Wanting Plastic Surgery Doesn’t Mean You Have Body Dismorphia
I have a vague recollection of a show from long ago where puppets or some cartoonish figures sang a jingle about things that were not quite the same. I believe the lyrics consisted of the observation that "one of these things is not like the other."
A group of objects would be presented, most of which were similar. Within the group was a black sheep object, some outlier that could be spotted by even the least astute child. The object that did not belong would be unmasked and chastened as being “not like the other.”
The lesson learned was that similar does not mean “the same.” Having learned that lesson, let's now apply it to big people stuff.
Plastic Surgery and Body Dismorphic Disorder
A desire or a need for plastic surgery does not constitute body dismorphic disorder. One of these things is not like the other.
People get plastic surgery for a number of reasons, most of which are legitimate and some of which are questionable. Almost none are the result of a psychiatric condition.
Some people desire plastic surgery because they have been in accidents and wish to have unsightly scars addressed. Others desire to have birth defects corrected or have birth marks removed. Removal of excess skin following extreme weight loss is another reason. Others opt for plastic surgery because of vanity or to improve self-esteem.
Body dismorphic disorder (BDD) as a catalyst for plastic surgery is something quite different. BDD is a psychiatric illness defined by an obsession with some minor physical flaw that causes impaired functioning or distress that cannot be explained by some other psychological disorder.
BDD affects about 1% to 2% of the population, but can be as much as 15 times more prevalent among those seeking plastic surgery. Those who get surgery seldom find relief, and surgeons who operate on them are at increased risk for litigation as well as potential violence.
Screening for Body Dismorphic Disorder
Most surgeons will avoid operating on people with body dismorphic disorder. They are a difficult population in need of psychiatric care, not to mention the impossible task of fixing a problem that doesn't actually exist.
Astute screening can help a surgeon identify a patient with BDD. Signs of body dismorphic disorder include excessive requests for aesthetic surgery, lack of satisfaction with prior surgeries, the belief that surgery is a solution to all of their problems, preoccupation with a defect, demanding behavior, and a psychiatric history.
If the patient presents as a candidate for BDD, the surgeon should refer her to follow up with a psychiatrist. While surgery on such individuals is broadly discouraged, the decision to proceed is at the discretion of the surgeon. Such a decision is made based on patient history, the severity of symptoms, the potential for patient satisfaction, the patient’s safety, and the surgeon's comfort level.
Eumorphic plastic surgery, or surgery as a treatment for patients in conjunction with psychotherapy, has also been discussed.
Related article: Body Dismorphic Disorder in Plastic Surgery Patients
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