Volume 3 Issue 2 February, 2013
Consultation Liaison Psychiatry Focus: Plastic Surgery
Cosmetic surgery is becoming increasingly popular across all sections of the population. Surgeons are required to recognize the potentially complex psychological milieu of various conditions and the procedures. Aesthetic surgeon is often challenged with conditions where he has to judge the appropriateness of patient requests. Body dysmorphic disorder (BDD): “imagined ugliness” in lay man language is a psychiatric disorder which a cosmetic surgeon is challenged with. The illness is related to body image, in which an individual has a preoccupation with one or more perceived or slight defects in his or her appearance. Affected individuals perceive themselves to be ugly despite having normal appearance and often present to plastic surgeons for aesthetic reasons. The older term for BDD is ‘dysmorphophobia’, which was first used by Italian psychiatrist Enrique Morselli hundred years ago.
DSM‐IV diagnostic criteria for BDD: A) Preoccupation with an imagined defect in appearance. B) The preoccupation causes clinically significant distress or impairment in social, occupational, or other important areas of functioning. C) The preoccupation is not better accounted for by other mental disorder.
BDD is most likely to develop in adolescence, especially in female. Patients have no or little insight into their illness. The type and severity of symptoms may vary from person to person. They often feel compelled to frequently repeat time‐consuming behaviours such as: checking their appearance in a mirror, seeking reassurance about their appearance, comparing themselves with models in magazines or people in the street and many more. Identifying the disorder is most important for plastic surgeon as there is strong evidence that they do not benefit from aesthetic surgery. Many studies have shown exacerbation or no change in symptoms after surgery leading to dissatisfaction of post operative result. They may develop grotesque surgically altered appearance compelling them to seek for more cosmetic surgeries leading to vicious cycle.
The patients seek consultations with multiple specialists like dermatologists, plastic surgeons until they find the one whom they feel to provide treatment they requested for. Patients may even shift to other body parts or aspect of their appearance seeking further consultations. Dissatisfaction from the post operative result may make them violent towards surgeon and sometimes even towards self. They may self mutilate to alter their appearance. The plastic surgeon evaluating the patient if suspects Body Dysmorphic Disorder, should strongly recommend him or her to the psychiatrist. Preparedness from plastic surgeon to confront resistance in seeking psychiatrist consultation is important for wellbeing of the patient.
JSS Medical College, Mysore
