What is the connection between cosmetic procedures and mental health?

Summary: Researchers reveal a higher rate of body dysmorphia, depression, anxiety, and personality disorders in those seeking cosmetic surgery procedures.

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Although we cannot be sure of the exact number of Australians undergoing cosmetic procedures, as there is no requirement for healthcare professionals to report their statistics, there is a consensus that demand is growing.

In 2015, the Australasian College of Cosmetic Physicians found that Australians spend more than $1 billion a year on non-invasive cosmetic procedures like Botox and fillers. This is more than 40% higher, per capita, than in the United States.

In the US, where the procedure statistics are reportedthere was a 42% increase in the number of filler procedures and a 40% increase in Botox procedures performed in the last year alone.

Rates of mental health problems in this group may be higher than in the general population, but apparently not enough is being done to ensure the psychological safety of people seeking cosmetic procedures.

body dysmorphic disorder

Body image concerns are generally the primary motivator for seeking cosmetic procedures of all kinds. These concerns are usually focused on the body part where aesthetic intervention is sought, such as the nose for a rhinoplasty.

Serious body image concerns are a key feature of several mental health conditions. The most common in people seeking cosmetic procedures is body dysmorphic disorder. In the general community, about 1-3% of people will experience body dysmorphic disorder, but in populations seeking cosmetic surgery, this increases to 16-23%.

body dysmorphic disorder It involves a preoccupation or obsession with one or more perceived flaws in physical appearance that are not visible or appear minor to other people. In response to failure distress, the person with body dysmorphic disorder will engage in repetitive behaviors (such as excessively checking body parts in the mirror) and mental acts (such as comparing their appearance to others).

These worries can have a significant negative impact on the person’s daily life, with some people too distraught to leave their home or even have dinner with family members for fear of being seen by others.

Since the distress associated with body dysmorphic disorder apparently stems from physical appearance issues, it makes sense that someone with body dysmorphic disorder would be much more likely to go to a cosmetic clinic for treatment than a mental health clinic.

The problem is that cosmetic intervention usually makes the person with body dysmorphic disorder feel the same or worse after the procedure. They may become even more concerned about the perceived flaw and seek further cosmetic procedures.

Patients with body dysmorphic disorder are also more like take legal action against their treating cosmetic physician after believing they have not received the result they wanted.

For these reasons, health professionals generally consider body dysmorphic disorder to be 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 cosmetic intervention, but the obsession can 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 best-studied disorder in this area, but it is not the only mental health condition that may be associated with poorer outcomes from cosmetic procedures.

according to a recent systematic reviewrates of depression (5-26%), anxiety (11-22%), and personality disorders (0-53%) in people seeking cosmetic surgery may be higher than in the general population (estimated at 10 %, 16% and 12% respectively).

However, these rates should be interpreted with some caution, as they largely depend on how the mental health diagnosis was made: physician-led interview (higher rates) versus mental health questionnaire (lower rates). Some interview approaches may suggest higher rates of mental health problems, as they may be unstructured and therefore of questionable validity compared to highly structured questionnaires.

See also

This shows the outline of a head.
This shows a woman touching her face.
In the US, where procedure statistics are reported, there has been a 42% increase in the number of filler procedures and a 40% increase in Botox procedures performed in the last year alone. The image is in the public domain.

Besides body dysmorphic disorder, research investigating other mental health conditions is limited. This may simply be due to the fact that a focus on body image is at the core of body dysmorphic disorder, making it a logical approach for cosmetic surgery research compared to other types of psychiatric disorders.

So what should happen?

Ideally, all cosmetic surgeons and professionals should receive sufficient training to enable them to perform a brief routine evaluation of all prospective patients. Those with signs that they are unlikely to gain psychological benefit from the procedure should undergo further evaluation by a mental health professional before undergoing the procedure.

This could include an in-depth clinical interview about the motivations for the procedure and completing a variety of standard mental health questionnaires.

If a person is determined to have a mental health problem in the evaluation process, it does not necessarily mean that the mental health professional recommends against continuing the procedure. They may suggest a course of psychological therapy to address the problem of concern and then undergo the cosmetic procedure.

At the moment, evaluations are only recommended rather than required for cosmetic surgery (and not for injectables like Botox and fillers). the guidelines they say an evaluation should be done if there are signs that the patient has “significant underlying psychological problems.”

This means that we trust the cosmetic physician to be able to detect such problems when they have only received basic psychological training in medical school, and when their business could possibly benefit from not attending to such diagnoses.

An August 2022 independent review by the Australian Health Professionals Regulation Agency and the Medical Board of Australia recommended that guidelines on mental health assessment be “strengthened” and stressed the importance of doctors receiving more training in screening for psychiatric disorders.

Ultimately, as cosmetic professionals treat patients who seek treatment for psychological rather than medical reasons, they must keep the patient’s well-being in mind, both for professional integrity and to protect themselves from legal action. Mandatory evaluation of all patients seeking any type of cosmetic procedure would likely improve overall patient satisfaction.

About this mental health research news

Author: sharp gem Y nicola rumsey
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Contact: Gemma Sharp and Nichola Rumsey – The Conversation
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