How to spot aesthetic patients with body dysmorphia or BDD

Considering whether to treat patients with body dysmorphia, also referred to as body dysmorphic disorder (BDD) can be a daunting and complex situation for many aesthetic clinicians, raising many questions. Is it ethical to continue treating body dysmorphic patients? How do you know if they have body dysmorphia? What if they feel judged or upset if you turn them away?

In this blog, Dr Tim Pearce introduces aesthetic nurse Emily Spence who has a unique insight into body dysmorphia as both an aesthetic practitioner and someone diagnosed with the disorder. The pair openly discussed Emily’s experience with body dysmorphia and her drive to raise awareness of the signs amongst aesthetic practitioners to help you screen patients correctly, manage patients with BDD, and deliver ethical treatment for the right reasons.

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A unique insight into body dysmorphic disorder (BDD)

Introducing the topic of body dysmorphic disorder (BDD), Dr Tim explained how nurse Emily, from Aumento Aesthetics in Chesterfield could give us all unique insight into the subject, having suffered from body dysmorphia since her teens.

Through personal experience of diagnosis and living with BDD, as well as being an aesthetic nurse delivering cosmetic treatments to others, Emily can pass on information and guidance for communicating with patients you suspect of having body dysmorphia to protect them from harm.

Dr Tim noted that he believes that most aesthetic clinicians only have a superficial understanding of body dysmorphia and may confuse the signs with an individual who has bad taste when it comes to the look that they are seeking, such as a result that appears to others as overtreatment. This would not be dysmorphic, but a form of expression, wanting to be noticed by others, in the same way as body modification with tattoos and piercings. Read how to diagnose: body dysmorphia versus body modification.

With patients exhibiting genuine signs of body dysmorphia, the concern is ending up in a losing game through continued aesthetic treatment, where both the clinician and the patient end up very unhappy. By spotting patients early, this can be avoided.

Body dysmorphia: Emily’s story

Emily shared her personal story, describing a need to conform to social ideals perpetuated by social media and celebrities from as young as 15, combined with bullying at school, family break-up, and a toxic romantic relationship. Initially, her obsession with her appearance manifested in excessive use of the gym and weight control, she did not have an eating disorder but had a compulsion to exercise to extremes to avoid weight gain. Once she was old enough to have cosmetic treatments, Emily described getting lip fillers and breast augmentation as soon as she could after her 18^th birthday, citing the influence of celebrity role models like Katie Price.

However, Emily was not satisfied, she described continually going back for further cosmetic treatments after a few months, repeatedly wanting to change something about herself and her appearance, requesting cheek, chin, nasolabial, and jawline filler, plus having more and more lip filler, without refusal by multiple practitioners. Emily was unable to comprehend a difference in lip size or augmentation herself, constantly wanting more, despite family members pointing it out and raising concerns, which she ignored.

Visiting a different aesthetic practitioner, Emily experienced the first mention that she might be suffering from body dysmorphia – due to her never-ending drive for perfection. Disappointed with the practitioner, she shrugged it off and continued her pattern of behaviour, unchallenged. Eventually, she was able to acknowledge that she had a problem, self-educating and referring herself to psychological therapists who helped with cognitive behavioural therapies (CBT). Listen to more of Emily’s journey in the full podcast with Dr Tim.

How to spot the signs and symptoms of BDD

As an aesthetic practitioner, it can be very difficult to help a patient to make the realisation that they have body dysmorphic tendencies. Using screening questionnaires that are now more widely available, can be a useful tool for clinicians, noted Emily. Why not download Dr Tim’s body dysmorphia and modification checklist.

With a desire to practice ethically, using values that ensure that everything you do is in the best interests of your patients, the information gathered from the questionnaire can help to explain to the patient that you care about their mental health and well-being, as a primary factor, over and above your business. If the results lead you to suspect that they have body dysmorphia, you can discuss and explain the symptoms and how you can further help with onward referral to a specialist. By ensuring that the patient understands that you are focused on their safety and well-being, you can give the reasons why you cannot treat them right-here-right-now with aesthetic enhancements, clarifying that this does not mean that they will never have treatment, simply that you believe they would benefit from intervention, advice, and guidance from a practitioner who can formally diagnose mental health concerns. Learn how to say “no” to an aesthetic patient without making them angry.

If the patient is in denial and cannot see what you are describing, they may be annoyed that you raised it, and are not going to perform the treatment, even though they want it; be prepared for them to be upset, warns Emily. However, remember, it is better to refuse treatment because you are protecting them and their mental health, and at that moment in time, they are not able to see the bigger picture or have the awareness that they may be suffering from body dysmorphic disorder.

The patient may discredit your suspicions, citing that they have not had multiple cosmetic surgeries, for example. However, Emily notes that this is a fallacy that she sees about BDD. Body dysmorphic tendencies are manifested more as a thought process, than extreme actions like multiple times under the knife. If a patient has obsessive thoughts about their body image, goes to the gym excessively, obsesses with make-up, or utilises non-invasive cosmetic treatments like dermal fillers repeatedly and to excess, these are all contributing signs for body dysmorphia showing that their mind is obsessing over body image, and it is affecting them every day and how they live their life. The underlying thoughts drive the behaviour, however, that manifests. Learn more tips and techniques from Emily and Dr Tim so you can have meaningful dialogue with patients who may be suffering from body dysmorphia.

Emily is passionate about raising awareness of body dysmorphia amongst medical professionals and patients. You can follow Nurse Emily on Instagram and download her CPD-accredited 27-page e-book on the ultimate guide for aesthetic practitioners when treating patients with BDD.

Dr Tim is always keen to hear about the experiences of his followers. So, if you have any questions, case studies, or discussion points for him, you can find Dr Tim Pearce on Instagram.

Aesthetics Mastery Show

Aesthetic treatments won’t make THESE patients happier. Spot patients with body dysmorphia!

Dr Tim introduces a recent Aesthetics Mastery Show dedicated to the issue of BDD, saying:

“Treating patients with body dysmorphia can be a daunting and complex situation for many clinicians. Is it ethical to continue treating dysmorphic patients? How do you know if they have body dysmorphia? What if they feel judged or upset if you turn them away?

“In this episode I chat to Nurse Emily, a talented aesthetic injector and a past sufferer of body dysmorphia.

“Not only does Emily open up about her experience of body dysmorphia with me, she explains her process for ethical treatment and management of dysmorphic patients so that you can ensure you are screening your patients correctly and treating them for the right reasons.”

Watch the full Aesthetics Mastery Show here.

The video has received a variety of comments from viewers on the YouTube channel, including some from patients as well as practitioners. Here are just a few:

@swierplife commented:

“Thanks Emily. I think this is rampant in aesthetics providers. Go to a conference and you can see this in 1/3 of the injectors. They don’t know when to stop, and chase every ounce of movement in their face.”

@teresatennis added:

“I listened to this twice. How wonderful and thank you!”

@user-ev8lt1zd7g said:

“Great interview on BDD.”

Read more comments and join in the debate on our YouTube channel.

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