Although not common, as an Orange County plastic surgeon, I have to be aware of body dysmorphic disorder (BDD) amongst my patients.
BDD is defined in the DSM-IV-TR (psychiatric classification) as:
Preoccupation with an imagined defect in appearance. If a slight physical anomaly is present, the person’s concern is markedly excessive.
The preoccupation causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
The preoccupation is not better accounted for by another mental disorder (e.g., dissatisfaction with body shape and size in Anorexia Nervosa).
If you feel you may have BDD or know of someone who may, these screening questions may be helpful:
Engaging in repetitive and time-consuming behaviors, such as looking in a mirror, picking at the skin, and trying to hide or cover up the perceived defect.
Constantly asking for reassurance that the “defect” is not visible or too obvious.
Measuring or touching the perceived defect.
Problems at work, school, or relationship due to inability to stop focusing about the perceived defect.
Feeling self-conscious and not wanting to go out in public, or feeling anxious when around people.
Repeated consultations with medical specialists to improve appearance.
Multiple procedures on the same area to fix the perceived defect.
The final diagnosis, of course, must be made by a qualified psychologist or psychiatrist.
Unfortunately, patients who suffer from BDD are often seen as vain or shallow. It is important to be sympathetic and understand the person’s inability to control their thoughts. The difficult part is convincing the patient he/she has a psychiatric condition which requires professional assistance. Many patients simply refuse to see a specialist and instead undergo multiple procedures, often resulting in “bizarre” or over-operated look on their face.
It is, nevertheless, up to the plastic surgeon to say no at some point. If a patient has unrealistic expectations or wants more surgery in an area which has already been improved, it is the ethical and professional responsibility of the surgeon to consider what the best interest of the patient is.
Michael A. Jazayeri, M.D. is a board certified plastic surgeon with over 10 years of experience. His office is located in Orange County, California. To schedule a complimentary consultation, please call 714-834-0101.