A condition that can take over your life

When you come to St Hugh’s, everything is centred around you – and that’s as much about ensuring that you’re in psychologically good place as it is physical.

“Body dysmorphic disorder, known as BDD for short, is a psychological condition that means you can’t stop thinking about one or more perceived flaws in your appearance,” says our Cosmetics Sister, Sarah Grantham.

“The key word here is ‘perceived’ because this condition affects how you feel and how you view yourself; often the flaw a person with BDD constantly worries about is invisible to others around them or is so minor that others don’t notice.

“But for the person with BDD, this is a major, life-affecting issue – embarrassment, anxiety, shame, stress… it can build up so much that some sufferers avoid social situations or going out at all.

“These feelings can be so intense that people with BDD find that they can’t think about much else – it almost takes over their life. For example, they might constantly check their appearance in the mirror or their reflection whenever they can, or intensely focus on grooming their appearance. For others, a symptom can be constantly seeking reassurance.

“Some BDD sufferers undergo cosmetic procedures to ‘correct’ the perceived flaw, and while they might initially be pleased, because the root cause has not been addressed – i.e., BDD and its symptoms – the fear, shame, anxiety and so on soon returns, and the cosmetic procedure either simply isn’t enough or good enough.

“BDD may be treated, by medicine or behavioural therapy, for example, so although it may feel like there’s no help, there is.

“But you can see why it’s vital that we here in the cosmetics team at St Hugh’s are ultra-aware of a person’s needs when they come to us – and that sometimes means that surgery is not for them.”

According to the Aesthetics Monthly Journal for medical professionals, the condition is continually gaining more recognition. It’s been estimated that around one in eight patients who present to facial plastic and reconstructive surgery settings suffer from the disorder, although it’s likely to be underreported. In terms of the general population, it is thought to affect 0.5% of people in the UK.

“Obsession with both invasive and non-invasive aesthetic procedures and increased insecurity isn’t an unusual occurrence and has led to patients putting themselves in danger,” said the journal’s recent report on the issue.

“One extreme example includes former model Hang Mioku, who injected herself with cooking oil after practitioners refused her any further procedures. Therefore, it’s not only important for practitioners to be able to identify the condition, but also to be aware of how to get the patient correct support.”

Sarah went on to explain that as well as a thorough pre-assessment prior to surgery, all cosmetic patients at St Hugh’s are required complete a psychological assessment to ensure they have made the right decision at the right time and are equipped to deal with any post-operative issues, should they arise. This is a standard policy at St Hugh’s, in line with the Care Quality Commission’s (CQC) framework.

“It’s all about ensuring patients receive the finest bespoke care before, during and after their stay with us,” she says. “It is vital that we identify and respond to the changing needs of and risks to people who use our services, that the procedure is suitable, and voluntary… basically, these assessments protect the patient, and the patient is at the heart of every single thing we do here.

“It’s not a case of questioning the patient but making sure the reasons why are sound – for the patient, and for us, too.”

The assessment is a mix of questionnaires and in-person appointments and includes topics like the patient’s area or areas of concern, discussing their decision to consider surgery, and their overall wellbeing.

“An essential part of what we do is making the entire patient journey clear, from the moment a person picks up the phone and calls us, or makes an enquiry, to when they’re recovering at home and beyond,” Sarah adds.

“Advances in plastic surgery, coupled with the vast range of treatments on offer, means there is now a bewildering array of cosmetic procedures available. The vast majority of procedures end with satisfied patients, but it is vitally important that people have a procedure for the right reasons, at the right time, in the right place and with an appropriately qualified plastic surgeon who understands their needs.

“This is not part of a ‘test’ and does not act as a way of ‘screening out’ people from having the procedure they want. This enables your surgical team to know enough information about you to support you in getting the best outcomes from surgery, both physically and psychologically. This is our Gold Standard of Care.”

To read more about BDD, visit the NHS’s information page here 

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