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Counselling before cosmetic procedures

Do you work in the cosmetics/aesthetics industries – or perhaps you have a loved one unhappy with their appearance?

Body Dysmorphia is a relatively common issue that causes people a great deal of distress. Imagine how you would feel if you were convinced that some aspect of your body was deformed, disfigured, grotesque or revolting. Would you be ashamed? Anxious about letting others see this part of you? Willing to go to great lengths to hide or alter this part of yourself?

Imagine now that you are bombarded by these thoughts and feelings about yourself; that these thoughts take up significant portions of your day, and are so distressing they crowd out your ability to think about other things, or enjoy different activities.

Body Dysmorphia

This is the experience of those with body dysmorphia. For some these thoughts are so overwhelming that they became depressed, or use alcohol or other drugs in an attempt to numb them. The distress experienced by those with body dysmorphia can be very intense and suicide rates are elevated.

Unfortunately for most sufferers, body dysmorphia goes undiagnosed. Why? For many, it is because they are ashamed or anxious about bringing their “disfigurement” to the attention of others.

There is often a sense that as it is the body, or a particular body-part that “causes” the distress, then the obvious thing to fix is the body itself. Indeed, up to 90% of people with body dysmorphia will engage in a range of behaviours intended to hide or fix their perceived flaws.

It is therefore unsurprising that people with body dysmorphia often present for both invasive and non-invasive cosmetic procedures. Although the estimated population prevalence of this condition is 2%, studies suggest that between 5 and 15% of people seeking aesthetic treatments experience this condition.

Unfortunately, the true cause of distress in body dysmorphia is not actually the body – but the distressing thought that people have. In the case of body dysmorphia, the focus of the person’s distress cannot be observed by others, or is very, very mild, and only observable on very close inspection. People with body dysmorphia therefore often remain unsatisfied with the result of cosmetic procedures. In fact, in general, efforts to hide or fix perceived flaws lead to an increase, rather than decrease in distress.

Treatment for Body Dysmorphic Disorder

Treatment for body dysmorphic disorder involves SSRIs (a form of anti-depressant medication), and targeted Cognitive Behavioural Therapy (CBT). Body dysmorphia-focused CBT aims to:
 reduce behavioural patterns that actually make the person’s distress worse;
 decrease body-related thoughts and beliefs;
 build a healthier sense of self;
 increase mindfulness;
 provide education regarding the nature of the condition and ways to treat it;
 implement motivational interviewing techniques.

Why Counselling Before Cosmetic Procedures is a Good Idea

As people with body dysmorphia frequently seek out cosmetic procedures, aestheticians have an opportunity to identify people who might benefit from professional assistance with their body image. These clients may be identified by:
 complaining of one or more “flaws” which are not observable, or which can only be observed at a very close range and are then only minor;
 this “flaw” causing the person to be distressed or notably preoccupied;
 their significant attempts to conceal the “flaw”;
 reporting of a history of trying to have the “flaw” fixed;
 having a history of being dissatisfied with the results of cosmetic procedures;
 being unusually motivated or demanding as a client.

If you work in the aesthetic or cosmetic industries and you identify clients who are distressed by perceived flaws in their bodies, or difficulties with their body-image more generally, then consider referring them to a psychologist for additional support.

Do You Have a Client Like This?

In discussing treatments with clients like this, it will be very important that you are clear about the results that they can expect, relative to the depth of the perceived problem as you are able to observe it. In general this is likely to mean that you provide very conservative estimations on what can be achieved.

There are varying views on whether more invasive procedures (such as surgery) should be done on patients suspected to have body dysmorphia. Where procedures are costly, or include greater risks or side-effects, it may be prudent to consider referring patients for counselling before cosmetic procedures.

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