Body dysmorphic disorder (BDD), or body dysmorphia, is a mental health condition where an individual spends a large amount of time worrying about problems with their appearance that are often completely unnoticeable to others. Anyone of any age can have BDD, however it is most common in teenagers and young adults. Approximately 80% of individuals with BDD experience lifetime suicidal ideation and 24% to 28% have attempted suicide.
In a clinical aesthetics setting, the population of patients with BDD can reach up to 53%. Given this, it is highly important that aesthetics professionals have both a sound understanding of the disorder and a plan of how best to manage clients who show signs of BDD.
Symptoms of Body Dysmorphic Disorder
Body Dysmorphic Disorder features a range of symptoms with which aesthetics professionals should become familiar. Individuals with BDD may:
- Be extremely preoccupied with a perceived flaw in appearance that to others cannot be seen or appears very minor
- Strongly believe they have a defect in their appearance that makes them ugly
- Believe that others take special notice of their looks in a negative way
- Engage frequently in behaviors aimed at fixing or hiding the perceived flaw that are difficult to control, such as checking mirrors, skin picking, and adjusting clothing or hair.
- Attempt to hide perceived flaws with clothes and make-up
- Constantly compare their appearance to others
- Frequently seek reassurance about their appearance
- Have perfectionist tendencies
- Avoid social situations where they could feel their flaws are ‘exposed’
- Seek aesthetic procedures with little satisfaction
Treating Clients with Body Dysmorphic Disorder
Although as aesthetic practitioners and medical professionals we must respect the patient’s choice to seek aesthetic treatment, we also have to bear in mind that providing treatment to clients with BDD can actually make their condition worse. It is highly likely that they will see the results of the treatment you provide as unsatisfactory, even if the procedure and outcome all went perfectly, and will seek repeated treatment and ‘fixes’ for flaws that only they can see. Even if the client is happy with the outcome of their treatment, this will only give them temporary relief before fixating on another perceived flaw. Aesthetic treatments cannot help the underlying psychological issues that perpetuate a clients’ body dysmorphia.
Screening for Body Dysmorphic Disorder in Your Aesthetics Practice
There are a number of Body Dysmorphic Disorder screening questionnaires available that you should incorporate into your consultation practice, for example the Body Dysmorphic Disorder Questionnaire (BDDQ) and the Dysmorphic Concern Questionnaire (DCQ). The Aesthetic Journal highlighted the following questions as a helpful starting point for screening your patients:
- Are you worried about how you look? (Yes/No);
if you are, do you think about your appearance problems a lot and wish you could think about them less? (Yes/No)
- How much time per day, on average, do you spend thinking about how you look?
(a) Less than 1 hour a day.
(b) 1-3 hours a day.
(c) More than three hours a day.
- Is your main concern with how you look that you aren’t thin enough or that you might become too fat? (Yes/No)
(a) How has this problem with how you look affected your life?
(b) Has it often upset you a lot? (Yes/No)
(c) Has it often gotten in the way of doing things with friends, your family, or dating? (Yes/No)
(d) Has it caused you any problems with work or study? (Yes/No)
- Are there things you avoid because of how you look? (Yes/No)
The Aesthetic Journal notes that as practitioners, you should suspect BDD if the patient answers yes to Question 1; (b) or (c) to Question 2; yes to any part of Question 3 and yes to Question 4.
What Should Aesthetic Practitioners Do If They Believe a Client Has Body Dysmorphic Disorder?
The key question is whether you as a practitioner believe that the client has complete capacity to choose aesthetic treatment. If following screening you do not feel comfortable providing treatments for a client, then follow your instinct and say no; explaining your thoughts regarding the possibility of BDD to the client and their treatment options if you feel it is appropriate to do so. The client may seek out another provider, but in our opinion, choosing not to treat a client you suspect may have Body Dysmorphic Disorder can only help to preserve your reputation as a responsible aesthetics practitioner.