Body dysmorphic disorder and appearance enhancing
David B. Sarwer
, Canice E. Crerand
Departments of Psychiatry and Surgery, Center for Weight and Eating Disorders and the Edwin and Fannie Gray Hall Center for Human
Appearance, University of Pennsylvania School of Medicine, 10 Penn Tower, 3400 Spruce Street, Philadelphia, PA 19104, United States
The Children’s Hospital of Philadelphia, Department of Psychology, Division of Plastic Surgery, The Edwin and Fannie Gray Hall Center for
Human Appearance, United States
Received 27 April 2007; received in revised form 14 August 2007; accepted 22 August 2007
This article reviews the literature on body dysmorphic disorder (BDD) in persons who seek appearance enhancing medical
treatments such as cosmetic surgery and dermatological treatment. We begin with a discussion of the growing popularity of
cosmetic surgical and minimally invasive treatments. The literature investigating the psychological characteristics is brieﬂy
highlighted. Studies investigating the rate of BDD among persons who seek appearance enhancing treatments are detailed and,
collectively, suggest that approximately 5–15% of individuals who seek these treatments suffer from BDD. Retrospective reports
suggest that persons with BDD rarely experience improvement in their symptoms following these treatments, leading some to
suggest that BDD is a contraindication to cosmetic surgery and other treatments. The clinical management of patients with BDD
who present for these treatments is brieﬂy described and directions for future research are provided.
# 2007 Elsevier Ltd. All rights reserved.
Keywords: Body dysmorphic disorder; Body image dissatisfaction; Cosmetic surgery; Dermatological treatment; Plastic surgery
The popularity of appearance enhancing medical
According the American Society of Plastic Sur-
geons, 10.9 million cosmetic surgical and minimally
invasive treatments were performed in 2006 (ASPS,
2007). Just under 2 million of these treatments were
traditional cosmetic surgical procedures such as
liposuction, breast augmentation, and rhinoplasty.
The vast majority, over 9.1 million, were minimally
invasive procedures such as Botox
chemical peels. The number of all of these procedures
has increased by 48% since 2000 and over 800% since
1992, the ﬁrst year that the ASPS started reporting
procedural statistics. While these numbers are stagger-
ing, they likely are an underestimate of the number of
procedures performed annually, as they do not account
for the growing number of non-plastic surgeons who
now offer these and other appearance enhancing
A discussion of the popularity of cosmetic surgery
must consider a number of contemporary theoretical
explanations (Sarwer, Crerand, & Gibbons, 2007;
Sarwer & Magee, 2006). These include the large body
of social psychological research on the role of physical
appearance in daily life as well as the growing literature
on body image and, speciﬁcally, its contribution to the
pursuit of appearance modifying behaviors. The role of
Available online at www.sciencedirect.com
Body Image 5 (2008) 50–58
* Corresponding author.
E-mail address: firstname.lastname@example.org (D.B. Sarwer).
1740-1445/$ – see front matter # 2007 Elsevier Ltd. All rights reserved.