A study by Crerand and colleagues (2006) found body dysmorphic disorder to be associated with cosmetic surgery. The study found that 7 to 15 percent of the patients, who undergo a cosmetic surgery, suffer from the disorder, and the study also found that individuals with body dysmorphic disorder don’t benefit from cosmetic surgeries.
In fact, they seem to get worse with increased symptoms. The prevalence of the disorder is 1 to 2 percent in the general population, and in college populations the rates are even higher (2.5 to 5 percent).
The most common surgeries are nose, lips, and breast operations. The disorder seems to have a high comorbidity with other psychological disorders, especially anxiety (obsessive-compulsive) disorders, and a number of personality disorders as well.
The diagnostic criteria are found in DSM-IV-TR (2000): (1) A preoccupation with an imagined or slight defect in appearance, and (2) Marked distress or impairment in social, occupational, or other areas of functioning resulting from the appearance preoccupation, and (3) the preoccupation is not attributable to the presence of another psychiatric disorder.
As you can see in the diagnostic criteria, the first criterion does, in fact, describe the majority of cosmetic surgery patients. Therefore, it can be difficult to distinguish the two groups from each other.
Body dysmorphic disorder is maintained by unrealistic attitudes about body image, and the misinterpretation of the facial expression of others as being more critical than they really are. Furthermore, they perceive their actual appearance as being far away from the ideal, and for this reason, they are likely to undergo cosmetic surgery to gain perfection.
These cognitive factors will increase anxiety and other negative emotions, because they feel insufficient. This results in maladaptive behaviours (e.g., mirror checking) to reduce the distress of feeling insufficient. The insufficiency is mainly attributable to the Western ideals of beauty.
A study by Gieler and colleagues (2008) shows that an increasing amount of, more or less, healthy individuals are taking the so-called life-style drugs, only to improve their appearances so that they don’t feel as inadequate.
There are some socio-cultural factors that are risk-factors for developing body dysmorphic disorder. If one is raised in a family characterized by rejection and critical opinions about appearance, one will be more likely to develop the disorder.
The onset of the disorder is typically seen in late adolescence, and hence the fact, one will be more vulnerable at that age (e.g. being bullied about one’s appearance). Time-consuming behaviours such as mirror checking is often associated with the disorder. Others may avoid mirrors and situations that may expose their defect.
It was found in one study that all participants reported engaging in at least one compulsive disorder. The compulsive disorders may, as a consequence, lead to impairment in social life. Current rates of obsessive-compulsive disorder range from 6 to 30 percent.
Body dysmorphic disorder has a high comorbidity with other psychological disorders such as depression, anxiety, and anger/hostility compared with other psychiatric disorders. For this reason, self-esteem and quality of life appear to be low.
Eating disorders such as anorexia and bulimia also appear to be frequently found in individuals with body dysmorphic disorder. 57 percent with body dysmorphic disorder were also found to have a co-existing personality disorder. Most frequently: avoidant, paranoid, obsessive-compulsive, and dependent personality disorders.