Aesthetic surgeries in body dysmorphic disorder: clinical and gender-specific patterns

Abstract Body dysmorphic disorder (BDD) is characterized by an excessive preoccupation with perceived appearance flaws, which is frequently associated with high psychological burden and engagement in cosmetic procedures (instead of seeking psychological help). This study exploratively examined clinical characteristics and the utilization of cosmetic procedures in a large online sample (N = 3,240), including – based on self-report – individuals with BDD (n = 1,837), subclinical symptoms (n = 392), and a control group with appearance concerns (n = 166). Participants completed standardized self-report measures assessing BDD symptoms, appearance concerns, mental health history, and cosmetic surgery experiences. Results indicated that approximately 30 % of individuals meeting full DSM-5 criteria for BDD had undergone at least one cosmetic procedure, with an even larger proportion interested in future surgeries. Satisfaction with past interventions was rather low, supporting prior evidence that cosmetic treatments rarely address the underlying psychopathology of BDD. Hierarchical regression analyses yielded that both BDD symptom severity and lower illness insight significantly predicted cosmetic surgery intent, whereas only symptom severity, but not insight, was associated with past surgery behavior. Furthermore, gender-based analyses revealed that while women and men did not differ in overall surgery rates, women more often pursued or planned facial and breast-related procedures, whereas men more frequently reported hair-related concerns and interventions. Women (vs. men) also reported higher symptom severity and greater barriers to accessing surgery, such as financial concerns and discouragement from people in their personal lives. Notably, more than 90 % of individuals with BDD had never received a formal BDD diagnosis, underscoring treatment barriers and under-recognition of BDD in clinical settings. These findings highlight the need for early screening, especially in cosmetic and dermatological contexts, as well as treatment concepts that include specific modules addressing the wish for cosmetic procedures. Competing Interest Statement The authors have declared no competing interest. Funding Statement The author(s) received no specific funding for this work. Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The study was approved by the Ethics Committee of Faculty 7 at the University of Münster (Approval No. 2017-32-JSch). Participants were informed about the voluntary nature of participation, confidentiality, and the use of their data for research purposes. Informed consent was obtained digitally at the beginning of the online survey, and participants were provided the option to withdraw at any time without consequences. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Data Availability All relevant data are within the manuscript and its Supporting Information files. This is because we do not have ethics approval to upload the entire data set.