Recently, a friend suggested I read Bodies, the most recent book by Susie Orbach. I had not previously heard of this book, but even a casual reading of the synopsis on Amazon confirms what we see every day at the OCD Center of Los Angeles. Between our clients with Body Dysmorphic Disorder (BDD), and the thousands (millions?) of cosmetic procedures that are basically the norm here in Los Angeles, it is painfully obvious that many people not only dislike their bodies, but are willing to undergo painful, expensive surgeries in an effort to reduce their insecurities.
BDD and Changing Cultural Views of Cosmetic Surgery
While dissatisfaction with one’s body is fairly common (and probably has been throughout history), one significant cultural shift that has occurred in recent years is that many are now willing, and financially able, to have surgeries and other procedures that were very rare just a generation ago. A mere 30 years ago, cosmetic procedures were uncommon – both the cost of the procedures and the cultural attitudes of the day were strong disincentives against having one’s appearance altered. Now, parents give their teenaged daughters nose jobs for birthday presents, and housewives have botox parties. And while cosmetic procedures used to be an almost exclusively female phenomenon, more and more men are now having work done as well.
Exploitation of Patients with BDD
While the easiest culprit to blame for this cultural shift is “the media” (surgically enhanced celebrities, airbrushed models, etc.) there is also a significant financial aspect to this issue. Not only are these procedures now less expensive, they are also being heavily marketed by big pharma. And many cosmetic surgeons are not above providing – and sometimes pushing – procedures that their patients simply do not need. We treated one man with Body Dysmorphic Disorder whose obsessions were with the appearance of his teeth and gums. He had a dentist who performed multiple, very expensive, totally unnecessary, procedures on our client’s perfectly nice looking mouth. I ultimately had to call his dentist and forcefully tell him he was harming our client and that he had to stop performing these unnecessary procedures. We also treated a client with BDD who was scheduled to have one minor cosmetic procedure for a legitimate skin problem. But on the morning of her surgery, as she lay on the gurney being prepped, her cosmetic surgeon talked her onto adding two additional (very expensive, totally unnecessary) procedures.
Finally, here is a personal story. In 1990 I had to have a nose job. Not a cosmetic nose job, but a long-delayed functional fixing of my nose which had been broken since high school. The doctor with whom I initially consulted kept telling me that he could do a (very expensive, totally unnecessary) cosmetic nose job at the same time. I repeatedly told him I had no interest in changing my appearance, but he kept revisiting the topic. The message was very clear – my nose, which I had heretofore considered aesthetically just fine, was unacceptable and worthy of a (very expensive, totally unnecessary) surgery. I ultimately dropped him and elected to have my nose fixed by an MD who willing to do the required surgery without trying to increase his revenue at my expense.
BDD and the Ethics of Cosmetic Surgery
One of guiding principles of medical ethics is “first, do no harm”. But, as we discussed in an earlier posting, two studies have found that cosmetic surgery in patients with Body Dysmorphic Disorder frequently results in increased BDD symptoms. Studies have also found that these surgeries are less effective than Cognitive-Behavioral Therapy in reducing the distress experienced by those with BDD.
Despite these findings, there is no shortage of unethical cosmetic surgeons, dentists, and other medical professionals quite willing to financially exploit the insecurities of people with Body Dysmorphic Disorder. Perhaps the most egregious example of this is the case of the late Michael Jackson, who by all accounts appeared to have BDD. Unfortunately, he was in the position of being able to afford numerous (very expensive, totally unnecessary) cosmetic procedures designed to alleviate his insecurities about his appearance. The result was a face that, in the end, scarcely looked human.
It is time the issue of unethical cosmetic surgeons came under scrutiny by state medical boards and the media so that the public is protected from doctors willing to exploit those with BDD.
•Tom Corboy, MFT, is the director of the OCD Center of Los Angeles, a private, outpatient clinic specializing in Cognitive-Behavioral Therapy (CBT) for the treatment of Obsessive-Compulsive Disorder (OCD) and related conditions, including BDD. In addition to individual therapy, the center offers six weekly therapy groups, as well as online therapy, telephone therapy, and intensive outpatient treatment. To contact the OCD Center of Los Angeles, click here.