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Body Dysmorphic Syndrome: What I look for

There is a small group of patients who have a condition called body dysmorphic syndrome or BDS where they have an unrealistic and usually negative concept of their appearance and seek out multiple repeated aesthetic treatments.
BDS or Body Dysmorphic Syndrome is a condition where people think about their real or perceived flaws for hours each day and have quite negative thoughts about their appearance. This causes them severe emotional distress and interferes with their functioning.
The syndrome is often present in young people and they will miss out on school, avoid social situations and isolate themselves from their family and friends because they fear that others will notice their flaws. They may even undergo unnecessary plastic surgery to correct their perceived imperfections and when they do have surgery they rarely find satisfaction with the results.
Body Dysmorphic Syndrome is a body image disorder and it is characterised by persistent intrusive preoccupations with an imagined or slight defect in the appearance.
People with Body Dysmorphic Syndrome can dislike any part of the body. They often find fault with their nose, their skin, their hair and occasionally with their eyes, particularly under eye hollowing. It most often develops in adolescents and teens and affects men and women equally. The causes are unclear but there may be biological and environmental factors that contribute to its development. There may be a genetic predisposition and there possibly is a neurobiological factor such as malfunctioning of serotonin in the brain. The person’s personality traits and life experiences contribute to the development of Body Dysmorphic Syndrome.
Body Dysmorphic Syndrome sufferers are also often compulsive and have repetitive behaviour to try and hide and improve their flaws such as checking in a mirror, excessive grooming, changing clothes excessively. People with Body Dysmorphic Syndrome often suffer from anxiety disorder such as obsessive compulsive disorder (OCD) or social anxiety disorder as well as depression and eating disorders.
My job as an oculoplastic surgeon is to be very careful when I see a younger person wanting aesthetic rejuvenating treatments or surgery around their eyes or face. In particular, the history is important. I have to find out exactly what concerns them, whether they have had previous treatments and how many of those treatments they have had, and whether they have been to see lots of different doctors for different opinions. Then I have to assess them objectively to see whether their problem is likely to be a genuine periorbital eyelid face problem or a very slight defect that they are seeing more magnified because of their Body Dysmorphic Syndrome.
If I suspect Body Dysmorphic Syndrome, I talk to the patient’s parents with their permission if they are under age, to their GP with their permission and if I have major concerns I have to write to the GP and express those concerns. The main thing I cannot do is to do unnecessary oculoplastic surgery or treatments to correct their perceived imperfection as they will never find satisfaction with the results. They will likely be disappointed. What they really need is a combination of treatments such as cognitive behavioural therapy (CBT) or antidepressant medicines from specialist physicians who are experienced in diagnosing and treating Body Dysmorphic Syndrome.

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