Recent statements at the Non-Surgical Symposium have raised some questions about whether validated screening tools are actually needed before non-surgical cosmetic procedures.
The Medical Board guidelines for non-surgical procedures state,
“2.2 The medical practitioner who will perform the cosmetic procedure or prescribe the cosmetic injectable must assess the patient for underlying psychological conditions such as body dysmorphic disorder (BDD), which may make them an unsuitable candidate for the procedure.”
They do not state that a ‘validated screening tool’ is needed for non-surgical cosmetic procedures, such as anti-wrinkle injections and filler, but it is needed for cosmetic surgery.
Dr Ann Tonkin, the head of the Medical Board of Australia, in her presentation at the Non-Surgical Symposium explained how BDD is a clear contraindication for both surgical and non-surgical cosmetic procedures, due to risks posed to the patient but also greater risk of patient dissatisfaction, complaints and litigation issues.
This begs the question – how is a non-surgical practitioner to assess for BDD, while still protecting themselves from complaints or litigation issues?
Without using a validated screening tool, a cosmetic practitioner could:
1) Come up with a few questions about BDD to add to their intake forms.
2) Ask the patient directly if they have been diagnosed with BDD
3) Have a few interview questions to assess their patients for BDD
However, in each of these scenarios, if there were a complaint or litigation issue, the onus would be on the cosmetic practitioner to justify the methods used and the questions asked, and prove, with documentation that these have been done.
NSS attendees heard from Annabel Herron, from Avant Medical Indemnity Insurance, about how crucial good documentation is when a complaint does occur. A case could easily be raised if the questions that were asked by the non-surgical practitioner did not constitute a valid or reasonable method for assessing BDD.
Further, we know that BDD is misdiagnosed and under-diagnosed in both cosmetic and mental health settings. Even psychologists or psychiatrists who are trained in the assessment of mental health disorders miss signs and symptoms of BDD. It is often termed an ‘invisible disorder’ because many BDD behaviours can take place at home, in private. A study by Joseph et al. (2017) showed that plastic surgeons only correctly identified 5% of patients BDD using their clinical intuition alone, compared to a validated BDD screening tool. The study also revealed that 84% of plastic surgeons had operated on someone with BDD unknowingly, only realising after the surgery when the patient returned unsatisfied.
Cosmetic practitioners are also well aware of the fact that most people seeking cosmetic treatments are dissatisfied with some aspect of their face or body. Distinguishing those with general body image concerns and BDD can be tricky – but data-driven screening tools do this very easily!
So, is a validated screening tool necessary for minor cosmetic procedures?
It is not a regulatory requirement. However you are still expected to assess for BDD so a validated screening tool is the best way to do that, and will:
1) Help you assess BDD in an evidence-based way in a very short time frame.
2) Have clear, solid documentation of your BDD assessment process on file – necessary if there are complaints or future litigation issues.
3) Have another piece of evidence to back up your gut instinct.
4) Have something to rely on and refer back to if you need to say no or refer a patient on for further assessment.
ReadyMind has a range of validated assessment tools for BDD and other psychological concerns which take between 1-5 minutes to administer.
To access our software to help you administer, score and report on your screening process, you can sign up here.
*Views my own and do not constitute regulatory or legal advice.
Dr Toni Pikoos, PhD.
