Photo Filters Spark the Need for a Guide to Help Cosmetic Surgeons Recognize Body Dysmorphic Disorder

You may have seen photos that have been altered or enhanced with Snapchat filters, maybe even taken some yourself. They are essentially virtual masks, and can range from faces with mustaches, sunglasses and colored hair to animal ears and flower crowns.

But in addition to adding objects, many of these filters also enhance facial features that are deemed traditionally attractive, such as enlarging eyes and lips, smoothing skin, enhancing cheekbones, slimming the face, and sharpening the chin.

While flipping through the filters can be a fun way to kill time or lighten a mood, researchers are beginning to find the way they artificially alter appearances might have negative consequences.

In response to an article from researchers at the Boston University School of Medicine which details the connections between photo filter apps and body dysmorphic disorder, Mass General researchers Jennifer Greenberg, PsyD, Hilary Weingarden, PhD, and Sabine Wilhelm, PhD, shared a series of guidelines that cosmetic surgeons can use to identify body dysmorphic disorder (BDD) and guide these patients toward the most helpful treatment, which may not include surgery at all.

What is body dysmorphic disorder?

BDD is a mental illness that affects how someone perceives their own physical appearance. According to the DSM-5, it is characterized by an excessive preoccupation with one or more “flaws” in a person’s physical appearance.

This preoccupation can manifest itself in a variety of ways, such as spending an excessive amount of time performing repetitive behaviors, frequent mirror checks and seeking cosmetic treatment to reduce stress related to their perceived flaws.

While some degree of dissatisfaction with one’s own appearance is common and normal, also called “normative discontent,” BDD involves a greater amount of time spent focusing on flaws to the point where it interferes with daily life and causes significant suffering.

This is why, for someone who may be at risk for BDD, researchers believe Snapchat filters could contribute to negative symptoms. Yes, some filters can add cat ears or make it so it is raining hearts, but they can also significantly distort a person’s face and create unrealistic expectations.

“A little adjusting on Facetune can smoothen out skin, and make teeth look whiter and eyes and lips bigger. A quick share on Instagram, and the likes and comments start rolling in. These filters and edits have become the norm, altering people’s perception of beauty worldwide.”

Susruthi Rajanala et al.

Body dysmorphic disorder and cosmetic surgery

In their JAMA Facial and Plastic Surgery editorial, Drs. Greenberg, Weingarden and Wilhelm discuss the need for cosmetics surgeons to be aware of influences like Snapchat and other applications that manipulate physical appearance, and how they may be triggering BDD and requests for cosmetic surgery.

They cite previous research which found that cosmetic procedures rarely help those with BDD due to the psychological roots of the disease. The distorted body image patients with BDD see is likely to remain even after cosmetic treatment, with research finding 81% of patients with BDD are dissatisfied with the results.

To better identify cases of BDD and provide proper psychiatric care, Greenberg et al. suggest using a brief screening measure called the Body Dysmorphic Disorder Questionnaire (BDDQ).

If the patient scores positively on the BDDQ, clinicians are advised to consider if the patient’s concern represents a true physical flaw and proceed with several follow up questions such as:

  • Have you ever struggled with depression, anxiety or other psychiatric problems?
  • Are you having suicidal thoughts?
  • Do you think cosmetic surgery will drastically improve happiness or solve all of your problems?
  • Have you undergone cosmetic surgeries in the past? Do you think the treatments were successful?

Getting the right treatment

If, after going through the BDDQ and follow-up questions, the patient appears to display symptoms of BDD, Greenberg et al. advise cosmetic surgeons to refer patients to a psychiatrist or psychologist as a primary course of treatment. 

“Many patients firmly believe that their appearance is “hideous” or “defective” rather than believing they have a psychological disorder.”

Weingarden et al.

Since the recommendation may cause disappointment and confusion, clinicians are advised to listen and acknowledge their feelings in a respectful way to avoid argument. The goal is to assure patients that the both parties want to find the most effective solution to help them feel better about their appearance, and to make sure they are getting the proper care they need.


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