What is the relationship between plastic surgery and mental health?

The American Society of Plastic Surgeons has reported an increase in interest in plastic surgery since the COVID-19 pandemic has led many people to video calls and become more conscious of their appearance.

In 2015, the College of Cosmetic Physicians of Australia found that Australians spend more than $1 billion annually on non-invasive cosmetic procedures such as Botox and fillers. This is more than 40 percent, per capita, higher than in the United States.

In the United States, where procedure statistics are reported, there was a 42 percent increase in the number of filler procedures and a 40 percent increase in Botox procedures in 2021 compared to 2020.

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 part of the body where a cosmetic intervention is being sought, such as the nose for rhinoplasty.

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 to 3 percent of people will have body dysmorphic disorder, but in the population seeking plastic surgery, this rises to 16 to 23 percent.

Body dysmorphic disorder involves a preoccupation or obsession with one or more perceived defects in physical appearance that are invisible or appear 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 the same or worse after the procedure. They may become more preoccupied with the perceived defect and seek more cosmetic procedures.

Patients with body dysmorphic disorder are also more likely to take legal action against their esthetician after believing they did not receive the outcome 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 have shown that people with body dysmorphic disorder can improve their symptoms after a cosmetic intervention, but the mania may just 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 is not the only mental health condition that may be associated with poor outcomes from cosmetic procedures.

According to a recent systematic review, rates of depression (5 to 26 percent), anxiety (11 to 22 percent), and personality disorders (up to 53 percent) in people seeking plastic surgery may be higher than in the general population (it is estimated at 10 percent, 16 percent). percent and 12 percent, respectively).

However, these rates must be interpreted with some caution as they depend greatly on how a mental health diagnosis is made. Physician-led interviews lead to higher rates while mental health questionnaires lead to 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 cosmetic surgery (and not at all for injections like Botox and fillers). The guidelines state that the evaluation should be performed 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.

An independent review in August 2022 by the Australian Health Practitioners Regulatory Agency and the Australian Medical Council recommended that guidance around mental health assessment should be “strengthened” and stressed the importance of medical practitioners receiving more training in detecting mental disorders.

The American Society of Plastic Surgeons also identifies body imbalance as a major concern among plastic surgeons.

Ultimately, as cosmetic practitioners treat patients who seek treatment for psychological rather than medical reasons, they must have the patient’s well-being at the forefront of their minds, whether through professional integrity or to protect themselves from legal action. Mandatory evaluation for all patients seeking any type of cosmetic procedure is likely to improve overall patient satisfaction.

If this article raises issues for you, or if you are concerned about someone you know, visit the Butterfly Foundation or call the National Helpline on 1800 33 4673.Conversation

Gemma Sharp is an NHMRC Senior Research Fellow at Monash University in Australia, and Nicola Rumsey is Emeritus Professor of Psychology at the University of the West of England in the UK. This article has been republished from The Conversation.

Gemma Sharp


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