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How cosmetic dermatologists manage patients with body dysmorphic disorder

How cosmetic dermatologists manage patients with body dysmorphic disorder
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It is not uncommon for people with body image problems to seek cosmetic procedures at a cosmetic clinic. How a cosmetic dermatologist establishes a person’s relationship with their body can prove complex, since a cosmetic dermatologist’s job is to help people increase body satisfaction. We take a look at the grey areas and where the lines are. 

The cosmetic industry draws criticism from several camps, and with good reason: we live in a culture that prizes youth and beauty, it can seem, above all else, and a cosmetic surgeon or dermatologist has made a business out of people wanting to improve their appearance. Our cultural messages affect everyone, with women seeming to suffer the brunt of it, but boys and men are not immune. Rates of anorexia in boys, for example, are startlingly high and growing.

Internal motivation and external motivation

It’s important to differentiate between body dysmorphic disorder and wanting to feel better about the way you look, but also to differentiate between wanting to look better for yourself, or for someone else. They are each different motivators. To understand this, we talk about internal and external motivation on top of body dysmorphia.

  1. Internal motivation is when someone wants to change their appearance to make themselves feel better and improve self-esteem.
  2. External motivation is someone who wants to change their appearance to achieve a secondary change, for example to make someone else love them more or be more attracted to them or to get ahead at work. This can happen when someone tells the patient to get a procedure. In cases of external motivation, the person will be encouraged not to have the procedure and probably turned down by a conscientious cosmetic doctor. Money is never the motivator to give someone a procedure they actually do not want.

What is body dysmorphic disorder?

Body dysmorphia is when a person thinks about their flaws (real or perceived) for hours every day, without being able to control negative thoughts. They don’t believe people who tell them they look good, and they may feel severe distress that interferes with everyday life. These people may skip work or school, avoid socialising or isolate themselves for fear of their perceived flaws being noticed. Unnecessary cosmetic surgeries or procedures may be sought to correct imperfections, but they are never satisfied with the results.

Body dysmorphia affects teenagers the most, and both genders nearly equally. It can apply to any part of their body, but often its hair, skin, nose, chest or stomach – the parts they see the most of when they look down or in a mirror. We are not sure why body dysmorphia appears, but there seems to be several contributing factors including personality traits, negative life events or bullying, and genetic predisposition. A person with body dysmorphia will camouflage their perceived flaw with their body position, clothes, makeup, hats, and hairstyles, and may constantly compare themselves to others, check (or avoid) mirrors compulsively, groom themselves and change clothes a lot. Basically, they are unnaturally intently focussed on themselves, in a bad way.

Because cosmetic dermatologists are skin doctors, not psychologists, they are tasked with the difficult question of figuring out when is someone using cosmetic treatments as a crutch for a deeper problem. This is when getting to know a patient is so important – figuring out when is someone completely out of touch with the way they look. It’s tricky, but there are clues.

Body dysmorphia – red flags

  • Flaws that are minimally visible
  • Flaws that are not visible
  • Bizarre requests (like wanting to look just like a celebrity)
  • Mottled psychological history

How a person with body dysmorphia is managed in a cosmetic clinic

It has been estimated that about 15 per cent of people coming into a cosmetic clinic for procedures has body dysmorphic disorder. A person with body dysmorphia is likely to walk out with a referral to a psychological clinic, with cosmetic treatments deferred.

Depression, anxiety and other psychological problems in the context of a cosmetic clinic

Previous psychological issues such as depression and anxiety do not exclude someone from cosmetic treatments, however, it’s important to talk these elements over with your dermatologist. Your doctor needs to know how dissatisfied with a part of your body you are – it’s important for building rapport and trust, and allows them to help you better.

Your well-being is our highest priority.
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