Plastic Surgery Consent and Body Dismorphic Disorder

Published on February 29, 2012 by

Dr. Larry Nichter of the Pacific Center for Plastic Surgery would like to inform prospective patients about the rising concern of Body Dysmorphic Disorder as it relates to plastic surgery.

An article from the Mayo Clinic on Body Dysmorphic Disorder describes the disorder:

Body dysmorphic disorder is a type of chronic mental illness in which you can’t stop thinking about a flaw with your appearance — a flaw that is either minor or imagined. But to you, your appearance seems so shameful that you don’t want to be seen by anyone. Body dysmorphic disorder has sometimes been called ‘imagined ugliness.’
The Mayo Clinic staff

Recent years have seen an increased awareness of plastic surgery patients with Body Dismorphic Disorder (BDD). One of the major concerns about patients with BDD is that they may not be competent to give an informed consent for the cosmetic procedures they elect to have.

A medical malpractice lawsuit involved a woman who, displeased with her abdominoplasty scars, claimed that she had been incapable of giving a genuinely informed consent because she had BDD. The case was later dismissed; the court ruled that the plaintiff’s surgeon had followed acceptable medical practice and did not have sufficient reason to refer the patient to a psychiatrist before surgery. The case does, however, highlight some of the problems BDD poses for informed consent when it comes to plastic surgery.

The legal definition of informed consent is rather broad, but it provides guidelines for determining the mental competency of the patient before they can consent to elective surgery. The law requires that doctors provide complete and accurate information about the procedure and its risks to the patient, and the patient must not be coerced or pressured in any way. Ultimately, a truly competent patient must be capable of refusing consent to surgery.

When a psychological disorder (such as BDD, dementia, a learning disorder, or a manic episode) prevents a patient from understanding the risks and likely result of a surgery they wish to have, the question arises as to whether their consent is legitimate. Although a patient’s consent cannot be retroactively revoked if they are diagnosed with BDD after surgery, plastic surgeons are always on the watch for signs of BDD when consulting with prospective patients. This is especially important in the field of plastic surgery because people with BDD are very likely to seek surgical solutions to what they believe is wrong with them.

At the Pacific Center for Plastic Surgery, our goal is to provide patients with lasting, satisfying results. An important step in achieving this goal is making sure that our patients are psychologically healthy enough to make an informed, rational decision in their choice to have plastic surgery.

Source: Informed Consent in Body Dysmorphic Disorder, Medscape Medical News

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