More than just filler: an empirically informed ethical analysis of non-surgical cosmetic procedures in body dysmorphic disorder

Lane, Natalie M

doi:10.1136/medethics-2019-105746

Cited by 4 publications

(8 citation statements)

References 27 publications

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“…NICE guidelines ( 2005 ) state that for people with mild disfigurements or blemishes seeking aesthetic procedures, healthcare professionals should routinely consider the possibility of BDD, and that those with suspected or diagnosed BDD seeking aesthetic treatment should also be assessed by a mental health professional with expertise in BDD. Medical ethics guidelines recommend that while patients’ aesthetic concerns should not be dismissed, aesthetic intervention is to be carefully considered against the risk of failure to meet the patient’s expectations or to address the underlying issues in the absence of accompanying psychological intervention (e.g., Lane, 2020 ).…”

Section: Discussionmentioning

confidence: 99%

“If only he were blind”: Shame, trauma, and dissociation among women with body dysmorphic disorder in physically intimate relationships

Stechler

Henton

2022

International Journal of Qualitative Studies on Health and Well

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Background Body Dysmorphic Disorder (BDD) involves a debilitating preoccupation with one’s appearance and associated difficulties in social and interpersonal relationships, according to the Diagnostic and Statistical Manual for Mental Disorders (DSM-5). Quantitative research has investigated the severity of relationship difficulties in BDD, while qualitative research has primarily focused on intrapersonal phenomena, although interpersonal difficulties, including with physical intimacy, have frequently emerged from these studies. Aims This study explores how women with BDD make sense of their lived experiences of physical intimacy in the context of current partner relationships. Method Six adult women participated in individual semi-structured interviews. The data was analysed using Interpretative Phenomenological Analysis. Results The analysis generated three superordinate themes: 1) The shame in being seen, 2) Disgust and detachment during intimacy, and 3) A flawed self, unworthy of relationships. Conclusions This study demonstrates how appearance-related concerns filter into the cognitive, behavioural, and emotional intersubjective spaces of physically intimate partnerships. Shame or trauma may be triggered and may be managed through disengagement or dissociation. Clinical implications These findings support calls for a full psychological assessment of the contextual and interpersonal components of BDD, and further suggest that psychological interventions for shame, trauma, and dissociation, such as compassion-focused therapy, imagery rescripting, or body-focused therapies, may be helpful additions to cognitive-behavioural or exposure and response prevention interventions for practitioners working with BDD.

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Section: Discussionmentioning

confidence: 99%

“If only he were blind”: Shame, trauma, and dissociation among women with body dysmorphic disorder in physically intimate relationships

Stechler

Henton

2022

International Journal of Qualitative Studies on Health and Well

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“…Body dysmorphic disorder (BDD), otherwise known as body dysmorphia, is a mental health condition involving persistent, excessive preoccupation with perceived flaws in one's physical appearance with a prevalence of 2%. [1][2][3] These flaws may be minor or imagined and may not be in line with how others see them. 2,3 BDD causes significant distress and anxiety and can lead to social isolation, depression, and suicidal thoughts.…”

Section: Introductionmentioning

confidence: 99%

“…[1][2][3] These flaws may be minor or imagined and may not be in line with how others see them. 2,3 BDD causes significant distress and anxiety and can lead to social isolation, depression, and suicidal thoughts. 4 The psychosocial impact of BDD is significant, with one-third being unable to attend employment or education and disproportionately high suicide rates.…”

Section: Introductionmentioning

confidence: 99%

“…4 The psychosocial impact of BDD is significant, with one-third being unable to attend employment or education and disproportionately high suicide rates. 2 BDD is notoriously difficult to diagnose as it can masquerade as anxiety or low self-esteem, making it challenging for healthcare professionals to identify. This complexity, coupled with the stigma surrounding mental health, often results in delayed diagnosis.…”

Section: Introductionmentioning

confidence: 99%

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An Evidence-based Pathway for Body Dysmorphic Disorder in Facial Aesthetics

Mandavia,

D'Souza,

Rupasinghe

et al. 2024

Facial Plast Surg

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Aesthetic procedures should be avoided in patients with Body Dysmorphic Disorder (BDD) since they can negatively impact mental health and lead to further aesthetic dissatisfaction. There are no evidence-based patient pathways for BDD in facial aesthetics which can result in the failure to identify patients with BDD, leading to unsuitable treatments and suboptimal patient care. We aim to construct the first evidence-based patient pathway for BDD in surgical and non-surgical facial aesthetics. A systematic review was performed and articles that discussed screening or patient pathways for BDD in field of facial aesthetics were included. We extracted relevant information from each article on screening tools and pathways for BDD. Data were synthesised by summarising the data under column headings into a structured narrative and into new tables. Based on this synthesis, a practical pathway for BDD was constructed. Forty articles fulfilled the criteria for inclusion. Twenty-eight BDD screening tools were discussed in the included articles, and we provide an overview of these tools. Thirty-one articles discussed patient pathways for BDD, and we synthesised this information into a structured narrative. Combining these findings we present an evidence-based patient pathway for BDD for patients presenting for facial aesthetic treatments. This systematic review has resulted in the first, evidence-based, patient pathway for BDD in surgical and non-surgical facial aesthetics. This practical pathway can be used by aesthetic clinicians to identify patients with potential BDD and provide clear guidance for managing cases where BDD is suspected. It will help reduce the number of facial aesthetic procedures performed on patients with BDD, safeguard patient mental well-being and prevent further aesthetic dissatisfaction.

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“…Part of this ethical practice is ensuring the bio‐, psycho‐ and social elements of practice are considered and monitored. This is particularly important in considering the impact of Body Dysmorphic Disorder (BDD) which is a significant risk factor in aesthetic procedures 9 . There is also an important financial consideration to be aware of in this sector, adding further complexity to the industry.…”

Section: Introductionmentioning

confidence: 99%

Quantitative and qualitative analysis of individual experiences post botulinum toxin injection ‐ United Kingdom Survey

Zargaran

Sousi

et al. 2023

Skin Health and Disease

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IntroductionIn the United Kingdom (UK), complications that arise following the administration of Botulinum Toxin are reported to the Medicines and Health Regulatory Agency (MHRA) via the Yellow Card Reporting Scheme. Over the past decade, there has been a significant increase in the number of non‐surgical aesthetic procedures. Concerns have been raised that the MHRA is not fully capturing complications in terms of volume and impact on patients.AimThis novel study explores the lived experiences of individuals who have experienced an adverse event following administration of Botulinum Toxin for aesthetic purposes. Using a combination of qualitative and quantitative methodologies, this analysis evaluates data relating to long‐lasting physical, psychological, emotional, and financial sequelae of complications arising from cosmetic Botulinum Toxin injections in the UK.MethodsA mixed method, qualitative and quantitative approach was adopted to gain comprehensive insights into patients' experiences. A focus group which comprised patient representatives, psychologists, and researchers reached a consensus on a 17‐question survey which was disseminated via social media channels. Deductive thematic analysis was used to analyse coded themes. Furthermore, for secondary analysis, sentiment analysis was used computationally as an innovative approach to identify and categorise free text responses associated with sentiments using natural language processing (NLP).ResultsIn the study, 655 responses were received, with 287 (44%) of respondents completing all questions. The mean age of respondents was 42.6 years old. 94.1% of respondents identified as female. In the sample, 79% of respondents reported an adverse event following their procedure, with the most common event being reported as ‘anxiety’. Findings revealed that 69% of respondents reported long‐lasting adverse effects. From the responses, 68.4% reported not having recovered physically, 63.5% of respondents stated that they had not recovered emotionally from complications, and 61.7% said that they have not recovered psychologically. In addition, 84% of respondents stated that they do not know who regulates the aesthetics industry. Furthermore, 92% of participants reported that their clinic or practitioner did not inform them about the Yellow Card Reporting Scheme. The sentiment analysis using the AFINN Lexicon yielded adjusted scores ranging from −3 to +2, with a mean value of −1.58.ConclusionThis is the largest survey in the UK completed by patients who experienced an adverse outcome following the aesthetic administration of Botulinum Toxin. Our study highlights the extent of the challenges faced by patients who experience an adverse event from physical, emotional, psychological, and financial perspectives. The lack of awareness of MHRA reporting structures and the lack of regulation within the UK's cosmetic injectables sector represent a significant public health challenge.

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More than just filler: an empirically informed ethical analysis of non-surgical cosmetic procedures in body dysmorphic disorder

Cited by 4 publications

References 27 publications

“If only he were blind”: Shame, trauma, and dissociation among women with body dysmorphic disorder in physically intimate relationships

“If only he were blind”: Shame, trauma, and dissociation among women with body dysmorphic disorder in physically intimate relationships

An Evidence-based Pathway for Body Dysmorphic Disorder in Facial Aesthetics

Quantitative and qualitative analysis of individual experiences post botulinum toxin injection ‐ United Kingdom Survey

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