Understanding body dysmorphic disorder: Insights from a plastic surgeon
|Published
In today’s world, we’re constantly bombarded by images of ideal beauty is. But what are we really supposed to look like? And how does this affect our self-image?
Dr Vaneshri Chetty-B, a renowned plastic surgeon, unpacks everything you need to know about Body Dysmorphic Disorder (BDD).
What is BDD?
Chetty-B explained that the condition is a mental health condition where people struggle to stop thinking about one or more perceived flaws in their appearance.
“These defects often seem minor or invisible to others. If you point them out, people might say it's no big deal,” she told Independent Media Lifestyle.
“We’re talking about minor defects but the person with BDD feels so embarrassed, ashamed, and anxious that they often avoid social situations.”
She added that modern media also plays a significant role in this issue.
“From the media we consume to the celebrities we admire and even our peers … Every element can reinforce unrealistic beauty standards. Over time, these pressures distort our self-image and may push individuals towards drastic measures to meet these societal expectations.”
Chetty-B explains how constant media exposure creates pressure to look and live a certain way.
“The media and celebrities make us feel like we need a specific car or look to be appealing,” she said.
This societal pressure often makes people feel they don’t measure up.
“You might see the latest trendy bar or club and feel that you don’t belong there because you don’t look the part,” she noted.
This feeling often prevents many from participating in social activities they might enjoy.
The plastic surgeon highlighted how these pressures create layers of negative feelings.
“When you constantly compare yourself to others and feel you don’t measure up, it leads to anxiety, depression, and low self-esteem,” she explained.
Poor body image can significantly also affect mental health.
“It leads to anxiety, depression, and low self-esteem,” she said. Addressing body image issues early is crucial for mental well-being.
Addressing BDD can’t be done in isolation and as as a plastic surgeon, she believes that she can’t work alone.
“We have to understand why someone wants a procedure and explore their background,” Chetty-B emphasised.
She also believes that plastic surgeons are often among the first to identify BDD in patients seeking cosmetic procedures, stressing that it’s crucial to work alongside psychiatrists and psychologists to provide comprehensive care.
Diagnosing BDD involves understanding where the problem started, how it developed, and providing ongoing counselling.
“Comprehensive support can help individuals navigate their struggles with BDD and promote healthier self-perceptions,” she said.
She pointed out that BDD is becoming more common in today’s society.
“With the kind of surgeries we perform, we see these issues frequently. It’s something we need to pay more attention to.”
Research indicates that around 85% of women and 79% of men are unhappy with their appearance. Chetty-B highlighted these numbers to emphasise the widespread nature of body dissatisfaction.
“If we consider these statistics, it’s clear why BDD is an important issue,” she noted.
BDD is more than just feeling unhappy with your looks.
“About 80% of people with BDD experience thoughts of suicide in their lifetime, and up to 28% actually attempt it,” Chetty-B said. “That’s a huge number and shows how serious this condition can be.”
Globally, 1% to 2% of the population suffer from BDD.
According to her, “There are even higher rates among those seeking cosmetic surgery. In plastic and reconstructive surgery settings, we see these individuals more frequently than in most other medical fields.”
“We are not in a position to say the procedure you’re requesting isn’t legitimate,” she pointed out.
She believes in understanding the motivation behind each request, as sometimes it’s very clear-cut.
For instance, many mothers seek help after having multiple children.
She explained: “A typical request might be, ‘I've had four kids, my tummy is hanging, it’s uncomfortable, I can’t find clothing to fit or go to the gym. I’m not having more kids. Can you help?’ That’s reasonable and something we encounter all the time.”
Recognising red flags
Chetty-B believes that certain signs can indicate deeper issues.
“When someone comes to you with a very small concern and says it affects them so much they avoid going out or only go to places with little light, that’s concerning”.
She described how further questions can reveal more about the patient’s state of mind.
“If someone says they’re consumed by their issue daily, spending hours in front of the mirror and hiding away, that’s not normal behaviour. This behaviour might hint at BDD.
“As plastic surgeons, we must be mindful of these signs and work closely with mental health professionals to ensure patients get the support they need,” she advised.
The expert shared the story of Anna (*not her real name), a 34-year-old marketing professional.
Anna sought a “mommy makeover”, a series of cosmetic procedures typically aimed at restoring a woman’s post-pregnancy body.
Chetty-B noticed that Anna was very anxious and had a history of depression, particularly after her last pregnancy, which was with twins.
“She had one child before the twins and had struggled with post-partum depression,” Chetty-B explained.
Anna tried various diets and exercise programmes for two years but couldn’t achieve the desired results. Her frustration grew as her twins reached two and a half years old. “Her professional performance and social interactions were being affected.”
After several consultations, Chetty-B and her team decided on a personalised treatment plan for Anna.
However, before proceeding with any surgery, Anna was referred to the clinic’s in-house psychologist.
“Our psychologist assessed her and started preoperative counselling sessions. This step was crucial to ensure Anna’s mental readiness for surgery.
By the time Anna was ready for her procedures, she had undergone thorough psychological support, making her better prepared for her physical transformation. Chetty-B’s approach highlights the importance of mental healthcare in successful cosmetic surgery outcomes.
There are many stories like that one where each one has their own individual journey to go through, but it’s quite gratifying to see it, I think the initial part of the journey is, of course, coming to terms with it in her instance, she said.
But surgery isn’t the only solution, Chetty-B pointed out.
“Counselling can help some people realise their issues aren’t as severe as they thought. Minor treatments, like peels, may be enough instead of full cosmetic surgery.”