What Your Medical Spa Staff Should Understand About Body Dysmorphic Disorder

Are you at risk of treating patients with Body Dysmorphic Disorder (BDD)? What should your staff be doing to screen and communicate with risky patients.

Everyone who's in the industry has delt with peatients who have unrealistic expecations and who make you think that there's not something quite right with their perception of themselves.

Most physicians avoid these patients after dealing with one or two of them that go from big cheerleaders before the treatment, to keying cars in the parking lot after the results don't live up to their unrealistic expectations.

It's something that everyone experiences and the more ethical providers aim to steer clear of these patients, but the result is that they'll go elsewhere.

Whill BDD seems to be underdiagnosed, there are some things we've learned that you might want to pass along to your clinic staff.

What have studies found out so far?

Many patients are faced with this concern that going under the knife would appease them, however symptoms of BDD can still linger. Many studies have shown that patients who have undergone cosmetic surgery still exhibit symptoms of BDD.

In a study conducted by Bouman, Mulkens, van der Lei (2017), a sizeable number of physicians are still unaware about body dysmorphic diagnostic disorder and what it entails both for the patient and the provider. In their study, they found when plastic surgeons refused patients to cosmetic treatment and had them referred to a psychologist, some of these patients attempted to sue the physicians. Additionally, their plastic surgeon sample considered surgery as a contraindication of BDD. Their sample also mentioned that they will not pursue with a procedure, provided the patient exhibited symptoms of BDD.

In the end, the researchers stressed the importance for cosmetic physicians to educate themselves further about recognizing the disorder, diagnosing the patient, and treating it.

Despite such events, there was research about the positive effects of cosmetic procedures with BDD also (Bowyer, Krebs, Mataix-Cols, Veale, and Monzani, 2016). One study was conducted that some patients manifested some BDD symptoms pre-surgery and the patient group reported satisfaction one year after the surgery (Felix et al., 2014).

What should you tell your staff to look for? (Note: This is not medical or legal advice, just an opinion.)

Patients may exhibit a number of symptoms and attitudes that staff can identify as potential problems including:

• If a patient thinks that a treatment is going to change their life in some kind of unrealistic way.
• Odd confidence that a physician is going to 'fix' them. These patients often are your most ardent supporters before the treatment.
• Wanting to 'stack' treatments together and build a pipeline of problems that they want fixed.

What can your clinic staff do?

• Understand that this is not really a vanity issue, even though it appears to be. BDD patients feel bad about this and their perceived as vain and shallow, but they're not able to stop obsessing. This is as real as depression, anxiety or other mental disorders.
• Understand that they have poor insight regarding their treatment and their body perception. You won't be able to 'talk them out of it'.
• Don't encourage BDD if you see symptoms. (I've seen a number of unethical clinics do just this.)

This isn't something that you want your staff to be in the dark about since there can be serious consequences if you don't take it seriously.

Stunted Emotional Growth From Botox In The UK?

Botox treatments on young patients (under 25) may retard their emotional growth and is "morally wrong" according to some UK clinicians.

At least that's a recent BBC headline that might be more link-baiting than actual research. 

According to the UK's Journal of Aesthetic Nursing, clinicians say there is a growing trend for under-25s to seek the wrinkle-smoothing injections but research suggests "frozen faces" could stop young people from learning how to express emotions fully. Additionally, a leading body of UK plastic surgeons says injecting teenagers for cosmetic reasons is "morally wrong".

What's going on here?

Nurse practitioner Helen Collier, who carried out the research, says reality TV shows and celebrity culture are driving young people to idealize the "inexpressive frozen face."

But she points to a well-known psychological theory, the facial feedback hypothesis, that suggests adolescents learn how best to relate to people by mimicking their facial expressions.

She says: "As a human being our ability to demonstrate a wide range of emotions is very dependent on facial expressions.

"Emotions such as empathy and sympathy help us to survive and grow into confident and communicative adults."

But she warns that a "growing generation of blank-faced" young people could be harming their ability to correctly convey their feelings.

"If you wipe those expressions out, this might stunt their emotional and social development," she says.

Dr Michael Lewis, a researcher in psychology at Cardiff University, says: "The expressions we make on our face affect the emotions we feel.

"We smile because we are happy, but smiling also makes us happy.

"Treatment with drugs like Botox prevents the patient from being able to make a particular expression and can therefore have an effect on our learning to feel emotions naturally."

Rajiv Grover, president of the British Association of Aesthetic Plastic Surgeons, says: "Injecting teenagers with Botox for cosmetic purposes is morally wrong and something that no ethical practitioner would do.

Of course this might have been morea bout Ms Collier's presentation at the Clinical Cosmetic and Reconstructive Expo and generating a little visibility for both the presenter and the venue.

I tend to agree with many of the premises here in that cosmetic treatments simply to cater to perceived imperfections for younger patients just shouldn't be performed, but it seems a stretch to say that the Botox is the cause rather that the effect. In the patients that I've seen that fall into this age group and are looking for cosmetic treatments there are already many factors that are contributing to this behavior in the first place rather that flowing from previous treatments.

Body dysmporphic disorder in the young is something that every cosmetic practioner runs into from time to time. It's up to each clinician to understand what the patient psychology is and how best to address it. Blaming the actual treatments is overly simplistic in my view.