Summary: Researchers reveal a higher rate of body dysmorphia, depression, anxiety, and personality disorders in those who seek plastic surgery procedures.
Although we cannot be sure of the exact numbers of Australians undergoing cosmetic procedures, as there is no requirement for health professionals to report their statistics, the consensus is that the demand is growing.
in 2015, College of Cosmetic Physicians of Australia It found that Australians spend more than $1 billion annually on non-invasive cosmetic procedures such as Botox and fillers. This is 40% higher per capita than in the United States.
In the United States, where the procedure Statistics are reportedThere has been a 42% increase in the number of fillers and a 40% increase in Botox procedures performed in the last year alone.
Rates of mental health problems may be higher in this group than in the general population, but apparently not enough efforts are being made to ensure the psychological safety of people who request cosmetic procedures.
Body dysmorphic disorder
Body image concerns are generally the main motivation for seeking cosmetic procedures of all kinds. These concerns Usually focus on the body part Where cosmetic interventions such as rhinoplasty are sought.
Intense concerns about body image are a major feature of many mental health conditions. The most common among people who seek cosmetic procedures is body dysmorphic disorder. In the general population, about 1-3% of people will suffer from body dysmorphic disorder, but in the population seeking plastic surgery, this rises to 16-23%.
Body dysmorphic disorder It involves a concern or obsession with one or more perceived defects in physical appearance that are not visible or seem minor to others. In response to distress related to the defect, the person with BDD engages in repetitive behaviors (such as excessively examining body parts in a mirror) and mental actions (such as comparing their appearance to other people).
These fears can have a significant negative impact on a person’s daily life, as some people feel so sad that they cannot leave their homes or even have dinner with family members for fear of being seen by others.
With the distress associated with BDD apparently caused by physical appearance issues, it makes more sense for a person with BDD to attend a beauty clinic for treatment than a mental health clinic.
The problem is that cosmetic intervention usually makes a person with body dysmorphic disorder feel it the same or worse After the operation. They may become more concerned about the perceived defect and seek more cosmetic procedures.
Patients with body dysmorphic disorder are, too more likeable Taking legal action against the treating cosmetic practitioner after believing they did not receive the result they wanted.
For these reasons, body dysmorphic disorder is generally considered by health professionals as a “red flag” or contraindication (a reason not to undergo a medical procedure) to cosmetic procedures.
However, this is not entirely clear. Some studies showed that people with body dysmorphic disorder can improve their symptoms after a cosmetic intervention, but the mania may move to another part of the body and the diagnosis of body dysmorphic disorder remains.
What about other mental health conditions?
Body dysmorphic disorder is by far the most well-studied disorder in this field, but it’s not the only mental health condition that may be associated with worse outcomes from cosmetic procedures.
according to A recent systematic reviewRates of depression (5-26%), anxiety (11-22%), and personality disorders (0-53%) in people seeking plastic surgery may be higher than in the general population (which is estimated at 10%, 16%) and 12% respectively. respectively).
However, these rates should be interpreted with some caution as they are highly dependent on how the mental health diagnosis is made – a physician-led interview (higher rates) versus a mental health questionnaire (lower rates). Some interview approaches can report higher rates of mental health problems because they can be quite unstructured and therefore of questionable reliability compared to highly structured questionnaires.
Besides body dysmorphic disorder, research investigating other mental health conditions is limited. This may be due to the fact that a focus on body image is at the core of body dysmorphic disorder, making it a logical focus for plastic surgery research compared to other types of psychiatric disorders.
So what should happen?
Ideally, all plastic surgeons and practitioners should receive sufficient training to enable them to perform a brief routine evaluation of all potential patients. Those who show signs that they are unlikely to derive psychological benefit from the procedure should undergo additional evaluation by a mental health professional prior to undergoing the procedure.
This could include an in-depth clinical interview about motivations for the procedure, and completing a range of standard mental health questionnaires.
If a person is found to have a mental health problem in the evaluation process, this does not necessarily mean that a mental health professional will recommend that they not pursue the procedure. They may suggest a course of psychotherapy to address the problem and then undergo the cosmetic procedure.
At the moment, evaluations are only recommended and not mandatory for plastic surgery (and not at all for injections like Botox and fillers). The Guidelines An evaluation should be undertaken if there are signs that the patient has ‘significant underlying psychiatric problems’.
This means that we rely on the medical aesthetic practitioner to be able to detect such problems when they have only had basic psychological training in medical school, and when their business could potentially benefit from not attending to such diagnoses.
in August 2022 Independent review The Australian Health Practitioners Regulatory Agency and the Australian Medical Council have recommended that guidelines around mental health assessment should be “strengthened” and stressed the importance of medical practitioners receiving more training in detecting mental disorders.
Ultimately, as cosmetic practitioners treat patients who seek treatment for psychological rather than medical reasons, they must have the patient’s well-being foremost in their minds, out of professional integrity and to protect themselves from legal action. Mandatory evaluation for all patients seeking any type of cosmetic procedure is likely to improve overall patient satisfaction.