Nose jobs and body dysmorphic disorder: More connected than you might think.

When I was pregnant with my children, something weird happened to my body. I'm not referring to the swollen ankles, or the stretch marks, or the smattering of broken blood vessels across my chest (in case you were searching for reasons to avoid becoming pregnant.) No, I'm talking about my nose. During those magical, perplexing nine months, my nose became plumper and rounder and wider. At first I thought I was imagining things; somehow directing all the anxiety about my pregnancy weight gain towards my nose. But it was true - my nose definitely changed. Now I had this thing, this snout on my face. I was Christina Ricci's character in Penelope, a girl cursed with a pig nose. An awful, protruding, pig nose.

Miraculously, things went back to normal after giving birth. But the post traumatic stress disorder remained. When I put on my makeup on the morning, my vision pinpoints directly to my nose. Has it become rounder? Is that a bump? I preen and examine, turning my head this way and that to be sure nothing has changed.

I have never considered a nose job, but I can certainly see why some women have. There are women who are at war with their big noses, though I kind of think a big nose can be striking on some. Nose jobs have become so socially acceptable that teenage girls are asking for them as sweet sixteen presents. And just weeks ago  Nightline ran a story a thirteen year-old girl who got who to prevent being bullied at school. Nose jobs these days are no big deal.

Or so we think. The New York Times recently reported that about one in three people who seek rhinoplasty (aka, a nose job) have symptoms of body dysmorphic disorder (BDD), "a mental health condition in which a person has an unnatural preoccupation with slight or imagined defects in appearance."
BDD, first introduced in the revised third edition of the Diagnostic and Statistical Manual of Mental Disorders in 1987, is characterized by a preoccupation with an aspect of one's appearance. People with BDD repeatedly change or examine the offending body part to the point that the obsession interferes with other aspects of their life.

Belgium researchers studied 266 patients over a 16-month period and say that as many of 43 percent of nose job patients may have the condition. The study, published in the August issue of Plastic and Reconstructive Surgery, shows a surprisingly high rate of body dysmorphic disorder among nose-job patients. Previous studies have shown that about 10 percent of patients seeking plastic surgery suffer from the condition.

“We know body image dissatisfaction falls on a continuum, and there has to be some degree of dissatisfaction that leads us to see a plastic surgeon in the first place,” said David B. Sarwer, associate professor of psychology at the Center for Human Appearance at the Perelman School of Medicine at the University of Pennsylvania. “It’s when it begins to interfere with daily functioning. Patients with more severe B.D.D. struggle to maintain social relationships and have difficulty getting to work or staying employed.”

It's important to note that the majority of BDD patients who have cosmetic surgery do not experience improvement in their BDD symptoms, often asking for multiple procedures on the same or other body features. In a small retrospective study of 200 individuals with BDD, 31 percent sought and 21 percent received surgical or minimally invasive treatment for BDD symptoms. Nearly all of these individuals continued to have BDD symptoms, and some actually developed new appearance preoccupations. A related a survey of 265 cosmetic surgeons, 178 (65 percent) reported treating patients with BDD, yet only one percent of the cases resulted in BDD symptom improvement.

It's kind of terrifying to imagine that there are physicians performing cosmetic surgery on patients with a mental illness who believe their looks are so damaged that they require it. It is the rare woman who can see herself honestly in the mirror without negative body thoughts clouding her perception. How many plastic surgeons actually turn away people who really look fine but are obsessed with changing a nose - or some other body part? This sort of obsession, fed by media presentation of impossibly perfectly beautiful women, fuels the plastic surgery industry. It is this anxiety, this quest for perfection based on skewed perceptions of appearance, that keeps surgeons in business. If every appearance-obsessed plastic surgery-obsessed patient was turned away, plastic surgeons would go broke in a hurry.

Have you ever considered a nose job, or other plastic surgery procedure? What do you think of this study? Are you surprised by the high correlation between body dysmorphic disorder and nose jobs?

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  1. I seriously thought I was the only one whose nose seems to keep growing. I look at pictures from high school or even from my 20s and I'm like WHAT HAPPENED? I was fine with my nose back then. But now I am def. obsessed with the shape and length of my mose more than any other body part at this point. Weirdness.

  2. I always think my nose is big because, well, when I was younger, it was big! I think over time I've "grown into" my nose.

    I think what people don't anticipate when they get a nose job is that it changes their entire face. And, more importantly, their nose looks like everyone else who has had a nose job if it's not done right.

    Then, of course, there are people who truly do look better with nose job. Ashlee Simpson comes to mind.

  3. If leg lengthening surgery was less risky and didn't require long recovery times, I might consider it (even though at 5'2" or so, I'm not short-short-short)... it would just make buying clothes so much easier (though even after leg lengthening, I'd probably still have issues finding tops that are properly proportioned). As for other types of surgery, does laser/LASIK count? I'm still wearing contacts, but have thought about laser so that I won't have to put anything in my eyes anymore!

  4. Oh there def is a high correlation between BDD and plastic surgery esp in those individuals who start and can't stop... Heidi Montag anyone? I did a presentation on this condition back in my college days, I suspected Michael Jackson to be afflicted by the condition too. It's a shame that surgeons will continue to perform these surgeries given the fragile mental state of some individuals but money rules. Wouldn't it be grand if extensive mental health evaluations were required of the patient before plastic surgery?! Though I'm sure certain practitioners would find ways around that too. Oh well, tis the society we live in. Anyway I have issues with my (giant) nose like a lot of people but I'm not willing to go under the knife for it! Great post!! I'm not a big commenter but I've been following your blog for a while now and absolutely love it.

  5. Wow, intriguing! But now that you mention it, it all makes sense! Of course I've considered a nose job, a boob job and now that I'm getting older, an eyelid lift seems to be in the running. In a strange way I'm glad I can't afford them because there is the possibility that I would become crazy obsessed and move on to other body parts. (Although I'm there with Cynthia C, I'd be in line for leg lengthening too!)
    When I worked at a certain store (home retail,) there was a woman who would come in every other week or so who from a distance was beautiful but up close it was very apparent she'd been worked on (there are tell tale traits,) and eventually I'd been told by several people that she had been on a talk show to tell her tale about her obsession with plastic surgery and has had over 20 surgeries! Not sure if it was true but like I said, you could tell she'd had a fair amount done. How much time/money could this possible take? How sad that she can't ever be comfortable in her own skin!

  6. Like CynthiaC, I've briefly thought about leg lengthening surgery, particularly while trying to reach things on the top two shelves of my cupboards! For years I've struggled with the size of my thighs, thinking of myself as somehow deformed. Seeing other pear shaped bloggers posting has made me realize these thighs are just something that makes me different and it's really okay. I also know now that most people have something about their own body that they don't absolutely love, even people society deems perfect in every way.

    BTW, LASIK was the best money I ever spent! ;)

  7. Oh I definitely know because a friend of mine suffered with male anorexia and had body dysmorphia. One thing he was obsessed with was the size of his nose. I saw nothing wrong with it. After he reached a healthy weight his parents let him get a nose job. He came to me like "LOOK!" I seriously didn't notice any change in his nose, yet to him it was completely different. It was such a bizarre thing to me. I guess if it helped him see his nose differently then it was worth it but he already is talking about chin liposuction *sigh*


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