Body Dysmorphic Disorder (BDD) and Plastic Surgery

 

Body dysmorphia is still misunderstood by many who simply consider it to be an extreme form of vanity. This is not the case, BDD is a serious mental health condition that impacts sufferers as much as disorders such as eating disorders, depression and anxiety. Everyone deserves help and understanding regardless of the mental health symptoms they are struggling with.

 

“Many people with BDD don’t always seek help as they are worried about being viewed as vain and narcissistic. The condition is incredibly misunderstood, and more funding is needed for research. Figures show that one in 330 people commit suicide each year because of their BDD, so it is important that the media helps to raise awareness of BDD and most importantly reinforce the fact that it is a treatable condition,” Prof Veale.

 

I believe, I started to struggle with the disorder when I was 15 and became determined to have breast augmentation as soon as I could. I finally was able to have a breast augmentation at the age of 20, a few months before my 21st birthday. My hope was that after having my breast enlarged I would be free to grow as a person and learn to love myself.

 

I was lucky to find a plastic surgeon who cared enough to spend hours talking to me and helped me to make sensible decisions regarding the procedures I went ahead with. BDD can impact how individuals make decisions and may make it more difficult for individuals struggling with this disorder, to fully comprehend the risks and complications of the procedure they are considering.

Visuals can be very helpful and I would recommend any plastic surgeon who has concerns about a patient, to provide images showing how possible complications can result in a poor outcome or the need for revision surgery. Provide your patient with enough time to absorb all the information. One week later I would advise you to send additional information and images to reiterate what can be realistically achieved and the risks and complications, followed by a telephone call to discuss the procedure again before agreeing to go ahead. Every plastic surgeons’ responsibility to ensure they do not perform any procedure, that could potentially damage their patient’s mental health.

With this in mind, research is still contradictory as to whether individuals diagnosed with BDD should have plastic surgery procedures. 

 

Social media and body image

 

Social media and the popularity of selfies on sites such as Facebook, Instagram and Snapchat have put pressure on vulnerable individuals to look a ‘certain’ way which may then develop into BDD.

 

Prof Veale says: “It is difficult to draw the line where body dissatisfaction stops and BDD starts. Social media, in particular Instagram, certainly play a part in showcasing perfect bodies and BDD patients just want to fit in with what they see.”

 

It is clear that an individual who is aware they have BDD would benefit from the appropriate psychological assistance prior to having plastic surgery. 

 

“At least a third of patients I see with BDD have had one or more procedures of cosmetic surgery. Although this can temporarily reduce the anxiety caused by their BDD, they will often find themselves fixating on another part of their body that they want to change. It is increasingly worrying that BDD patients are able to undergo cosmetic procedures and I’m concerned that some patients may have ‘botched’ surgery which will ultimately make the condition worse,” Prof Veale says.

 

Does the denial of plastic surgery help an individual with BDD?

 

Every surgeon needs to feel confident that any plastic surgery procedures they perform will not have a detrimental effect on the individual. I agree ‘that some patients may have ‘botched’ surgery which will ultimately make the condition worse’. However, as someone who feels they may have struggled with BDD I strongly believe denying surgery may actually make things worse. Personally, if I hadn’t been fortunate enough to be under the care of Douglas McGeorge I would have sought any surgeon willing to do what I wanted, putting me at a much higher risk.

 

In addition, if the right to choose is taken away, then the number of individuals that may seek help is likely to reduce. Put simply, to encourage anyone with a mental illness to be open and honest they need to be given the same rights as anyone, to choose what they want to do to their body. This is why I would encourage any ethical, plastic surgeon to consider their patient’s ability to make sensible decisions and provide advice and support, rather than simply turning them away if they are asking for surgery that has high associated risks.

 

A health psychology study on narcissistic and histrionic personality disorders and body dysmorphic disorder identified that they are three of the most commonly associated psychiatric conditions identified in individuals that desire plastic surgery. The results demonstrated an overall improvement in the impact of BDD after the plastic surgery procedures were undertaken. [Plastic and Reconstructive Surgery: December 2010 – Volume 126 – Issue 6 – p 2243-2251doi: 10.1097/PRS.0b013e3181f445ae]

 

Advice for family and friends

 

BDD can be very difficult to diagnose, however, there are symptoms that could indicate an individual may have BDD. Don’t be afraid to ask someone if they have heard of BDD if you notice they are struggling with any or a combination of these symptoms. Body dysmorphic disorder should be treated seriously and it is unlikely an individual will seek help without encouragement.

 

For more information about the signs and symptoms of BDD

 

When you suspect someone is struggling with any or a combination of these symptoms, please try talking to them about BDD. 

 

 

My Personal Conviction

 

It may be argued that protecting an individual’s right to choose is the only way that individuals impacted by BDD are going to be open about their symptoms and therefore have access to psychological assistance, to support them after plastic surgery.

 

I will be forever grateful to Douglas for his support and I am still extremely happy with my results almost 15 years later. 

 

My Allergen breast implants have now been withdrawn and after extensive research, I have decided to keep my implants due to the risks of revision surgery being far higher than the extremely low risk of developing BIA-ALCL. 

 

For more information from the 1st World Consensus Conference on BIA-ALCL and the latest statistics and research BIA-ALCL

 

 

Sources

 

Professor David Veale (MBBS, BSc, MD, FBPsS, FRCPsych, FBABCP, MPhil) Consultant Psychiatrist at The Priory Hospital in North London. He is one of the world’s leading experts on BDD and runs a specialist treatment center.