What is the relationship between cosmetic procedures and mental health?

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

source: The conversation

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

In 2015, the College of Cosmetic Physicians of Australia found that Australians spend more than $1 billion a year on non-invasive cosmetic procedures such as Botox and fillers. That’s more than 40% more per capita than in the United States.

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.

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

Body dysmorphic disorder

Body image concerns are usually the primary motivator for seeking cosmetic procedures of any kind. These concerns are usually directed at the part of the body where cosmetic intervention is sought, such as the nose for rhinoplasty.

Serious body image problems are a key feature of several mental health conditions. The most common among 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 rises to 16-23%.

Body dysmorphic disorder involves a preoccupation or obsession with one or more perceived flaws in physical appearance that are not visible or seem insignificant to other people. In response to the distress associated with the flaw, the person with body dysmorphic disorder will engage in repetitive behaviors (such as excessively checking body parts in the mirror) and mental actions (such as comparing their appearance to other people).

These concerns can have a significant negative impact on a person’s daily life, with some people too worried 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 appears to stem from appearance concerns, it makes sense that someone with body dysmorphic disorder would be much more likely to present to a cosmetic treatment clinic than a mental health clinic.

The problem is that cosmetic surgery usually leaves the person with body dysmorphic disorder feeling the same or worse after the procedure. They may become even more concerned about the perceived flaw and seek additional cosmetic procedures.

Patients with body dysmorphic disorder are also more likely to take legal action against their esthetician after they feel they did not get the result they wanted.

For these reasons, body dysmorphic disorder is generally considered by healthcare professionals to be a “red flag” or contraindication (a reason not to undergo a medical procedure) for cosmetic procedures.

However, this is not entirely clear. Some studies show that people with body dysmorphic disorder may improve their symptoms after cosmetic intervention, but the obsession may simply move to another part of the body and the diagnosis of body dysmorphic disorder may remain.

What about other mental health conditions?

Body dysmorphic disorder is the most well-studied disorder in this area, but it is not the only mental health condition that may be associated with poorer results from cosmetic procedures.

According to a recent systematic review, rates of depression (5-26%), anxiety (11-22%), and personality disorders (0-53%) in people seeking cosmetic surgery may be higher than the general population (which are calculated to be 10%, 16% and 12% respectively).

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

See also

It 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. Image is in the public domain

Beyond body dysmorphic disorder, research examining other mental health conditions is limited. This may simply be because a focus on body image is at the heart of body dysmorphic disorder, making it a logical focus for research on cosmetic surgery compared to other types of psychiatric disorders.

So what should happen?

Ideally, all cosmetic surgeons and medical practitioners should receive sufficient training to be able to perform a brief routine assessment of all prospective patients. Those with signs indicating that they are unlikely to derive psychological benefit from the procedure should undergo further evaluation by a mental health professional before undergoing the procedure.

This may include an in-depth clinical interview about the rationale for the procedure and completion of a set of standard mental health questionnaires.

If the assessment process reveals that a person has a mental health problem, this does not necessarily mean that the mental health professional would recommend against the procedure. They may offer a course of psychological therapy to deal with the problematic issue and then undergo a cosmetic procedure.

Currently, assessments are only recommended, not mandatory for cosmetic surgery (and not at all for injectables like botox and fillers). The guidelines say that an assessment should be done if there are signs that the patient has “significant underlying psychological problems”.

This means that we rely on the cosmetic practitioner being able to spot such issues when they may have only received basic psychological training in medical school and where their business could potentially benefit from not paying attention to such diagnoses.

An August 2022 independent review by the Australian Health Practitioners Regulation Agency and the Medical Council of Australia recommended that guidance on mental health assessment be “strengthened” and highlighted the importance of practitioners receiving more training in detecting mental health problems. disorders.

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

About this mental health research news

Author: Gemma Sharp and Nicola Rumsey
source: The conversation
Contact: Gemma Sharp and Nicola Rumsey – The Conversation
Image: Image is in the public domain

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