Tens of thousands of people have surgery or cosmetic procedures to enhance their appearance but how do you know if you’ve gone too far? And what help is out there for treatment addiction? Heather Stephen reports. 

You pop into a clinic for a spot of Botox and a few fillers, then think maybe you’d look better after a nose job, and book in for some lipo for that jelly belly you’ve never managed to shift with exercise.

But beware. Having multiple procedures could be a sign you have Body Dysmorphic Disorder (BDD) – a condition which causes people to have a distorted view of their looks and spend an inordinate amount of time worrying about their appearance.

People who have this disorder may see themselves to be ugly despite reassurances from others and some seek cosmetic surgery for a perceived ‘defect’. But experts say they are often dissatisfied with treatment and return for repeat procedures as they continue to feel unattractive and even repulsive.

According to the Body Dysmorphic Disorder Foundation, two out of every 100 people in the UK has BDD and it can have a devastating effect on your life.

Some people with the condition carry so much shame they don’t want to leave the house, may spend several hours a day thinking about the way they look or go to great lengths to camouflage their appearance with makeup.

A UK Government report estimated that nearly one in five cosmetic surgery patients could have BDD but research shows that only two out of 10 of these patients are happy with the results of their surgery.

And experts say BDD is just the tip of the iceberg because addiction to cosmetic treatments can also be caused by a deep rooted dissatisfaction with appearance which can only be addressed by counselling or psychiatrist treatment.

The British Association of Aesthetic Plastic Surgeons (BAAPS) wants all patients to be screened for psychological disorders before surgery to protect vulnerable people from having unnecessary procedures.vii

Ingrid Collins, a consultant psychologist at the London Medical Centre, agrees doctors have a duty to look out for patients who may be seeking treatments because of a mental health problem.

And she believes aesthetic doctors could consider referring patients to a psychologist or use psychological screening questionnaires to make sure they are appropriate for treatment.

“There is often an emotional reason why a person wants to change the way they look, whether from a perceived inadequacy or feelings of insecurity.” – Ingrid Collins, psychologist.

‘There is often an emotional reason why a person wants to change the way they look, whether from a perceived inadequacy or feelings of insecurity,’ she says.

‘And doctors giving cosmetic treatments should take steps to assess whether their patients have a psychiatric disorder or whether they are developing an addiction.’

Cosmetic surgeon Naveen Cavale says it can be challenging for surgeons to distinguish whether patients have a psychological addiction to surgery but he says there are warning signs.

‘If someone seems to have unrealistic expectations or has perhaps shopped around a lot for surgeons that would send up a red flag,’ says Mr Cavale.

‘In these circumstances I might suggest to the patient they go home and think more carefully about whether the operation is really going to make them happy.

‘At my private practice I sometimes advise patients I am concerned about to see a psychiatrist colleague but often people don’t want to do this and unfortunately I can’t stop them from getting the treatment somewhere else.’

If you have BDD the chances are no amount of surgery is going to make you feel good but how can you tell if you have a problem?

According to the BDD Foundation some giveaway signs are if you:

• Check your appearance in the mirror several times a day
• Avoid going out because you are worried about your looks
• Wear heavy makeup all the time
• Spend more than an hour a day thinking about a perceived defect.

People with BDD most commonly complain about their skin, followed by their nose, hair, eyes, chin, lips and build and it affects equal numbers of men and women.

It is not known why people develop the disorder. There is thought to be a genetic link and a poor relationship with a parent or teasing during adolescence may make you more vulnerable.

So, what can be done? Well, mild cases of BDD are currently treated with cognitive behaviour therapy (CBT), which has been shown to be helpful in reducing symptoms and is the only psychological treatment for BDD supported by research.

CBT, combined with anti-depressants are recommended for more severe symptoms and, in studies, between two thirds to three quarters of people taking anti-depressants for BDD saw an improvement in their symptoms of at least 30 per cent.

So if you think you might be going too far with treatments speak to your doctor and you might just find the answer to your problems without going anywhere near a needle or knife.

Online help: 

• Take a questionnaire to see if you might have dysmorphia on the The Body Dysmorphic Disorder Foundation site http://bddfoundation.org/
• Anxiety UK has useful information on depression and other mental health issues www.anxietyuk.org.uk/
• The charity MIND has links to support and services on its site http://www.mind.org.uk/