Body dysmorphia – in the eyes of the beholder - Sovereign Health Group
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Body dysmorphia – in the eyes of the beholder
02-15-17 Category: Empowerment, Mental Health

They say bartenders and hair stylists are the frontline therapists, as they’re listening ears when people come to them to escape problems or feel good about themselves.

Cosmetic surgeons are perhaps the third leg to this therapeutic pedestal and – though they are often typified to the contrary – can offer sincere, timely interventions for a demographic otherwise hard to reach: those with body dysmorphic disorder, or BDD.

A newly released study shows BDD may be underdiagnosed in patients seeking cosmetic procedures. Cosmetic clinicians could be the most well-received mediators to recommend treatment for this mental health issue.

Body dysmorphia and its different shapes

Body dysmorphia is categorized in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, as an obsessive compulsive spectrum disorder. The National Institutes of Health explains BDD “consists of a distressing or impairing preoccupation with imagined or slight defects in appearance. … It is important to recognize and appropriately treat BDD, as this disorder is associated with marked impairment in psychosocial functioning, notably poor quality of life, and high suicidality rates.”

Sovereign Health of California incorporates a biopsychosocial assessment in our eating disorder program prior to admission. We also use cognitive behavioral therapy and other evidenced-based modalities to treat all co-occurring conditions concurrently.

Marek Dobke, M.D., is a professor of surgery and the head of the Division of Plastic Surgery at the University of California, San Diego, and holds his own practice in La Jolla, California. He emphasizes that there are different volumes to body dysmorphia and not all necessitate treatment.

“Depending on how we define body dysmorphic disorder, those within the practice of cosmetic surgery position themselves appropriately in helping this patient.” He goes on to describe what he calls a reasonable BDD. “Someone comes in and they have a slight mole, that may seem large to them and they’d like it removed. Their reaction and perception is dysmorphic but the feature is easily resolved. There are extremes: There are situations when body dysmorphic disorder is easier to understand or understandable,” Dr. Dobke says.

He goes on to explain another scenario. “Let’s say a young girl cannot get a date and is socially isolated because she has huge breasts. That’s not an aberration to not to like [this body feature] you just have to be practical about it. We can easily resolve, and it would be insensitive to send her to a psychiatrist for this. So plastic surgery frequently is in a position that gauges body dysmorphic disorder,” and often when they have the patients’ full attention and receptivity.

BDD and a warm-lead intervention

Katharine Phillips, M.D., with the International OCD Foundations agrees. “Perhaps the most important thing to keep in mind is that many patients with BDD do not spontaneously reveal their BDD symptoms to their clinician because they are too embarrassed and ashamed, fear being negatively judged.”

Dr. Dobke reveals, “when you are dealing with extremes it’s easier to redirect the patient” – whether it is a singular desire for change within cultural norms, he says, or an unreasonable BDD case that can be intercepted within the cosmetic surgery team – “but it’s much harder when body dysmorphic disorder is more occult and not apparent. … This is where plastic surgery experience must be utilized to do what’s best for the patient.”

The study

A survey in February’s issue of the journal Plastic and Reconstructive Surgery polled nearly 175 cosmetic professionals in the Netherlands and found:

  • Only 7 percent routinely addressed body image concerns through the lens of mental health.
  • Less than half reported collaborating with psychologists or psychiatrists.
  • Seventy percent of the respondents said they would refuse to perform cosmetic procedures in a patient they screened who demonstrated having serious BDD.
  • Sixteen percent of cosmetic professionals reported verbal confrontations by patients.
  • Six percent received legal threats.

In an article on the study, Science Daily details “most patients with BDD seek plastic surgery or other cosmetic procedures,” which can lead to reliable business for a plastic surgeon. “However, they are generally dissatisfied with the results,” which can lead to subsequent bad reviews for the practice, but then again a patient’s unaddressed BDD “often cause[s] them to desire further procedures. As a result, BDD is considered a ‘contraindication’ for cosmetic procedures.”

Contraindication as it may be, Dr. Dobke says his industry colleagues have an opportunity to be the bastion for BDD recognition and intervention.

Drawing the line

Dr. Dobke explains that cosmetic surgeons are equipped to handle both sides of the extremity pendulum: cosmetic alterations for reasonable requests and interventions for serious BDD. “In general, in the cosmetic arena, we do not operate after one encounter; there is often requests for a second meeting and request that the prospective patient be accompanied by a third party, come with spouse or parents … so we avoid operating based on impulse – and body dysmorphic disorder frequently ends up in our office because of impulse, or [mentally ill] and persistent [calling].”

Dr. Dobke says, in his practice, he sees about one mentally disordered person in need of treatment a month, and likely more, as the plastic surgery prospects go through a dutiful prescreen team.

“Probably there is more than I meet. With the extreme cases where there is nothing abnormal with the individual and they still insist … we still see the patient, to help the patient. We cannot allow the patient to come in unscrupulous hands and be exploited elsewhere. We know beforehand we will not even touch the patient but at least we will try to channel the patient and the implications.”

Dr. Dobke affirms that intervention supersedes business opportunity, because BDD individuals have high suicidality, and there is no gain from operating on someone who self-harms and has suicidal ideations. He has seen from experience the difference an intervention in his office could have made with someone with extreme BDD.

If you know someone who – or you, perhaps – frequently obsesses over and loathes body features in a perpetual preoccupation, there is no more dramatic makeover than one from the inside, out. Sovereign Health is licensed to treat mental disorders that drive substance abuse, eating disorders and psychological issues. We offer refreshing coastal and desert oasis retreats so individuals can get away to recover and revamp: first the mind, then the body. Call our 24/7 helpline for details.

About the author

Kristin Currin-Sheehan is a Sovereign Health writer and her intriguing storytelling has been featured with Sovereign Health, KPBS TV/FM, FOX5 News in San Diego and NPR. Her illustrative and relatable approach to digital and broadcast news bridges businesses and consumers, news and community. For more information and other inquiries about this media, contact the author at

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