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Body Dysmorphic Disorder: A Commonsense Approach to Cosmetic Surgery

Colleen is a psychotherapist retired from private practice, specializing in human relationships.


What Is Body Dysmorphia?

While several definitions of this disorder have been provided by eminent clinicians, they all concur that it constitutes obsession with a real or self-perceived physical flaw. This belief can curtail or even destroy the sufferer’s progress throughout life. As such, it deserves to be explored and respected with care due to any condition which impedes the sufferer’s pathways.

Sadly, some celebrities have had so many well-publicised operations as to render seeking cosmetic procedures almost farcical. Perhaps we need to rethink whether this cynicism is valid or fair to those in search of uplifting benefits without seismic expectations.

The Endless Quest To Appear Young Forever

There is some debate as to whether Spanish explorer Ponce De Leon (1474-1521) truly sought the fountain of youth. After becoming the governor of Puerto Rico, he sailed to Florida, where some believe he hoped to locate this enchanted wellspring. Whether or not this was his mission, the eagerness to believe in this possibility indicates the depth of yearning by so many to appear eternally young and alluring.

Though almost certainly coincidental, a large percentage of the wealthy elderly retire to Miami, Florida. One documentary stated a large number of residents purchase facelifts which, rather than looking natural, make their faces appear “cut” as additional proof of their wealth.


A Healthy Response to Potential Taunting

The daughter of one young couple was born with a distinctive mole on one cheek. Given their awareness that children often prey upon the sensitivities of others, these parents understood the potentially lasting damage generated by childhood ridicule.

They decided that if their daughter mentioned hurtful remarks at around the age of eight, they would try to deflect her sadness by saying her tormentors, in all probability, were doing all they could to distract others from their own shortcomings.

Still, if this harassment continued, the couple agreed to ask their daughter if she would like a doctor to remove the mole. Fortunately, this issue did not arise. As the girl matured into a lovely young woman, the mole stayed the same. Currently, as an adult, she has worked as a long-term anchor person on a TV program in a major American city.


On the other hand, when a wealthy couple found their teenage son being mocked and ostracised due to his weight, they paid a hefty sum for his liposuction. Currently, he has gained back the weight and may well be heavier than he was before.

The danger in this approach can be the belief in the ability of a skilled surgeon to erase any traces of ageing or self-indulgence long after the elasticity of the skin and muscles can bounce back from an ongoing onslaught.

The Fear of Being Fat

Writer Caitlin Moran has written in her 2011 memoir, How to Be a Woman, the current penultimate insult, ranging from playground to office lounge, is to be called fat, or one of its synonyms. Even someone who has always been slim, aware of the caloric content of nearly every bite, can be gutted by the sense of this underlying horror. What if this malevolent person intuits some vulnerability which may result in future corpulence?

A humorous mirror has been made which, while functioning as a looking-glass, can also “say,” at the push of a button, any number of things women revel in hearing, spoken in an amorous tone. Market research has shown “You’ve lost weight” to be the most frequently visited. Though other buttons provide further compliments, the one praising weight loss is the first to receive an avalanche of attention.

Why Should Weight Be an Issue?

In her delightful though at times searing book, Shrill: Notes from a Loud Woman, actress-comedian Lindy West overrides the taboo of mentioning weight as a factor in finding success and being viewed with the same respect as their slimmer peers. Why, Ms. West asks, should anyone slog through life with a disheartening body image simply by weighing significantly more than societal boundaries allow?

Her viewpoint, endorsing self-acceptance, freed a bandwidth of women from viewing themselves as unworthy of worthwhile careers as well as romantic relationships. Inferentially, such procedures as liposuction reinforce the shallow nature of societal values and the willingness of so many to succumb to their pressure.

The beautiful is that which is desirable in itself.

— Aristotle

A middle ground is offered by Novelist Judith Krantz in her autobiography Sex and Shopping: Confessions of a Nice Jewish Girl.

Ms. Krantz believes lines and wrinkles do not represent developing character. Such qualities as empathy, compassion, and strength evolve within our maturing selves and need not be illustrated by signs of ageing. For those who can afford them, Ms. Krantz advocates their use, assuming their goals are within reasonable boundaries.


Contracts in Relationships

Body dysmorphia is on the spectrum of Obsessive Compulsive Disorders: (OCD.) In the most serious cases, the victim can become agoraphobic due to an overpowering terror of being rebuffed. It can feel cruel to insist on a contract, sometimes written and signed by both parties. Still, this can prove essential in order to preserve a relationship.

Those who do not understand OCD do not realise providing reassurance can be akin to giving an addict a drug or a diabetic food with high sugar content. Such contracts can sometimes mean reassurance at longer and longer intervals until it is eradicated.


What Constitutes Attractiveness?

One partner in a long-term relationship persisted in asking her partner whether she thought she was ugly. In time, overwhelmed by these ceaseless queries, the partner responded, “I find you beautiful because of my love for you. Whether or not you truly have global beauty is not for me to define.”

In her book Feeling Good About the Way You Look, German psychologist, Sabine Wilhelm offers a step-by-step way for those agonising from a sense of their own unattractiveness. In addition, she provides suggestions for those close to those trapped by their sense of being less attractive than almost anyone else.

One helpful but non-confrontational method might be to ask, when appropriate, ”Does shaping your right eyebrow mean more to you than walking in late to your closest friend’s wedding?”

"Is your mother’s view of your hairstyle more important to you than your own?”

Ability To Create a Unique Type of Beauty

French Actress and director Eva Le Gallienne, was revered for years in the French theatre. According to actress Mariette Hartley’s memoir, Breaking the Silence, at some point during her middle years, a fire gravely damaged her hands to the point of ruining the acting career which she had begun to build during her teens.

This actress decided to shape an illusion which could bring her hands grace and elegance.

In time, she began receiving letters praising her for her hand gestures, which enhanced her performance.

Arguably, this praise could have been offered by way of sympathy, still, seeing her during her final years, Ms. Hartley believed such compliments were based on genuine skill rather than sympathy or compassion.

Everything has its beauty, but not everyone sees it.

— Confucius

Exploring the Wish for Cosmetic Surgery

While some cosmetic surgeons will operate on anyone willing to pay the price, ethical doctors will do all they can to ascertain expectations. At times, with the aid of a psychotherapist, the surgeon will opt not to operate if the requested results cannot be achieved.

If a woman over 50 brings photos taken during her high school graduation, senior prom, wedding day, and such, a meticulous surgeon will explain the benefits and limitations which can be provided and those which cannot be.

The Search for “the other one”

In her final memoir, Unsinkable—its title based on her major film performance in The Unsinkable Molly Brown, long-term actress Debbie Reynolds recounts the vicissitudes of the ageing process. Whatever method may be deployed, the erosion of time can be halted for only so long.

Debbie Reynolds admits the reflection shown in her mirror looks like it must belong to someone else. Still, along with other ageing actresses, Ms. Reynolds made every effort to continue her career, applauded by many.

This truth is continued in her daughter Carrie Fisher’s last memoir, The Princess Diarist.

Recognised by a young mother and small daughter, Carrie showed them a picture of herself as Princess Leia in the film Star Wars. At that, the child brightened, but only for a brief enough time to understand the difference.

Seeing an updated photo and the true Carrie Fisher, she wailed, ”But I want the other one.”

Perhaps, on some level, no matter how old we become, many of us continue to yearn and even believe, in some miraculous way, we can return to "the other one."

© 2020 Colleen Swan


Colleen Swan (author) from County Durham on April 29, 2020:

Hi Paula, I always enjoy your comments. My view on cosmetic surgery is if one feature is causing you misery, there is no reason not to have it changed. Sadly, it can become addictive in the sense of moving from feature to feature until a face is all but destroyed. The strange thing about my mum's friend is that she did not seem to feel the least hard done by. This husband sounds like a bit of a fuss budget in that he apparently also complained that she slurped her soup. It was such a different time, that when my mum and dad were shopping and mum picked up a can of tuna, my dad thought nothing of taking out of her hand saying "you don't want that". Later she was horrified to think she had allowed that. Colleen

Suzie from Carson City on April 28, 2020:

Colleen....As always, Thank you for an exceptionally well-presented,educational article. Your Title actually speaks volumes. When cosmetic surgery is an elective procedure, "common sense" is a vital part of any end result.

Surely, we realize that there are necessary procedures,to correct an abnormality or an injury that can interfere with quality of life. However, those who suffer from BDD, unfortunately have a serious tendency to go above and beyond, once too often. This is when we can see some of the disastrous results we've seen, especially regarding Hollywood celebrities. The old expression, "Too much of a good thing," comes to mind.

The story you share of your mother's friend, has stunned me to to the point of having no comment at all. My shock that a husband would ask & any woman would comply, leaves me SPEECHLESS!

Good to see you, Colleen! Cheers, Paula

Ann Carr from SW England on April 27, 2020:

Oh my! That's a horrendous request to make - and she did it! You're so right, it was a completely different time, but then I know people who are like that now, sadly.

Colleen Swan (author) from County Durham on April 27, 2020:

Hi Ann, Yes, there are people who can say "take me as I am or forget it". Some allow the views of others to deplete them. Some years ago a friend of my mum's around 30 had her teeth taken out because her husband didn't like them. How can anyone claim to love someone and make that kind of demand. It certainly was a different time. Colleen

Ann Carr from SW England on April 26, 2020:

Hello Colleen. This is informative and well-argued. There are so many aspects of this problem. I suppose it comes down to self-confidence but that is a difficult thing to achieve, especially if others are cruelly critical.

You've given us much food for thought. On a personal level, I would not choose to go through pain in order to change my lot, if it was merely to look younger. Disfigurement is another matter altogether.

I hope you're keeping well in these strange times.


Colleen Swan (author) from County Durham on April 26, 2020:

Thank you Umesh for your input.

Umesh Chandra Bhatt from Kharghar, Navi Mumbai, India on April 26, 2020:

Interesting article. Well presented.