How To Spot Body Dysmorphic Disorder

Aesthetic medicine naturally attracts patients who are interested in making the most of their appearance. For some, injectables are tied not only to optimising their looks, but to their self-esteem and how they view themselves.

One of the most common mental health issues to look out for among aesthetics patients, is body dysmorphic disorder (BDD).

This is essentially when taking an interest in your appearance tips over into an all-consuming, never-ending source of worry. BDD patients may not even realise they have a problem. This is why injectors need to be adept at spotting body dysmorphic disorder in aesthetics patients.

How to spot body dysmorphic disorder

BDD can cause anxiety, depression, self-harm and suicidal thoughts in men or women. These present as a result of the individual constantly obsessing over perceived flaws and “imperfections”.

The NHS advises that some of the key signs of BDD involve those affected:

• obsessively worrying about their face or a specific area of their body
• regularly comparing their looks with other people’s
• frequently looking at themselves in mirrors, or avoiding their reflection altogether
• making a lot of effort to conceal perceived flaws, including with makeup and clothing
• picking at their skin to make it “smooth”.

Other common symptoms of body dysmorphia, as outlined by the mental health charity Mind, include:

• feeling they need unnecessary plastic surgery and/or tweakments
• experiencing shame, guilt and loneliness
• self-harming
• isolating themselves
• believing their face or body lacks proportion or is not symmetrical
• worrying people think they are vain
• developing obsessive compulsions as coping mechanisms
• wearing heavy makeup
• tanning excessively.

What causes BDD?

Whilst the pathology of body dysmorphia is unconfirmed, it is believed to be linked to genetics or a past trauma, particularly where this is appearance-related, such as bullying or teasing. It may also be caused by a chemical imbalance in the brain.

Those affected by BDD may also have additional mental health problems. Commonly these are obsessive compulsive disorder (OCD), an eating disorder and/or generalised anxiety disorder.

Are patients with BDD suitable for aesthetic treatments?

We would caution aesthetic medicine practitioners against treating any patients where BDD is suspected. People with BDD should certainly be considered unsuitable for injectables.

After having so much time to focus on themselves during lockdown, this type of patient is even more of a no-go for any injector post-lockdown.

One potential exemption here is emergency care, for instance where a patient with BDD has tried to inject their own filler or botulinum toxin.

Where an urgent care patient with signs of BDD presents, you should take a view as to who is best placed to treat them. You may need to speak to their GP or other healthcare provider, if possible, to make an informed decision.

BDD is, of course, not the only potential mental health issue you should be looking out for during a clinical consultation. However, this is a particular problem aesthetics practitioners come up against and requires an ethical stance. If you come from a place of “patient first”, your conclusions will always be centred on their best interests.

Remember: if there are any red flags that cause you to suspect a patient may have body dysmorphia, it is best to refuse treatment. Patients can be convincing in their arguments when refused, but don’t be swayed.

Be clear when outlining your decision and reasoning. You may wish to point them in the direction of resources they may find helpful, such as the Body Dysmorphic Disorder Foundation UK charity website. You may also find it useful to build a relationship with a counsellor or psychotherapist so you can make referrals, where appropriate.

Refusing patients is a normal part of being a trustworthy, ethical injector who puts patients’ best interests ahead of profit. This is the reputation you want and the one which will ultimately bring your business the best quality clients.

Article last fact-checked: 20 January 2023