BDD and Plastic Surgery

Modern Family actor Reid Ewing has been in the news this week discussing his struggles with body dysmorphic disorder (BDD) and the plastic surgery operations he sought out to “fix” his “problem.”

BDD has been the topic of more media stories and discussions lately, though many people do not understand the disorder, especially when it comes to its relationship with cosmetic surgery.

Not everyone who seeks out cosmetic surgery to fix a perceived flaw has BDD, just like not everyone who has BDD seeks out plastic surgery. But how can you know the difference? How do families and loved ones know when to be concerned? And when should cosmetic surgeons recommend treatment for BDD rather than costly cosmetic surgeries?

I like to explain the difference between normal and disordered thinking this way:

A common story shared by many people with different psychiatric disorders is the experience of having your brain “get stuck” on a thought, idea, or problem. For those struggling with substance abuse, a lot of time is spent thinking about getting their next high. For individuals with an eating disorder they spend a lot of time thinking about their weight, for example.

We know from research using brain imaging technology that the brains of people with BDD actually process visual information differently than individuals without BDD. As a result they become preoccupied with details about their appearance even when those details are not noticed by others.

Reid Ewin recently explained his experience working with cosmetic surgeons to fix his perceived flaws in a blog on the Huffington Post:

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, and that was that. My history with eating disorders and the cases of obsessive compulsive disorder in my family never came up. None of the doctors suggested I consult a psychologist for what was clearly a psychological issue rather than a cosmetic one or warn me about the potential for addiction.

People with body dysmorphic disorder often become addicted to cosmetic surgery. Gambling with your looks, paired with all the pain meds doctors load you up on, make it a highly addictive experience. It’s a problem that is rarely taken seriously because of the public shaming of those who have had work done. The secrecy that surrounds cosmetic surgery keeps the unethical work practiced by many of these doctors from ever coming to light. I think people often choose cosmetic surgery in order to be accepted, but it usually leaves them feeling even more like an outsider. We don’t hear enough stories about cosmetic surgery from this perspective.

Unfortunately, this experience is common among individuals with BDD. The thinking, “If I can change how I look, then it will solve the problem,” is a dangerous trap to fall into. Reid’s story is a perfect example of the lack of training in the cosmetic surgery industry and the cycle of botched surgeries that can ensnare individuals with BDD.

But even when surgeries go as planned for individuals with BDD, the most common outcome is no change in the severity of BDD symptoms (Phillips et al., 2001). This means a person with BDD could be fixated on a perceived problem with his nose, undergo surgery that may perfectly correct the perceived flaw, but he still would not be satisfied with his appearance.

For someone with BDD, surgery cannot “fix” the problem because the real issue isn’t actually about an individual’s appearance. For those lucky enough to get a proper BDD diagnosis and find a properly trained mental health therapist, treatment is available and effective for many. But for the majority of those affected, not only do they not know where to look for help, they don’t really know what the problem is.

Stories like Reid’s are critical to increasing awareness and visibility of BDD. It is a crippling psychiatric disorder with high rates of suicidality. We want to applaud Reid for his courage in sharing his story as a way of helping so many affected by this cruel disorder.