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

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.