It is questionable whether a mental health consideration is thought of enough when performing facial aesthetic consultations with our clients. Are we considering their body language, content and context of their concerns and asking about any recent life events that have been traumatic, distressing or life changing? All of these things can be suggestive of someone who may be more vulnerable, are they seeking aesthetic treatment for the wrong reasons? Will it worsen their mental well being? Will they undoubtedly have post-treatment regret? It could be argued that we are all too quick to proceed with treatment, spending a lot of time ensuring there general health is suitable, that they are informed of injectable treatments and the risks associated. Questioning a persons mental health may seem uncomfortable for some but if we really are ensuring patient safety then it is something that should always be addressed.
As an aesthetic practitioner we see many clients on a regular basis, new and returning. People are coming to us with an incentive to alter and enhance their physical appearance, some potential clients are more vulnerable than others. Body dysmorphic disorder (BDD) is often under-recognized and under-diagnosed, it is a mental health condition where a person spends a lot of time obsessing and worrying about their appearance. They highlight flaws that may actually not exist and often seek aesthetic treatments and alterations as a method to relieve their dissatisfaction with how they look. As part of any consultation it is key for practitioners to determine why someone is seeking aesthetic treatment, whether their reasoning is either clinically indicated or made autonomously by someone whose mental health is not compromised due to a disorder or recent traumatic event. Social media has undoubtedly played a role in accelerating our obsessions with beauty and has created pressure among men and women to maintain youthful appearances and enhance features to fit current trends exposed across social media platforms by celebrities and influencers.
It is important for practitioners to be aware of how to recognise potential BDD clients and know how to screen and refer on to the appropriate professionals if and when necessary. The disorder is treatable and clients should be prepared for a referral, communication is key with clients and documentation should be adequately maintained. A concern for some aesthetic practitioners is if they are to refuse a BDD client treatment that the client in question will then go else where to a practitioner who may not have their best interests at heart or consider their safety. This concern should not coerce practitioners in to treatment as it runs the risk of escalating their condition. Instead communication with the client and a referral to a competent mental health professional/GP is required.
A client with BDD will associate changing a facial 'flaw' with injectable treatment as a means of solving their self-dissatisfaction and will inevitably be disappointed post treatment when they still feel low in mood, anxious and self-conscious as their condition can be be resolved by a physical change and instead their mental health needs to be professionally diagnosed and managed.
Treatment for BDD can include Cognitive Behavioral Therapy (CBT) and/or a type of anti-depressant medication (Selective serotonin re-uptake inhibitors), commonly Fluoxetine is prescribed initially. We are still unsure of the cause of BDD, some evidence does suggest it can be genetically linked, if you have been exposed to a relative with BDD or Obsessive Compulsive Disorder (OCD), it can reflect in your own behavior. A chemical imbalance in the brain is present with BDD.
There are a number of screening questionnaires available to practitioners which can be used in clinics:
- The Cosmetic Procedure Screening Questionnaire (COPS)
- The Body Dysmorphic Disorder Questionnaire (BDDQ)
- The Yale Brown Obsessive Compulsive Scale Modified for Body Dysmorphic Disorder,
- Body Dysmorphic Disorder, NICE Guidance
- Body Dysmorphic Disorder, Five Questions Psychiatric Evaluation for Cosmetic
Procedure by Veale.
Some suggestive signs of a BDD client can include things such as using medical jargon but maybe in an incorrect form or context, hiding behind baggy clothing or having their hair covering their face. Referring to their feature as "this nose" as opposed to "my nose" personally detaching themselves from it. Some BDD sufferers may have been to numerous practitioners previously and also may have already had quite an extensive history of treatments. BDD suffers can sometimes struggle with eye contact and generally express low mood and self-esteem. They may highlight a "flaw" or a feature they dislike that you may not feel exists and can often be seen avoiding mirrors which can be noticed during consultation.
Screening tools can be a useful guide however, without adequate mental health training, understandably some practitioners do not feel comfortable that they are competent enough to use them. Alternatively just asking basic questions such as "how often do you think about your appearance?" Or, "what impact does your appearance have upon your daily life?" Can be a good enough indicator to highlight a possible vulnerability among clients. Client safety should always be at the forefront of all practice.
Thank you for reading!
nhs.uk. (2017). Body dysmorphic disorder (BDD). [online] Available at: https://www.nhs.uk/conditions/body-dysmorphia/ [Accessed 23 Apr. 2019].