The Plastic Surgery/Body Dysmorphic Disorder Link

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People with BDD become preoccupied with perceived physical flaws. Image by Xenia.

People with BDD become preoccupied with perceived physical flaws. Image by Xenia.

A recent report produced by the American Society for Aesthetic Plastic Surgery (ASAPS) reports that Americans are increasingly turning to plastic surgery to improve their appearances.

2013 proved to be a boon for plastic surgeons, as Americans spent the largest amount on plastic surgery since before the Great Recession of 2008. There was a 12% increase in cosmetic procedures, with liposuction and breast augmentation heading the list of most popular procedures.

Eyelid and nose surgeries, as well as tummy tucks, also reached the top five list in terms of popularity.

Women and Plastic Surgery

Women disproportionately access plastic surgery;doctors performed 90.6% of the procedures on women. ASAPS attributes the growth of the industry to a recovering economy. The president-elect of the organization, Dr. Michael Edwards, believes that once people have disposable income at hand, they are more likely to invest in their appearances.

A darker side of plastic surgery suggests a link between immense social pressure to emulate models and movie stars, and appear ‘perfect.’ The strong gender discrepancy in obtainment of cosmetic surgery bolsters this point. Many women are subject to the societal and personal expectations of appearing young and slender, and they elect for surgery to help fulfill those expectations.

More problematically, some people seeking plastic surgery actually have a psychiatric disorder, Body Dysmorphic Disorder (BDD), in which they develop a distorted view of their own bodies.

BDD: Seeing is not Believing

People who have been diagnosed with BDD have significant dissatisfaction with their body images. They are preoccupied or obsessed with a minor or nonexistent flaw in their physical appearances, such as imaginary stomach flab in a person who appears to have a flat stomach. The flaw can involve one particular area of the body, or the body as a whole.

The preoccupation with the body flaw causes the person to feel distressed and to function poorly. One feature of BDD is obsessive-compulsive type of behavior, including endless mirror gazing and skin picking. These habits often cause BDD sufferers to avoid other people. Often, people with BDD have poor relationships and are socially isolated.

While this condition only affects around 2% of the general population, BDD is 15 times more prevalent in patients who seek to obtain plastic surgery. Furthermore, patients with BDD have been found to have an increased propensity toward enacting violent or threatening behaviors toward their surgeons. BDD has a neurobiological basis, so surgery without mental health intervention is unlikely to help those with BDD to accept their bodies.

Still No Satisfaction

A 2012 study led by Dr. Sandra Mulkens of Maastricht University in the Netherlands found that plastic surgery either was completely ineffective in treating BDD, or caused the symptoms to be worse. The researchers sent questionnaires to patients who had received plastic surgery to determine level of satisfaction in patients with BDD. The results showed that the patients who displayed a high level of BDD symptoms were more likely to feel dissatisfied with the results of the surgery than patients with a low level of BDD symptoms.

Given that surgery alone does not help, plastic surgeons are recommended to screen their patients before performing surgery. Common red lights that suggest BDD are repeated consultations with cosmetic surgeons, expectations that all of a patient’s problems will be solved through the surgery, and demanding behavior. If the pre-surgery screening points toward BDD, the patient should be referred to a psychiatrist. Interestingly, one accepted potential treatment for BDD is surgery, as long as it’s accompanied by psychotherapy.

Selfie-Induced Societal Pressure

A study by another medical organization, the American Academy of Facial Plastic and Reconstructive Surgery, points to another trend that suggests poor mental health: social media leading patients to request plastic surgery. Patients have explained to their surgeons that photo sharing and increased exposure of their images on social media sites have led them to seek surgery, such as rhinoplasty (nose jobs) and hair transplants. Seeing their pictures on sites leads people to view themselves with a far more critical eye. It seems that their self images are jabbed by their selfies, causing increased dissatisfaction.

Even more disturbing from a mental health viewpoint, the study found a connection between bullying and cosmetic surgery. The same study found that 69% of plastic surgeons surveyed reported that bullying prompts children and teens to undergo plastic surgery. They, and their parents, are willing to undergo the pain, risk and cost of unnecessary surgery in order to escape the scarring effects of bullying.

Plastic Surgery: Right or Wrong?

Plastic surgery can lift the spirit as well as the body. Its many proponents can spout the physical and mental benefits. Yet, behind the growing popularity of cosmetic procedures often lies insidious factors, such as low self-esteem, peer pressure, bullying and even Body Dysmorphic Disorder. In some cases, mental health treatment, and not a surgical consultation, is in order.

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