What is the relationship between cosmetic procedures and mental health?

summary: Researchers reveal higher rates of body dysmorphia, depression, anxiety and personality disorders among those seeking cosmetic surgery procedures.

Source: Conversation

While we cannot be sure of the exact number of Australians undergoing cosmetic procedures, as there is no requirement for health professionals to report their figures, calls for consensus are growing.

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

In the US, where procedure statistics are reported, the number of filler procedures increased by 42% and Botox procedures by 40% in the past year.

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

body dysmorphic disorder

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

Severe body image concern is a core feature of many mental health conditions. Body dysmorphic disorder is the most prevalent among people seeking cosmetic procedures. In the general community, approximately 1–3% of people will experience body dysmorphic disorder, but this rises to 16–23% in the population seeking cosmetic surgery.

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

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

With the distress associated with body dysmorphic disorder seemingly stemming from physical appearance issues, it makes sense that someone with body dysmorphic disorder is more likely to come to a cosmetic clinic for treatment than a mental health clinic. .

The problem is, cosmetic interventions usually leave the person with body dysmorphic disorder feeling the same or worse after the procedure. They may become even more preoccupied with the perceived defect and seek further cosmetic procedures.

Patients with body dysmorphic disorder are more likely to take legal action against the cosmetic practitioner who treated them after believing they did not get the results they wanted.

For these reasons, body dysmorphic disorder is generally considered by health professionals to be a “red flag” or a contraindication (a reason not to undergo a medical procedure) for 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 may simply 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 most well-studied disorder in this area, but it is not the only mental health condition that may be associated with worse outcomes from cosmetic procedures.

According to a recent systematic review, rates of depression (5–26%), anxiety (11–22%) and personality disorders (0–53%) among people who undergo cosmetic surgery are higher than the general population (which is estimated). can be more than to be 10%, 16% and 12% respectively).

However, these rates should be interpreted with some caution as they depend greatly on how the mental health diagnosis was made – therapist-led interview (higher rates) versus mental health questionnaire (lower rates). Some interview approaches may suggest higher rates of mental health issues because they can be quite unstructured and thus have questionable validity compared to highly structured questionnaires.

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In this a woman is seen touching her face
In the US, where procedure statistics are reported, the number of filler procedures increased by 42% and Botox procedures by 40% in the past year. image is in the public domain

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

So what should happen?

Ideally, all cosmetic surgeons and physicians should receive sufficient training to conduct a brief routine assessment of all potential patients. Those with symptoms that indicate they are unlikely to derive psychological benefit from the procedure should undergo further evaluation by a mental health professional prior to undergoing the procedure.

This may involve an in-depth clinical interview about motivations for the procedure and the completion of a series of standard mental health questionnaires.

If a person is found to have a mental health issue in the assessment process, it does not mean that the mental health professional will recommend against following the process. They may suggest a course of psychological therapy to address the issue of anxiety and then undergo a cosmetic procedure.

At the moment, evaluation is only recommended rather than mandatory for cosmetic surgery (and not at all for injections like Botox and fillers). The guidelines say that an evaluation should be carried out if there are indications that the patient has “significant underlying psychological problems”.

This means that we are relying on cosmetic medical practitioners to be able to detect such issues when they may have received only basic psychological training in medical school, and when it is their business not to engage in such diagnosis. There can be benefits.

An August 2022 independent review by the Australian Health Practitioner Regulation Agency and the Medical Board of Australia recommended “strengthening” mental health assessment guidelines and the importance of medical practitioners receiving more training in detecting mental disorders emphasised.

Ultimately, since cosmetic therapists are treating patients who are seeking treatment for psychological rather than medical reasons, they must put the common good of mind before the patient in order to act with professional integrity and to protect themselves from legal action. Mandatory evaluation of all patients seeking any type of cosmetic procedure will improve overall patient satisfaction.

About this mental health research news

Author: Gemma Sharpe and Nicola Rumsey
Source: Conversation
contact: Gemma Sharpe and Nicola Rumsey – The Conversation
image: image is in the public domain

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