cosmetic surgery. In the weeks after the operation, he was let feeling isolated and afraid to show his face to others. Convinced he needed more treatment to improve his appearance further, he met another surgeon who operated on him on the very same day. In the years that followed, Ewing had a number of other surgeries with two other doctors, but he claims that not once was he referred for a psychological assessment.

He wrote: “Of the four doctors who worked on me, not one had mental health screenings in place for their patients, except for asking if I had a history of depression, which I said I did.”

If surgeons were to make prospective patients aware of the alternatives rather than operating on those they suspect to have mental health issues, not only could patients benefit, but those working within the industry could also benefit too.

The legal implications of operating on BDD sufferers

Although there are no laws that stage surgeons must carry out a psychological assessment on all prospective patients, those that operate on patients with BDD could see themselves facing legal implications in the future. Researchers have suggested that BDD sufferers are unable to properly consent to such drastic measures as they’re mentally ill and see themselves in a distorted light.

Due to the legal issues commonly associated with conducting cosmetic surgery on people with body dysmorphia, not to mention the risks to an individual’s mental wellbeing, it could be argued that those within the industry need to take more care when assessing the mental health of prospective patients.

Since BDD is a psychological condition and studies have suggested it cannot simply be fixed with the help of a surgeon’s scalpel, patients could go through a costly and painful procedure only to feel no better about their appearance after their scars have healed.

By screening those seeking cosmetic treatments and assessing their motivations and psychiatric status, surgeons can minimize the risk of dissatisfied patients and costly legal proceedings.

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