Aesthetic surgeons and physicians grasp the challenges that come with treating patients with body dysmorphic disorder (BDD), but these providers might be underdiagnosing patients who have an unhealthy preoccupation with perceived flaws in their appearances, according to a recent study.
Studies have suggested that BDD occurs in about 2% of the general population and about 10% of patients seeking cosmetic procedures, according to a press release by the American Society of Plastic Surgeons.
Yet, the 173 plastic surgeons, dermatologists and cosmetic doctors surveyed for this study indicated they rarely encounter BDD patients. Two-thirds of participants reported that they had seen between one and five BDD patients in their practices during the past year.
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Considered a contraindication for cosmetic procedures, BDD, when it was detected, was a red flag for many of the doctors surveyed; 70% reported they would refuse to perform cosmetic procedures in BDD patients.
Most of the cosmetic professionals surveyed said they were familiar with BDD and the criteria for diagnosing it, according to the release. And most indicated that they sometimes or often addressed body image problems while consulting with patients. However, only 7% said they routinely screen for BDD. Less than half of those surveyed said they collaborated with psychologists or psychiatrists when they encountered BDD patients.
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The researchers found plastic surgeons were more likely to refer BDD patients to mental health professionals and to refuse treatment to these patients, compared to dermatologists or cosmetic doctors.
Not only were some aware of the potential problems with BDD patients but they had also experienced problems. About 16% of those responding reported verbal altercations; 6% had received legal threats, according to the release.
Cosmetic professionals should be educated in how to recognize and manage psychological contraindications to cosmetic procedures, the authors conclude.
"This would make the exploration of body image problems (such as BDD) a standard topic in every patient encounter in a cosmetic clinic,” they write.
This might help. RealSelf recently launched an online resource to help patients identify safety issues, including becoming more aware if they might have BDD. The resource includes an online BDD self-test that anyone can take.