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Identifying possible BDD Aesthetic practitioner Dr Reena Jasani recommends that practitioners implement routine screening during all initial consultations. She says, “Questions that practitioners can ask would include: which area(s) would you like treating and why? How frequently do you check or look at that area of your body? Have you had any previous cosmetic treatment and how satisfied are you with your previous treatment?” Miss Payne also suggests asking whether the treatment will increase the patient’s self-confidence and self-esteem. If there are concerns that the patient may have symptoms relating to BDD, Dr Jasani then recommends specific screening tools and questionnaires, such as the BDD QuestionnaireDermatology Version (BDDQ-DV). “By completing these questionnaires and having a consultation with the patient, the aesthetic practitioner will have a better idea of patient concerns, motivations and expectations. If BDD is suspected, a referral for psychological assessment would be an appropriate step to take for formal diagnosis,” she adds. Dr Jasani also emphasises that BDD should not be confused for insecurity, and vice versa, for which aesthetic procedures can be hugely beneficial. “From my own experience, the level of insecurity can range Aesthetics looks into the importance of being from someone being mildly self-conscious about the able to identify when a patient might be part of their body to being severely impacted by it suffering from BDD (but still may not have BDD),” she says, adding, “Their level of insecurity depends on multiple factors such Body dysmorphic disorder (BDD) is a psychological condition as their overall confidence in themselves, any recent significant life continually gaining more recognition in the aesthetics specialty. It’s events (such as a breakup or divorce), whether their flaw/concern is been estimated that around one in eight patients who present to facial also noticed by others – amongst other considerations. In the majority plastic and reconstructive surgery settings suffer from the disorder, of these cases, I find patients often feel empowered after undergoing although it’s likely to be underreported.1 In terms of the general cosmetic treatment. They feel better in themselves, have increased population, it is thought to affect 0.5% of people in the UK.2 Recently, self-esteem and confidence, and the results are satisfactory to both the reality star Katie Price stated that BDD could be the reason behind her practitioner and patient.” latest round of plastic surgery, having already undergone around 20 surgical procedures as well as numerous non-invasive treatments.3 Potential impact on practitioners Obsession with both invasive and non-invasive aesthetic procedures One study of the literature indicated that having a mental illness is and increased insecurity isn’t an unusual occurrence, and has led to often linked to dissatisfaction following cosmetic procedures.5 This is patients putting themselves in danger. One extreme example includes a main focus of the BAAPS course, and Miss Payne notes that a lot former model Hang Mioku, who injected herself with cooking oil after of the content will be aimed at how to manage patient expectations. practitioners refused her any further procedures.4 Therefore, it’s not She comments, “There is the patient who will go from practitioner only important for practitioners to be able to identify the condition, but also to be aware of how to get the patient correct support. The British Association of Aesthetic Plastic Surgeons (BAAPS) recently highlighted the importance of practitioner knowledge and skills in this area by launching a new psychology course for its members, aiming to equip surgeons with the necessary skills to respond to psychological factors in patient consultations. Plastic, cosmetic and reconstructive surgeon and BAAPS board member, Miss Caroline Payne commented, “BAAPS has run psychology courses before, but we have changed the emphasis in this new course to enhance the psychological skills of the surgeon in helping patients. BDD is a spectrum of symptoms and can be very mild to quite unsettling for the patient, so for those that work in the aesthetics industry, knowing how to unpack a patient’s needs and Miss Caroline Payne desires and isolate targeted goals can help us decide whether a patient has actual symptoms of BDD.”
Recognising Body Dysmorphic Disorder
"We must be there to help patients in the understanding of their expectations and whether they can be realistically achieved"
Reproduced from Aesthetics | Volume 8/Issue 9 - August 2021
