What is body dysmorphic disorder?


BDD is a mental disorder characterized by an exaggerated perception and obsessive focus on an otherwise unnoticeable or insignificant flaw in one's appearance. According to the American Psychiatric Association's DSM-5 diagnostic criteria, these individuals experience intense anxiety about their physical appearance, frequently engaging in behaviors such as mirror gazing, comparisons, and a constant need for approval. This obsession leads to serious disruptions in social relationships, work, and overall functioning.

Why Should Body Dysmorphic Disorder Be Screened in Cosmetic Surgery Patients?

A significant number of individuals seeking cosmetic procedures may experience severe obsessions with their appearance. So, at what point do these obsessions become a psychiatric disorder? This condition, called body dysmorphic disorder (BDD), is quite common in cosmetic dermatology but often overlooked. However, cosmetic procedures performed on patients with BDD can cause serious problems both in terms of outcome and the patient-doctor relationship. In this article, we will discuss the importance of screening for body dysmorphic disorder in cosmetic dermatology clinics, based on a scientific pilot study.

Why does BDD pose a significant risk in aesthetic procedures?
Patients with BDD frequently undergo aesthetic procedures to correct what they perceive as a "flaw" in their appearance. However, the procedures often fail to produce the desired results because the problem is psychological, not physical. In this case,

Patient satisfaction decreases, and complaints and requests for repeat procedures increase.

Legal risks and even physical threats may arise for the healthcare professional performing the procedure.

The patient may perceive their appearance as worsening after the procedure.

According to the literature, 10% of patients with BDD have threatened surgeons, 2% have physically assaulted them, and unfortunately, some physicians have lost their lives as a result of these causes.

How common is BDD in aesthetic clinics?
While the prevalence of BDD in the general population ranges from 0.7% to 2.4%, this rate rises to over 14% in patients presenting to aesthetic clinics. This dramatic increase demonstrates that BDD is a condition that must be considered in cosmetic dermatology. However, many clinics still lack systematic screening for BDD, creating significant risks for both patients and practitioners.

What was the purpose of the multi-stage screening protocol?

In this pilot study conducted at eight aesthetic clinics in the United States, the aim was to assess the possibility of BDD in individuals seeking aesthetic procedures through a confidential and systematic screening. Practitioners administered an anonymous pre-screening form to all new patients. The form included unhealthy motivational statements such as "I want to look perfect" or "I want to look 20 again." Patients who selected such statements were then subjected to a second, detailed screening.

What did the study results show?
During the 16-week screening period:

A total of 734 patients were evaluated.

4.2% (31 patients) progressed to the second stage of screening.

Nine of these patients (29%) tested positive for BDD.

Of those who tested positive, 77.8% (7 patients) were not treated.

Two of these 7 patients were subsequently placed on appropriate treatment after additional evaluation, and a positive outcome was obtained.

These results demonstrate that a simple and effective screening protocol can identify individuals at risk for BDD and make the process safer.

Why is screening so critical?
Patients with BDD who experience dissatisfaction after the procedure may be in a psychological state that can harm not only themselves but also the practitioner. Furthermore, the ability of an individual diagnosed with BDD to give medical consent can be questionable. Therefore, the physician should evaluate not only the aesthetic suitability of the procedure but also the patient's psychological suitability.

How can BDD screening be initiated in aesthetic clinics?
A simple, anonymous preliminary screening form can be used for new patient applications.

Individuals who indicate unhealthy motivations should be evaluated in a second stage evaluation.

If necessary, psychological support should be offered to the patient before the procedure.

Practitioners should receive training on BDD and learn to identify high-risk individuals.

Conclusion: In aesthetics, not only appearance but also the inner world is important.
Aesthetic dermatology practices should be conducted with an approach that considers not only physical but also psychological integrity. Procedures performed on individuals with body dysmorphic disorder can often cause harm rather than benefit. Therefore, systematic BDD screening in aesthetic clinics is vital for the safety of both patients and healthcare professionals.

Dr. Fatma Yıldız
Ankara Life Polyclinic
"On the path to beauty, one must begin with a healthy mindset."