BDD and Plastic Surgery: When to Seek Treatment

Woman Dealing with Depression and Eating Disorders

Body Dysmorphic Disorder (BDD) is a disorder where a person becomes obsessed and fixated on a particular area or areas of their body. This fixation can range from the shape of their nose, flaw on the skin, or other aspects of the body. Often it is surrounded by feelings of shame, self-hatred, and overly-critical thoughts about one’s appearance.

What is BDD

Often thoughts around flawed areas of the body and appearance occur for at least one hour per day with excessive amounts of time spent in front of a mirror or reflective surface. A person becomes fixated on the perceived flaw and may try to cover up with accessories, makeup, etc. Individuals may avoid public places or social gathers due to the perceived defect.

Often people may begin to stay isolated and not leave their house. Typically other issues such as depression, anxiety, and low self-esteem are common. When individuals have BDD, it often interferes with day-to-day functioning and/or can cause significant emotional distress [1].

Types of Plastic Surgery

Due to the nature of this disorder, many people will turn to cosmetic or plastic surgery rather than therapy to correct their perceived flaws.

Usually, plastic surgery is seen as a way to reduce body dissatisfaction related to appearance, and the belief that surgery will change their appearance will result in increased self-esteem and improved mood.

It is estimated that of those with BDD, 26-40% seek out plastic surgery and 64% received some type of medical treatment for surgical or dermatological care for BDD.

Woman struggling with BDDObsession with the nose is one of the most common areas with BDD. Cosmetic rhinoplasty is one of the most common plastic surgery procedures done. In those who sought this type of surgery, 21% met the criteria for BDD [1].

Dermatology is also another highly sought after surgery due to skin preoccupations in those with BDD. Typically topical agents, chemical peels, plastic surgery, nonablative lasers, and fillers are most common. Even with plastic surgery, most individuals with BDD tend to be dissatisfied with the outcome of the procedures.

Mental Health

Suicide rates are also high for those struggling with BDD. Often other mental health issues are underlying the BDD symptoms. Following plastic surgery, many individuals may feel more depressed due to a perceived lack of improvement in their appearance [1].

Often those with BDD are secretive about their disorder due to the shame and distress it causes them. Individuals when seeking treatment may not discuss their concerns with a medical professional for fear that their concerns will be dismissed. Even if plastic surgery is done, following the procedure, new appearance issues developed [2].

The motivation for seeking surgery in studies have found that individuals want to improve their self-esteem or to improve their appearance for romantic relationships.

Understanding the motivation behind why a person is seeking surgery is important in knowing if therapy needs to be recommended.

Seeking Treatment

Knowing when to search for treatment can be difficult for those struggling with BDD. Often if a person or loved one finds that the sufferer is trying multiple plastic surgery procedures on one area or areas of their body, this is one indication that it is more than just aesthetic purposes.

Secondly, asking about a person’s dissatisfaction with their appearance. From this, you can decide if a person is in extreme distress or emotional distress.

Another indication that someone needs treatment for BDD is to ask how much time a person is spending thinking about and looking at their perceived areas of concern. Do they spend a majority of the day trying to cover up or conceal their flaw? Do those activities interfere with their day-to-day functioning and well-being?

Looking at employment history is another indicator of whether someone needs to seek treatment. Is the sufferer working or have their behaviors caused them to be let go from their position.

Do their activities prevent them from seeking employment? Assessing the amount of time that the behaviors take away from daily living and necessary activities is also an indicator of how severe the disorder is and if treatment is needed.

Typically a person’s mood, sleep, appetite, and concentration will be disrupted due to the BDD symptoms. Eating disorders can also occur in this population and may seek multiple surgeries to obtain the ‘perfect’ body.

Woman near waterfall

Often many people will comb magazines and photos online to have examples to show surgeons the type of body they prefer. These are also indicators of BDD.

Those who struggle with BDD report an extreme amount of body dissatisfaction that derails their daily functioning. This condition is believed to affect 2% of the population. It is hard to get a more firm number due to lack of reported symptoms.

With concern for self-harm and suicidality within this population, it is essential that individuals seek help from a mental health professional and psychiatrist for medication management.

Seeking treatment can be scary, but it can also be liberating for a person who struggles with body dysmorphic disorder. It can slowly take over a person’s life and leave them isolated and alone with their negative thinking.

The negative thinking can lead to depression, anxiety, and socially odd behaviors that the person begins to believe as truth. Seeking help is imperative for those who feel that they are flawed, spend more time than not ruminating and body checking, as well as seeking out numerous surgeries for their perceived flaws.

With therapy techniques such as cognitive behavioral, dialectical behavioral therapy, peer support, and anxiety desensitization tools, a person can recover from body dysmorphic disorder and live a healthy and fruitful life.

Image of Libby Lyons and familyAbout the Author: Libby Lyons is a Licensed Clinical Social Worker and Certified Eating Disorder Specialist (CEDS). Libby has been practicing in the field of eating disorders, addictions, depression, anxiety and other comorbid issues in various agencies. Libby has previously worked as a contractor for the United States Air Force Domestic Violence Program, Saint Louis University Student Health and Counseling, Saint Louis Behavioral Medicine Institute Eating Disorders Program, and has been in Private Practice.

Libby currently works as a counselor at Fontbonne University and is a Adjunct Professor at Saint Louis University, and is a contributing author for Addiction Hope and Eating Disorder Hope. Libby lives in the St. Louis area with her husband and two daughters. She enjoys spending time with her family, running, and watching movies.


[1] Cosmetic Treatments and Body Dysmorphic Disorder. (2014, December 04). Retrieved July 31, 2017, from
[2] Sarwer, D., & Spitzer, J. (2012). Body Image Dysmorphic Disorder in Persons Who Undergo Aesthetic Medical Treatments. Retrieved July 31, 2017, from Aesthetic Surgery Journal 32(8) 999–1009

The opinions and views of our guest contributors are shared to provide a broad perspective of eating disorders. These are not necessarily the views of Eating Disorder Hope, but an effort to offer discussion of various issues by different concerned individuals.

We at Eating Disorder Hope understand that eating disorders result from a combination of environmental and genetic factors. If you or a loved one are suffering from an eating disorder, please know that there is hope for you, and seek immediate professional help.

Published on October 9, 2017.
Reviewed By: Jacquelyn Ekern, MS, LPC on October 9, 2017.
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