Skin Dysmorphia

As individuals, we often focus on flaws that no one else notices. We’re all human, and being hard on ourselves is something we commonly do. But doing so can become or be a sign of a very real mental health concern—one that estheticians may see often in the treatment room. Body Dysmorphic Disorder, or BDD, happens when there is a fixation with one or more perceived flaws in physical appearance that are not observed by others or are seen as very slight by others. People with BDD actually see themselves differently than how others see them.¹ To be clear, many people are self-conscious about one thing or another with their body, but this does not mean they have a disorder. However, it’s important for estheticians to recognize the difference between run-of-the-mill insecurities and BDD. 

Characteristics of BDD 

BDD involves compulsively obsessing over a perceived flaw that is not really there and may impact other aspects of the individuals life leading to anxiety, stress, depression, shame, etc.² Behaviors seen in BDD sufferers usually include compulsively checking the mirror, comparing themselves to others, skin picking, or researching treatments and even hopping from one practitioner to another to get the treatment they think they desperately need. People who have been diagnosed with BDD suffer from fixations on the appearance of their skin, facial features, or their hair and is often accompanied by other disorders like OCD, excoriation disorder, dermatillomania, or trichotillomania.³  

Who Gets BDD 

• BDD affects about 3 percent of adults in the US  
• About 40 percent of people with BDD are men and about 60% are women. 
• The average age of onset is 12 years old. 

According to a 2022 study published in the British Journal of Dermatology, symptoms of BDD were five times more frequent in patients with dermatological conditions.⁴ This is where the term skin dysmorphia may have come from. Because of perceived flaws in the skin, many people with BDD will turn to esthetics as well as dermatology and plastic surgery to “correct” these flaws.  

Since BDD is a psychiatric disorder, it requires psychiatric treatment rather than esthetic treatment. If you believe your client may be suffering from BDD, screening during consultation could include questions about procedure history and satisfaction. Keep in mind that esthetic procedures usually provide no benefit in patients with BDD—no matter how good the results are, they are never good enough, and the obsession is still present. Clients who are dissatisfied with their esthetic procedures may feel guilty and/or angry with themselves—or their practitioner—for not improving their appearance. It is important that estheticians equip themselves with the correct knowledge and tools to be able to recognize BDD and refer patients out to get the help they need. 

By Maggie Staszcuk

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