Elsevier

Body Image

Volume 5, Issue 1, March 2008, Pages 50-58
Body Image

Review article
Body dysmorphic disorder and appearance enhancing medical treatments

https://doi.org/10.1016/j.bodyim.2007.08.003Get rights and content

Abstract

This article reviews the literature on body dysmorphic disorder (BDD) in persons who seek appearance enhancing medical treatments such as cosmetic surgery and dermatological treatment. We begin with a discussion of the growing popularity of cosmetic surgical and minimally invasive treatments. The literature investigating the psychological characteristics is briefly highlighted. Studies investigating the rate of BDD among persons who seek appearance enhancing treatments are detailed and, collectively, suggest that approximately 5–15% of individuals who seek these treatments suffer from BDD. Retrospective reports suggest that persons with BDD rarely experience improvement in their symptoms following these treatments, leading some to suggest that BDD is a contraindication to cosmetic surgery and other treatments. The clinical management of patients with BDD who present for these treatments is briefly described and directions for future research are provided.

Section snippets

The popularity of appearance enhancing medical treatments

According the American Society of Plastic Surgeons, 10.9 million cosmetic surgical and minimally invasive treatments were performed in 2006 (ASPS, 2007). Just under 2 million of these treatments were traditional cosmetic surgical procedures such as liposuction, breast augmentation, and rhinoplasty. The vast majority, over 9.1 million, were minimally invasive procedures such as Botox® injections and chemical peels. The number of all of these procedures has increased by 48% since 2000 and over

Psychological aspects of cosmetic surgery

Surprising to many individuals, there is a large literature on the psychological aspects of cosmetic surgery (Crerand, Cash, & Whitaker, 2006; Sarwer, in press; Sarwer & Crerand, 2004; Sarwer, Didie, & Gibbons, 2006). Research in this area dates back almost 50 years to the pioneering work of plastic surgeons and psychiatrists at Johns Hopkins University. Early studies in this area relied heavily on unstructured clinical interviews performed by psychoanalytically trained psychiatrists. Perhaps

Descriptive and diagnostic issues

Case reports in the cosmetic surgery and dermatology literatures describing symptoms consistent with body dysmorphic disorder (BDD) appeared prior to the disorder's inclusion in the Diagnostic and Statistical Manual of Mental Disorders (DSM). Descriptions of “minimal deformity” and “insatiable” patients were reported in the cosmetic surgery literature in the 1960s (Edgerton, Jacobson, & Meyer, 1960; Knorr, Edgerton, & Hoopes, 1967). Case reports of “dysmorphophobia” and “dermatological

Cosmetic surgery patients

Over the past decade, a number of studies have investigated the rate of BDD among persons who present for cosmetic surgery (see Table 1). The first study in this area found that 7% of patients met diagnostic criteria for the disorder (Sarwer, Wadden, et al., 1998). International studies, which typically relied upon clinical interviews, reported slightly higher rates of BDD (Ishigooka et al., 1998; Vargel & Ulusahin, 2001; Vindigni et al., 2002). However, methodological limitations, such as

The effect of appearance enhancing medical treatments on BDD

The efficacy of cosmetic surgery or other appearance enhancing treatments on BDD has yet to be formally investigated. A randomized controlled trial of this issue would face a number of methodological and ethical challenges. Therefore, our understanding of the effect of appearance enhancing treatments on BDD is gleaned from clinical reports and retrospective studies (Crerand et al., 2005; Phillips, Grant, et al., 2001; Veale et al., 1996).

These studies indicate that appearance enhancing

Directions for future research

Over the past decade, much has been learned about the relationship between BDD and appearance enhancing medical procedures. The rate of BDD in cosmetic surgical and dermatology populations has been well-established, and the frequency with which BDD patients seek and receive cosmetic treatments has been documented. Despite these advances, additional research is needed to further investigate BDD among persons who present for appearance enhancing treatments. Future studies are needed to identify

References (91)

  • D.B. Sarwer

    Awareness and identification of body dysmorphic disorder by aesthetic surgeons: Results of a survey of American Society for Aesthetic Plastic Surgery members

    Aesthetic Surgery Journal

    (2002)
  • D.B. Sarwer et al.

    Body image and cosmetic medical treatments

    Body Image: An International Journal of Research

    (2004)
  • D.B. Sarwer et al.

    Body image and obesity in adulthood

    Psychiatric Clinics of North America

    (2005)
  • D.B. Sarwer et al.

    The psychology of cosmetic surgery: A review and reconceptualization

    Clinical Psychology Review

    (1998)
  • D.B. Sarwer et al.

    Body image dissatisfaction in women seeking rhytidectomy or blepharoplasty

    Aesthetic Surgery Journal

    (1997)
  • M.B. Schwartz et al.

    Obesity and body image

    Body Image: An International Journal of Research

    (2004)
  • O. Uzun et al.

    Body dysmorphic disorder in patients with acne

    Comprehensive Psychiatry

    (2003)
  • D. Veale et al.

    Cosmetic rhinoplasty in body dysmorphic disorder

    The British Association of Plastic Surgeons

    (2003)
  • S. Wilhelm et al.

    Cognitive behavior group therapy for body dysmorphic disorder: A case series

    Behaviour Research Therapy

    (1999)
  • C. Altamura et al.

    Clinical and subclinical body dysmorphic disorder

    European Archives of Psychiatry and Clinical Neuroscience

    (2001)
  • American Society of Plastic Surgeons. (2007). National Clearinghouse of Plastic Surgery Procedural Statistics...
  • J. Banbury et al.

    Prospective analysis of the outcome of subpectoral breast augmentation: Sensory changes, muscle function, and body image

    Plastic and Reconstructive Surgery

    (2004)
  • M.A. Bolton et al.

    Measuring outcomes in plastic surgery: Body image and quality of life in abdominoplasty patients

    Plastic and Reconstructive Surgery

    (2003)
  • L.A. Brinton et al.

    Mortality among augmentation mammoplasty patients

    Epidemiology

    (2001)
  • L.A. Brinton et al.

    Mortality rates among augmentation mammoplasty patients: An update

    Epidemiology

    (2006)
  • T.F. Cash et al.

    Women's psychosocial outcomes of breast augmentation with silicone gel-filled implants: A 2-year prospective study

    Plastic and Reconstructive Surgery

    (2002)
  • D.J. Castle et al.

    Correlated of dysmorphic concern in people seeking cosmetic enhancement

    Australian and New Zealand Journal of Psychiatry

    (2004)
  • J. Cotterill

    Dermatological non-disease: A common and potentially fatal disturbance of cutaneous body image

    British Journal of Dermatology

    (1981)
  • J. Cotterill

    Body dysmorphic disorder

    Dermatologic Clinics

    (1996)
  • C.E. Crerand et al.

    Cosmetic surgery of the face

  • C.E. Crerand et al.

    Body dysmorphic disorder and cosmetic surgery

    Plastic and Reconstructive Surgery

    (2006)
  • C.E. Crerand et al.

    Rate of body dysmorphic disorder among patients seeking facial cosmetic procedures

    Psychiatric Annals

    (2004)
  • S.J. Cunningham et al.

    Psychological assessment of patients requesting orthognathic surgery and the relevance of body dysmorphic disorder

    British Journal of Orthodontics

    (1998)
  • A. De Jongh et al.

    Mental disorders in dental practice: A case report of body dysmorphic disorder

    Special Care in Dentistry

    (2004)
  • E.R. Didie et al.

    Factors which influence the decision to undergo cosmetic breast augmentation surgery

    Journal of Women's Health

    (2003)
  • R.G. Dufresne et al.

    A screening questionnaire for body dysmorphic disorder in a cosmetic dermatologic surgery practice

    Dermatologic Surgery

    (2001)
  • M. Gorney

    Professional and legal considerations in cosmetic surgery

  • T.A. Grossbart et al.

    Psychosocial issues and their relevance to the cosmetic surgery patient

  • W. Harth et al.

    Botulinophilia: Contraindication for therapy with botulinum toxin

    International Journal of Clinical Pharmacology and Therapeutics

    (2001)
  • C. Herren et al.

    Body dysmorphic disorder: Diagnosis and treatment

    General Dentistry

    (2003)
  • E. Hollander et al.

    Clomipramine vs desipramine crossover trial in body dysmorphic disorder: Selective efficacy of a serotonin reuptake inhibitor in imagined ugliness

    Archives of General Psychiatry

    (1999)
  • E. Hollander et al.

    Treatment of body-dysmorphic disorder with serotonin reuptake blockers

    American Journal of Psychiatry

    (1989)
  • R.J. Honigman et al.

    A review of psychosocial outcomes for patients seeking cosmetic surgery

    Plastic and Reconstructive Surgery

    (2004)
  • J. Ishigooka et al.

    Demographic features of patients seeking cosmetic surgery

    Psychiatry and Clinical Neuroscience

    (1998)
  • P.H. Jacobsen et al.

    Mortality and suicide among Danish women with cosmetic breast implants

    Archives of Internal Medicine

    (2004)

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