Body Dysmorphic Disorder (BDD) in Plastic Surgery Patients

Patient Expert

I've spent the last six months or more engrossed in social media sites covering plastic surgery. And as I sit here recovering from my second round of body contouring after massive weight loss, I ponder on the body image of many patients I have encountered during that time, as well as my own image of my body.

I and the many patients I interact with on a daily basis may have found our bodies unattractive, or even ugly, after losing 100 lbs. or more. We are left with excess sagging skin that cannot be exercised or dieted away. Body contouring plastic surgery is the only way to restore the body's normal shape.

Having body image issues about one's breasts, thighs, and tummy being deflated and sagging is quite understandable. Desiring to have the sexy body you always have wanted is normal. And if you can afford plastic surgery, then I encourage you to follow your heart's desire.

However, obsessive worry about your body or some part of your body is not normal or healthy. The American Psychiatric Association reports that as many as 7-15% of patients undergoing plastic surgery have Body Dysmorphic Disorder. Body Dysmorphic Disorder is a psychiatric illness affecting 2.4% of the population, and more common than bipolar or schizophrenia.

According to Mayo Clinic, "When you have Body Dysmorphic Disorder, you intensely obsess over your appearance and body image, often for many hours a day. Your perceived flaw causes you significant distress, and your obsession impacts your ability to function in your daily life. You may seek out numerous cosmetic procedures or excessively exercise to try to "fix" your perceived flaw, but you're never satisfied."

The American Psychiatric Association reports that persons with BDD who choose to undergo plastic surgery are generally unhappy with the results, and later often become concerned with another body part. They are often consumed with thoughts about the postoperative site. Plastic surgeons have occasionally been victims of violence, even murder, by patients with BDD who are in despair over their procedural outcomes.

A prospective study was done to evaluate the effect of cosmetic surgery and the stability of body dysmorphic disorder diagnosis in patients with a minimal defect in appearance, with and without BDD, five years after their request for plastic surgery. Researchers conducted phone interviews to re-evaluate 24 patients, 10 with BDD and 14 non-BDD. Seven of the BDD patients had undergone cosmetic surgery versus 8 non-BDD. Patient satisfaction with the intervention was high in both groups. Nevertheless at follow-up, six of the seven operated BDD patients still had a BDD diagnosis and exhibited higher levels of handicap and psychiatric comorbidity compared to their non-BDD counterparts. Moreover, three non-BDD patients had developed a BDD at follow-up.


American Psychiatric Association

Mayo Clinic Body Dysmorphic Disorder

PubMed Body dysmorphic disorder and cosmetic surgery: evolution of 24 subjects with a minimal defect in appearance 5 years after their request for cosmetic surgery.