Body Dysmorphic Disorder Among Aesthetic Medicine Patients – A Literature Review
DOI:
https://doi.org/10.12775/QS.2025.48.66861Keywords
Body Dysmorphic Disorder, Psychiatry, Aesthetics, EthicsAbstract
Introduction: Body Dysmorphic Disorder (BDD) is a psychiatric disorder characterised by an excessive focus on perceived flaws in one's appearance. It leads to a strong psychological distress, social withdrawal, and unnecessary aesthetic procedures. The rise of aesthetic medicine in the 21st century has made BDD an important clinical and ethical issue for practitioners.
Aim of the study: This study aims to present the prevalence of BDD, its characteristics, diagnostic difficulties, and treatment. We also discuss ethical challenges associated with aesthetic medicine procedures and clinical management recommendations for aesthetic medicine practitioners.
Materials and methods: A search of the literature review was performed using PubMed, Google Scholar, Scopus, and other databases. We focused primarily on studies published between 2017 and 2025. The following keywords and their combinations were used: “Body Dysmorphic Disorder”, “Aesthetic Medicine”, “Cosmetic Procedures”, “Psychiatry”, “Screening”, “Ethics”.
Brief description of state of knowledge: BDD is more common in aesthetic medicine patients than in the general population and is influenced by social media and culture. Patients with BDD present alterations in the function and structure of the central nervous system. There are a few screening tools easy to use in the everyday practice of an aesthetician. Treatment includes pharmacotherapy and psychotherapy.
Summary: BDD poses many clinical and ethical challenges. Cosmetic interventions alone rarely address underlying psychological distress long-term. Both cognitive-behavioural therapy and pharmacotherapy are useful tools in the treatment of BDD. Integrating screening and patient-centred approaches has the potential to improve safety, satisfaction, and long-term well-being in patients with this disorder.
References
1. Sarwer DB, Magee L, Clark V. Physical appearance and cosmetic medical treatments: physiological and sociocultural influences. J Cosmet Dermatol. 2003;2(1):29-39. doi:10.1111/j.1473-2130.2003.00003.x.
2. Haas, C. F., et al.(2008). Motivating factors for seeking cosmetic surgery: a synthesis of the literature. Plastic surgical nursing: official journal of the American Society of Plastic and Reconstructive Surgical Nurses, 28(4), 177–182. https://doi.org/10.1097/PSN.0b013e31818ea832
3. Kaleeny JD, Janis JE. Body dysmorphic disorder in aesthetic and reconstructive plastic surgery – A systematic review and meta-analysis. Healthcare (Basel). 2024;12(13):1333. doi:10.3390/healthcare12131333.
4. Di Mattei VE, Pagani Bagliacca E, Ambrosi A, Lanfranchi L, Preis FB, Sarno L. The Impact of Cosmetic Plastic Surgery on Body Image and Psychological Well-Being: A Preliminary Study. Int J Psychol Behav Anal. 2015;1(1):103. doi:10.15344/2455-3867/2015/103
5. W.L. Toh, D.J. Castle, R.L. Mountjoy et al. Insight in body dysmorphic disorder (BDD) relative to obsessive-compulsive disorder (OCD) and psychotic disorders: revisiting this issue in light of DSM-5 Compr Psychiatr, 77 (2017), pp. 100-108 https://doi.org/10.1016/j.comppsych.2017.06.004
6. Almuhanna N. (2022). Prevalence of Body Dysmorphic Disorder Among Saudi Female Patients Seeking Cosmetic Procedures. European Psychiatry, 65(Suppl 1), S294–S295. https://doi.org/10.1192/j.eurpsy.2022.751
7. Salari, N., Kazeminia, M., Heydari, M., Darvishi, N., Ghasemi, H., Shohaimi, S., & Mohammadi, M. (2022). Body dysmorphic disorder in individuals requesting cosmetic surgery: A systematic review and meta-analysis. Journal of plastic, reconstructive & aesthetic surgery : JPRAS, 75(7), 2325–2336. https://doi.org/10.1016/j.bjps.2022.04.098
8. Yurtsever, I., Matusiak, Ł., & Szepietowski, J. C. (2022). To Inject or to Reject? The Body Image Perception among Aesthetic Dermatology Patients. Journal of clinical medicine, 12(1), 172. https://doi.org/10.3390/jcm12010172
9. Eisen, J. L., Phillips, K. A., Coles, M. E., & Rasmussen, S. A. (2004). Insight in obsessive compulsive disorder and body dysmorphic disorder. Comprehensive psychiatry, 45(1), 10–15. https://doi.org/10.1016/j.comppsych.2003.09.010
10. Higgins, S., & Wysong, A. (2017). Cosmetic Surgery and Body Dysmorphic Disorder - An Update. International journal of women's dermatology, 4(1), 43–48. https://doi.org/10.1016/j.ijwd.2017.09.007
11. Gunstad, J., & Phillips, K. A. (2003). Axis I comorbidity in body dysmorphic disorder. Comprehensive psychiatry, 44(4), 270–276. https://doi.org/10.1016/S0010-440X(03)00088-9
12. Phillips KA, Hart AS, Niemiec MA. Comorbidity and personality in body dysmorphic disorder. In: Phillips KA, editor. Body Dysmorphic Disorder: Advances in Research and Clinical Practice. New York: Oxford University Press; 2017. doi:10.1093/med/9780190254131.003.0011.
13. Bowyer, L., Krebs, G., Mataix-Cols, D., et al. (2016). A critical review of cosmetic treatment outcomes in body dysmorphic disorder. Body image, 19, 1–8. https://doi.org/10.1016/j.bodyim.2016.07.001
14. Crerand, C. E., Menard, W., & Phillips, K. A. (2010). Surgical and minimally invasive cosmetic procedures among persons with body dysmorphic disorder. Annals of plastic surgery, 65(1), 11–16. https://doi.org/10.1097/SAP.0b013e3181bba08f
15. Kuhn, H., Cunha, P. R., Matthews, N. H., & Kroumpouzos, G. (2018). Body dysmorphic disorder in the cosmetic practice. Giornale italiano di dermatologia e venereologia : organo ufficiale, Societa italiana di dermatologia e sifilografia, 153(4), 506–515. https://doi.org/10.23736/S0392-0488.18.05972-2
16. Feusner, J. D., Arienzo, D., Li, W., et al. (2013). White matter microstructure in body dysmorphic disorder and its clinical correlates. Psychiatry research, 211(2), 132–140. https://doi.org/10.1016/j.pscychresns.2012.11.001
17. Buescher, L. S., & Buescher, K. L. (2006). Body dysmorphic disorder. Dermatologic clinics, 24(2), 251–vii. https://doi.org/10.1016/j.det.2006.01.008
18. Martínez-Líbano, J. et al. (2025). Prevalence and post-pandemic consequences of body dysmorphic disorder: a systematic review with meta-analysis. Health psychology report, 13(3), 215–225. https://doi.org/10.5114/hpr/202321
19. Malcolm, A., Pikoos, T. D., Grace, S. A., Castle, D. J., & Rossell, S. L. (2021). Childhood maltreatment and trauma is common and severe in body dysmorphic disorder. Comprehensive psychiatry, 109, 152256. https://doi.org/10.1016/j.comppsych.2021.152256
20. Gupta, M., Jassi, A., & Krebs, G. (2023). The association between social media use and body dysmorphic symptoms in young people. Frontiers in psychology, 14, 1231801. https://doi.org/10.3389/fpsyg.2023.1231801
21. Kuck, N., Cafitz, L., Bürkner, P. C., Hoppen, L., Wilhelm, S., & Buhlmann, U. (2021). Body dysmorphic disorder and self-esteem: a meta-analysis. BMC psychiatry, 21(1), 310. https://doi.org/10.1186/s12888-021-03185-3
22. Pérez-Buenfil, A., & Morales-Sánchez, A. (2025). Prevalence of Body Dysmorphic Disorder: A Systematic Review and Meta-Analysis. Journal of cosmetic dermatology, 24(4), e70121. https://doi.org/10.1111/jocd.70121
23. Phillips et al.. (2006). Gender similarities and differences in 200 individuals with body dysmorphic disorder. Comprehensive psychiatry, 47(2), 77–87. https://doi.org/10.1016/j.comppsych.2005.07.002
24. Sampogna, F., Samela, T., Abeni, D., et al. European Society for Dermatology and Psychiatry (ESDaP) Study collaborators (2025). A cross-sectional study on gender differences in body dysmorphic concerns in patients with skin conditions in relation to sociodemographic, clinical and psychological variables. Journal of the European Academy of Dermatology and Venereology: JEADV, 39(4), 823–832. https://doi.org/10.1111/jdv.20247
25. Malcolm, A., Pikoos, T. D., Castle, D. J., et al. (2021). An update on gender differences in major symptom phenomenology among adults with body dysmorphic disorder. Psychiatry research, 295, 113619. https://doi.org/10.1016/j.psychres.2020.113619
26. Hong, K., Nezgovorova, V., Uzunova, G. , et al. (2019). Pharmacological Treatment of Body Dysmorphic Disorder. Current neuropharmacology, 17(8), 697–702. https://doi.org/10.2174/1570159X16666180426153940
27. Phillips K. A. (2010). Pharmacotherapy for Body Dysmorphic Disorder. Psychiatric annals, 40(7), 325–332. https://doi.org/10.3928/00485713-20100701-05
28. Linde, J., Rück, C., Bjureberg, J., Ivanov, V. Z., Djurfeldt, D. R., & Ramnerö, J. (2015). Acceptance-Based Exposure Therapy for Body Dysmorphic Disorder: A Pilot Study. Behavior therapy, 46(4), 423–431. https://doi.org/10.1016/j.beth.2015.05.002
29. Dehbaneh, M. A. (2019). Effectiveness of acceptance and commitment therapy in improving interpersonal problems, quality of life, and worry in patients with body dysmorphic disorder. Electronic Journal of General Medicine, 16(1), em105. https://doi.org/10.29333/ejgm/93468
30. Liu, Y., Lai, L., Wilhelm, S., Phillips, K. A., Guo, Y., Greenberg, J. L., & Ren, Z. (2024). The efficacy of psychological treatments on body dysmorphic disorder: a meta-analysis and trial sequential analysis of randomized controlled trials. Psychological medicine, 54(15), 1–14. Advance online publication. https://doi.org/10.1017/S0033291724002733
31. Mufaddel, A., Osman, O. T., Almugaddam, F., & Jafferany, M. (2013). A review of body dysmorphic disorder and its presentation in different clinical settings. The primary care companion for CNS disorders, 15(4), PCC.12r01464. https://doi.org/10.4088/PCC.12r01464
32. Higgins, S., & Wysong, A. (2017). Cosmetic Surgery and Body Dysmorphic Disorder - An Update. International journal of women's dermatology, 4(1), 43–48. https://doi.org/10.1016/j.ijwd.2017.09.007
33. Schieber, K., Kollei, I., de Zwaan, M., Müller, A., & Martin, A. (2013). Personality traits as vulnerability factors in body dysmorphic disorder. Psychiatry research, 210(1), 242–246. https://doi.org/10.1016/j.psychres.2013.06.009
34. Veale, D., Kinderman, P., Riley, S., & Lambrou, C. (2003). Self-discrepancy in body dysmorphic disorder. The British journal of clinical psychology, 42(Pt 2), 157–169. https://doi.org/10.1348/014466503321903571
35. Ahluwalia, R., Bhatia, N. K., Kumar, P. S., & Kaur, P. (2017). Body dysmorphic disorder: Diagnosis, clinical aspects and treatment strategies. Indian journal of dental research : official publication of Indian Society for Dental Research, 28(2), 193–197. https://doi.org/10.4103/ijdr.IJDR_669_15
36. Siegfried, E., Ayrolles, A., & Rahioui, H. (2018). L’obsession de dysmorphie corporelle : perspectives d’évolution de la prise en charge [Body dysmorphic disorder: Future prospects of medical care]. L'Encephale, 44(3), 288–290. https://doi.org/10.1016/j.encep.2017.08.001
37. Bjornsson, A. S., Didie, E. R., & Phillips, K. A. (2010). Body dysmorphic disorder. Dialogues in clinical neuroscience, 12(2), 221–232. https://doi.org/10.31887/DCNS.2010.12.2/abjornsson
38. Pereira, I. N., Chattopadhyay, R., Fitzpatrick, S., Nguyen, S., & Hassan, H. (2023). Evidence-based review: Screening body dysmorphic disorder in aesthetic clinical settings. Journal of cosmetic dermatology, 22(7), 1951–1966. https://doi.org/10.1111/jocd.15685
39. Türk, C. B., Maymone, M. B. C., & Kroumpouzos, G. (2023). Body dysmorphic disorder: A critical appraisal of diagnostic, screening, and assessment tools. Clinics in dermatology, 41(1), 16–27. https://doi.org/10.1016/j.clindermatol.2023.03.001
40. Sheehan, D. V., Lecrubier, Y., Sheehan, K. H., Amorim, P., Janavs, J., Weiller, E., Hergueta, T., Baker, R., & Dunbar, G. C. (1998). The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. The Journal of clinical psychiatry, 59 Suppl 20, 22–57.
41. Picavet, V., Gabriëls, L., Jorissen, M., & Hellings, P. W. (2011). Screening tools for body dysmorphic disorder in a cosmetic surgery setting. The Laryngoscope, 121(12), 2535–2541. https://doi.org/10.1002/lary.21728
42. Mancuso, S. G., Knoesen, N. P., & Castle, D. J. (2010). The Dysmorphic Concern Questionnaire: A screening measure for body dysmorphic disorder. The Australian and New Zealand journal of psychiatry, 44(6), 535–542. https://doi.org/10.3109/00048671003596055
43. Nejadsarvari, N., & Ebrahimi, A. (2014). Different aspects of informed consent in aesthetic surgeries. World journal of plastic surgery, 3(2), 81–86.
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