When looks can kill
How Body Dysmorphic Disorder is impacting mental health and driving plastic surgery in South Africa
The Forever Institute is shedding light on the often-overlooked mental health implications of body dysmorphic disorder (BDD) and the ethical responsibilities of the cosmetic surgery industry. With a rising number of individuals seeking elective cosmetic procedures, we emphasise the importance of integrating psychological screenings into the pre-surgical process to ensure the well-being of patients.
Understanding body dysmorphic disorder
BDD is a severe mental health condition characterised by obsessive concerns over perceived flaws in one’s appearance. People with BDD may spend excessive time thinking about their appearance, engaging in repetitive behaviours such as checking mirrors, seeking reassurance, or obsession with certain body parts, particularly related to their face or head, or with their weight or body shape and avoiding social situations due to their psychological concerns of social acceptance and self-worth.
Globally research estimates that approximately 80% of individuals with BDD experience lifetime suicidal ideation, and almost 30% have attempted suicide as a direct consequence. The disorder typically begins in adolescence and affects both men and women equally.
BDD is more than just a desire for aesthetic improvement. It is a debilitating condition that significantly impacts an individual’s mental health. As a plastic surgeon, I have a duty to recognise the signs of BDD and ensure our patients are mentally prepared for surgery.
The impact of social media on body image
In today’s digital age, social media plays a substantial role in shaping body image perceptions. The relentless exposure to curated images and beauty standards can exacerbate feelings of inadequacy and fuel the desire for cosmetic alterations. This phenomenon is particularly prevalent among younger generations who are more susceptible to the pressures of achieving a ‘perfect’ appearance.
Statistics released in January 2024 by social listening and analytics company, Meltwater, indicate that South Africa has the highest internet usage rates in the world: South Africans between 16 and 64 years spend over nine hours a day online. Other studies estimate that South African teens are using social media up to 55 times a day, which is undoubtably shaping their view of the world and themselves. As teenagers, 68% of South Africans admit they are concerned about their appearance and 66% worry about being excluded by their peers.
The pressure to look a certain way due to social media influence is significant. This is a red flag for the need for a balanced narrative that promotes positive body image and mental health awareness, from a young age.
Ethical considerations in cosmetic surgery
I am an advocate of the integration of psychological assessments as a standard practice before undergoing any elective cosmetic procedure. Such screenings can identify underlying mental health issues, like BDD, that might be driving the desire for surgery.
As a plastic surgeon I have an ethical responsibility to my patients. I must be certain that surgical interventions do not inadvertently harm those who may need psychological support rather than surgical alteration.
To combat the negative impacts of BDD and social media pressures, it is crucial to promote a positive body image. The Forever Institute is at the forefront of incorporating innovations in cosmetic surgery that prioritise natural, safer, and more sustainable outcomes.
Several case studies from The Forever Institute illustrate the impact of comprehensive pre-surgical screenings and ethical practices.
We have recently enhanced the in-house service offerings at The Forever Institute to include a psychologist who has experience in treating body dysmorphia. We have several non-surgical options for our patients to consider if they are not ideal candidates for surgical interventions due to their mental wellness. They may require some time to improve their mental health under the care of our healthcare professionals before undertaking a surgical procedure to alter their appearance.