by Megan M. Kelly, PhD, Elizabeth R. Didie, PhD, & Ashley S. Hart, PhD
Reasons for Cosmetic Treatments
Since appearance concerns are the focus of BDD, individuals with this disorder commonly seek out and receive cosmetic treatments to correct their perceived “flaws” instead of psychiatric treatments. Individuals with BDD seek out cosmetic treatments in order to reduce body dissatisfaction related to their appearance concerns, and believe that changing their appearance with these treatments will resolve these appearance concerns (Mulkens et al., 2012). However, these treatments don’t usually make their appearance concerns disappear, often the level of distress and degree of concern remain unchanged, and in some cases, the appearance concerns may get worse (Crerand et al., 2005; Phillips et al., 2001).
Types of Cosmetic Treatments
- Cosmetic surgery is a commonly sought treatment for individuals with BDD, with 26%-40% of individuals with BDD pursuing cosmetic surgery.
- In two studies, 71%-76% sought and 64%-66% received some type of medical treatment for BDD (e.g., surgical, dermatological, dental).
- In American cosmetic surgery samples, 7%-8% of individuals meet criteria for BDD and in international cosmetic populations, the prevalence rates vary greatly, ranging between 3%-53%.
- Cosmetic rhinoplasty is one of the most common cosmetic surgical procedures received by individuals with BDD because preoccupations with the nose is one of the most common preoccupations in BDD. Research on individuals seeking rhinoplasty found that 21% met criteria for BDD. According to this study, patients with BDD are different from patients without BDD who normally seek rhinoplasty – they tend to be younger, more depressed, more anxious, are more preoccupied by thoughts about their nose, have more compulsive behaviors, and have poorer psychosocial functioning.
- Skin concerns are another common BDD concern and as a result, dermatologists are the physicians most often seen by individuals with BDD.
- Prevalence rates of BDD in dermatology settings range from 9%-15%. One recent study showed that 14% of individuals in cosmetic dermatology settings met criteria for BDD compared to 7% in general dermatology settings (Conrado et al., 2009). The most common dermatological treatments that were sought in this study were the use of topical agents, chemical peels, plastic surgeries, nonablative lasers, fillers, systemic isotretinoin, and botulinum toxin.
- In addition, compared to individuals with BDD in general dermatology settings, individuals with BDD in cosmetic dermatology settings are more likely to be dissatisfied with the treatment outcome.
- Individuals with BDD also seek out other types of cosmetic procedures, including dental and other aesthetic treatments. In one study, 4.2% of dental patients met criteria for BDD compared to 1.5% in a general population sample (De Jongh, Aartman, Parvaneh, & Ilik, 2009).
- Another study of orthodontic patients indicated that 7.5% met criteria for BDD (Hepburn & Cunningham, 2006).
- Two studies have investigated the prevalence of BDD in reconstructive surgical settings (e.g., breast reconstruction), and found that 7%-16% of patients showed symptoms consistent with BDD.
- Individuals with BDD also seek out treatments from paraprofessionals, for instance, seeking electrolysis, hair plugs, and other types of nonmedical treatments.
Effect of Cosmetic Treatment on Individuals with BDD
Most individuals with BDD continue to be dissatisfied with their appearance following cosmetic treatment. Amongst a sample of 200 patients with BDD who received cosmetic surgery, the most common outcome was no change in the severity of BDD symptoms (Phillips et al., 2001). In a sample of individuals with BDD who received surgical and minimally invasive procedures for their appearance concerns, 25% showed a longer-term improvement in their preoccupation with the treated body part, but only 2.3% of surgical and minimally invasive procedures led to longer-term improvement in overall BDD symptoms (Crerand, Menard, & Phillips, 2010).
Research on dermatology patients with BDD indicates that they are often dissatisfied with and have a poor response to dermatology treatments. In addition, clinical observations indicate that appearance preoccupations may shift to other body areas following cosmetic treatments. In some patients, BDD symptoms may become more severe following cosmetic treatments.
One area for concern is the risk of suicidality and violent behavior in some individuals with BDD who seek cosmetic treatments. Rates of suicidality in individuals with BDD are quite high, including suicidal ideation and suicide attempts. In some cases, individuals with BDD can become depressed following cosmetic treatments, because they are upset about the lack of improvement in their symptoms or what they perceive to be a procedure that made their appearance look worse.
Although there is little research on the association between cosmetic treatments and risk for suicidality, studies of women who have sought breast augmentation have shown suicide rates that were two to three times higher than rates in the general population. Higher rates of suicidality in this population may be related to BDD psychopathology, although a direct link has not been made. In addition, there is an increased risk of violent behavior towards physicians providing cosmetic treatments. In one study, 2% of cosmetic surgeons indicated that they had been physically threatened by a patient with BDD (Sarwer, 2002).
Since cosmetic treatments for BDD rarely resolve symptoms of BDD, and in some cases, make symptoms worse, cosmetic treatments are not recommended for this disorder. Several evidence-based treatments exist for BDD that are associated with improvement in symptoms and functioning, including serotonin reuptake inhibitors (SRIs), and cognitive-behavioral therapy.
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