Body Dysmorphic Disorder

Dr. Katharine A. Phillips reported on Body Dysmorphic Syndrome in World Psychiatry in 2004.   The review article describes the behaviors and symptoms of dysmorphophobia.   Generally patients with this problem have the perception that something is wrong with their appearance.   Frequently they focus on their face and head.   They turn to abnormal behaviors, such as excessive grooming (e.g., applying makeup, hair styling), camouflaging (e.g., with a hat, clothes, or makeup), frequent clothing changes, reassurance seeking, skin picking, and/or eating a restricted diet.   These behaviors typically occur for many hours a day and are difficult to resist or control.  Sometimes cosmetic surgery is considered.   It is also reported that this syndrome  is frequently associated with delusional thinking, depression, substance use disorders, and social phobias.

Sadly, the late Michael Jackson expressed many of these symptoms with his bizarre habits of mask wearing, weight loss, prescription drug use, and multiple cosmetic surgery procedures.   Depression and delusional thoughts may have ultimately contributed to his demise.

Patients sometimes come into my office with a history of prior multiple cosmetic surgery procedures.   We interview them carefully with regards to their expectations and motives for surgery.   This is particularly critical when they have had multiple procedures on a single facial feature, such as the nose.   We try to guide these patients to psychiatric care in an effort to rule out serious psychological problems.   Unfortunately, not all offices have this policy.   It seems that determined patients will often find someone willing to perform another cosmetic surgery procedure, when a reputable physician has counseled  against surgery.

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