Is Body Dysmorphic Disorder Screening Mandatory Before Cosmetic Procedures?


As aesthetic procedures become increasingly common in the lives of more and more people, the psychological well-being of individuals seeking these services is also becoming increasingly important. The pursuit of aesthetic treatments, particularly by individuals with body dysmorphic disorder (BDD), can pose serious risks for both the patient and the practitioner. So, should BDD screening be performed in non-surgical aesthetic procedures? Why is it so important? Here are the answers to these questions and a noteworthy study…

What is Body Dysmorphic Disorder?
Body dysmorphic disorder is a psychiatric disorder characterized by an intense focus on and obsession with flaws in an individual's physical appearance that are unnoticed or deemed unimportant by others. The individual may constantly look in the mirror, seek approval from others about their appearance, or attempt to "correct" this perceived flaw through cosmetic procedures.

According to the DSM-5 diagnostic criteria, a BDD diagnosis can be made in the following situations:

The perceived physical flaw is insignificant or invisible to others.

The individual exhibits obsessive behaviors about this defect (constantly looking in the mirror, picking at skin, making comparisons, etc.).

This condition seriously impacts the individual's social life, professional functioning, or overall quality of life.

BDD can be accompanied by depression, anxiety, social phobia, and even suicide risk. For these individuals, cosmetic procedures, however, are not a solution but rather a tool that increases their risk.

Why Should BDD Screening Be Conducted in Aesthetic Clinics?
Individuals with BDD are highly likely to be dissatisfied with cosmetic procedures. Some patients may even believe their appearance has worsened after the procedure. This is not only psychologically distressing but also poses serious legal and security risks for the practitioner. There are cases in the literature of plastic surgeons who have been threatened or even physically assaulted by patients with BDD.

Unfortunately, however, many aesthetic clinics do not systematically screen for BDD. One reason for this is the scarcity of screening tools and the practitioner's lack of knowledge on the subject.

Is it Possible to Reduce Risks with a Multi-Stage Screening Protocol?
In a new pilot study conducted in the US, a multi-stage BDD screening protocol was implemented at eight different medical aesthetic clinics. The protocol began with anonymous pre-screening forms given to new patients aged 18-65 seeking aesthetic procedures. These forms assessed the individual's aesthetic motivation, and statements such as "I want to look perfect" or "I want to feel like I'm 20 again" were considered red flags.

Patients deemed at risk after this pre-screening were then subjected to a more comprehensive second evaluation. The striking results were:

734 patients were screened over a 16-week period.

4.2% advanced to the second stage.

29% of these patients were found to be positive for BDD.

77.8% of the positive patients did not receive treatment.

However, some patients were treated in a controlled manner after the third evaluation, and positive results were achieved.

These findings demonstrate the importance of a confidential yet effective screening protocol for both patient safety and managing clinical responsibility.

Recommendations for Aesthetic Clinics
Receive BDD training: All aesthetic practitioners should participate in basic psychiatric awareness training to recognize the signs of BDD.

Use simple yet effective screening forms: Structured questions aimed at understanding the patient's aesthetic motivation can help identify red flags early.

Don't hesitate to refuse treatment: Refusing treatment for individuals with questionable or positive screening results protects both the patient and the clinic staff.

Provide specialist referral: Individuals at risk for BDD should be appropriately referred to a psychiatrist. This allows the patient to receive the necessary psychological support.

Take the consent process seriously: In cases like BDD, even the capacity to consent can be questionable. Therefore, consent forms should be detailed and descriptive, and a specialist should be consulted if necessary.

Conclusion: The Limits of Beauty Begin with Psychology
Aesthetic procedures are about much more than simply altering appearance. A person's desire for aesthetic procedures often stems from psychological needs and deep-seated motivations. Early diagnosis and appropriate management of conditions such as body dysmorphic disorder are crucial for both patient health and clinical reputation. Remember, the best aesthetic results are achieved through appropriate patient selection, ethical approach, and psychological awareness.