Will looking prettier on the outside make you feel better on the inside?
For some, cosmetic surgery is a godsend -- an opportunity to, for example, restore a breast removed because of cancer or to correct disfiguring scars caused by acne. But for a select few, sometimes called "plastic surgery junkies," plastic surgery, especially repeat operations, is a sign of a psychiatric illness.
These people may suffer from body dysmorphic disorder or "imagined ugliness", and for them, cosmetic surgery does not make them look prettier or feel better. But research may help identify those with this condition.
People with body dysmorphic disorder believe they, or parts of their bodies, are horribly ugly even though they generally look fine. Expert Rod J. Rohrich, MD, says those who are easiest to spot are preoccupied with a physical "defect" so tiny most people can't even see it.
"This preoccupation causes them to be totally impaired socially and functionally," Rohrich tells WebMD. "They won't go out, they won't go to their job, and their preoccupation is not explained by something else, like another psychiatric disorder or a death in the family."
Rohrich is a professor and chairman of the department of plastic surgery at the University of Texas Southwestern Medical Center in Dallas. He was not involved in this research but has written about body dysmorphic disorder.
People with body dysmorphic disorder are not helped by plastic surgery because once one "defect" is repaired they become preoccupied with another. These people will benefit more from mental health care, in the form of medication or psychotherapy, than from cosmetic surgery.
Unfortunately, people with body dysmorphic disorder are hard to pinpoint. They blend into the crowd of individuals who are seeking plastic surgery because of a healthier desire to want a prettier nose or larger breasts. After all, most people are dissatisfied with some aspect of the way they look. What makes it a psychiatric problem is simply a question of degree of concern.
Steve Kisely, MD, and colleagues compared individuals seeking plastic surgery purely for the sake of looking nicer with another group seeking plastic surgery for medical reasons. All participants filled out questionnaires about their mental health as well as their concerns about appearance.
People whose responses indicated mental health problems, like anxiety, depression, and negative feelings about how they looked, were more likely to seek plastic surgery just to look nicer than because there was really something wrong. Therefore, these questionnaires could help identify people with imagined ugliness before they undergo another unnecessary nip and tuck.
Kisely, an associate professor of psychiatry at Fremantle Hospital and a consultant in Consultation-Liaison Psychiatry at the University of Western Australia, is presenting his findings at an annual meeting of the Royal College of Psychiatry in London.
"Plastic/cosmetic surgery may not provide the answer if you are very concerned about your appearance, and especially if your family/friends don't seem to understand your level of distress," says Kisely. "Psychological help may also be needed. The analogy is with anorexia nervosa. If you carry on dieting even when your family says you are too thin, further weight loss is not the answer. You may need other interventions."
Originally published July 11, 2001.
Medically reviewed Feb. 5, 2003.