More Than Just Filler? Body Dysmorphic Disorder and Non-Surgical Cosmetic Procedures

By Natalie M Lane.

High streets across the country may have been largely shuttered up over the past few months. But cast your mind back, and you’ll recall that it’s no longer just food, drink, and clothing on offer in the typical, bustling town centre – but lip plumping, skin smoothing, and cheek augmentation too. The UK non-surgical cosmetic procedures industry has boomed in recent years, with a myriad of different interventions on offer – foremost among them Botox and dermal fillers.

The sector has not escaped controversy, however, and has been subject to a number of critical reviews. In 2017, the Nuffield Council on Bioethics undertook an evaluation of the industry, advocating changes to promote ethical good practice, including standardising practitioner training and registration, introducing mandatory product safety regulation, and prohibiting irresponsible marketing.

Yet, one group has been mostly overlooked in ethical considerations: individuals with the psychiatric condition body dysmorphic disorder (BDD). BDD is characterised by an overwhelming preoccupation with a perceived defect in one’s appearance which, in the eyes of others, is non-existent or very slight, and thus out of proportion to the significant psychological distress and impairment in social functioning that it generates. Unsurprisingly, BDD is commonly associated with seeking cosmetic intervention, including non-surgical procedures.

In a JME article, I begin to address this knowledge gap. Semi-structured interviews were carried out with a range of non-surgical cosmetic practitioners and mental health professionals, in order to highlight the unique ethical challenges raised when individuals with BDD consult for non-surgical procedures. These findings guide in-depth ethical analysis of issues regarding best interests and capacity to consent to non-surgical cosmetic procedures in individuals with BDD.

The paper gives rise to a number of recommendations. Firstly, evaluation of risks and benefits of non-surgical cosmetic intervention in individuals with BDD suggests that such procedures are generally not in their best interests, as they have poor outcomes and risk incurring adverse effects. Therefore, a precautionary approach of refusing to carry out non-surgical intervention in this context, and instead referring to mental health services is advised.

Secondly, values which arise from the condition itself (defined as pathological values) – namely an intense dislike of a particular feature – are proposed to underpin certain decisions regarding non-surgical cosmetic procedures made by individuals with BDD. It is argued that such values impair decision-making capacity, as they do not represent true expressions of autonomy. Therefore, decisions dictated by pathological values can, and should, be justifiably overridden when they risk harm, such as that associated with non-surgical cosmetic intervention.

So, while the shutters may currently be down on cosmetic clinics across the country, it remains important to cast light on the ethical issues raised when individuals with BDD consult for non-surgical cosmetic procedures. My paper aims to do exactly that.


Paper title: More Than Just Filler: An Empirically Informed Ethical Analysis of Non-Surgical Cosmetic Procedures in Body Dysmorphic Disorder

Author: Natalie M Lane1, 2


1Department of Psychiatry, NHS Lanarkshire, Glasgow, Scotland

2Department of Global Health & Social Medicine, King’s College London

Competing interests: None declared.

Social media accounts of post author: @nataliemlane

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