BODY DYSMORPHIC DISORDER AND MICROPIGMENTATION
by Linda H Dixon MD and Brandi Romero ©
The purpose of this article is to discuss Body Dysmorphic Disorder and micropigmentation. Usually the domain of plastic surgeons, it can present in clients seeking permanent makeup so it is important to be aware of ways they may present for micropigmentation. These are not just picky people. People who suffer from BDD have an underlying mental illness which needs diagnosis and treatment before we should work on them.
The questions to ask are: Can we make these clients happy? Should we even try? If you do try, are you more likely to get blamed for bad results and even sued by these clients? To what lengths will a client with BDD go to "punish" you and make your life miserable?
MIRROR MIRROR ON THE WALL
One of your first clues to a client with BDD is how they react to a mirror in your reception area. Do they pay more attention to themselves or to checking in for their appointment.
The first documented reference to Body Dysmorphic Disorder was by an Italian psychiatrist named Enrico Morselli who coined the term ‘dysmorphophobia’. Morselli noticed that some of his patients experienced acute fears of deformity and painful desperation1,2.
Since Morselli’s description of this condition, many psychiatrists have added to the understanding of the disorder and its treatment resulting in the description that now resides in the DSM-5™3.
“Body dysmorphic disorder (BDD): Individuals with body dysmorphic disorder are preoccupied with one or more perceived defects or flaws in their physical appearance that are not observable or appear slight to others.”
The outstanding feature of the condition is a preoccupation and even an obsession with perceived flaws in one’s physical appearance. To another person those flaws may be minor or even non-existent but to the BDD sufferer they are exaggerated and cause anxiety and distress. A person with BDD may go to extraordinary lengths to remedy their perceived deformity including seeking out cosmetic and surgical treatments; they may spend prolonged period of time obsessing over or attempting to conceal their imagined defects which in their view make them ugly to others4.
BDD most often begins in early adolescence and occasionally in late childhood.5 Its effects can be quite debilitating particularly for those who have no insight into their condition. Some patients may realise their perceptions are exaggerated. Other patients may be convinced that their delusional self perceptions of ugliness and deformity are real 5. The altered perceptions of self can be so overwhelming that the patient may also suffer recurrent bouts of depression and might even feel suicidal at times6,7.
One of the dangers associated with providing permanent or long lasting cosmetic and/or surgical treatments for BDD sufferers is that both the patient and the treatment provider can be locked into a never ending cycle of Treatment-Dissatisfaction With Outcome-Requests/Demands for Additional Treatments4regardless of the quality of the outcome.
The needs of the BDD sufferer are far beyond the skills of a MicroPigmentation specialist and fall squarely within an area of specialised medical and psychiatric treatment. In most instances a gentle but firm suggestion that the patient should seek assistance and guidance from their treating doctors is the best option.
Micropigmentation technicians should never permit themselves to be pressured or bullied into providing services to a client. Permanent make-up is an elective procedure. The practitioner is not obligated to perform these services, especially if these services are against the practitioner’s judgement and/or personal conscience. We suggest that the following disclaimer could be added to your web site and printed literature. Since local regulations may differ, legal advice should be obtained.
All procedures are considered elective. (Insert Your Name here) may accept or deny service to any potential client (patient) due to potential medical concerns and/or personal conscience.
References upon request.