Cosmetic Surgery on Patients with Body Dysmorphic Disorder: The Medical, Legal, and Ethical Implications

Kristen M. Nugent, King & Spalding

Abstract

The issue of cosmetic surgery performed on patients with body dysmorphic disorder (“BDD”), a form of mental illness in which sufferers experience great distress and preoccupation with imagined or exaggerated physical flaws, exists at the intersection of the medical, legal, and psychiatric fields. The perspectives and professional judgments of practitioners and scholars in all three sectors will inevitably conflict, as members of each group—in good faith, and based on their respective training, experience, and varying levels of risk aversion—try to formulate policies and procedures for determining whether and when BDD is a contraindication to cosmetic surgery. Where there is disagreement as to under what conditions and with what precautions a plastic surgeon may safely perform an elective procedure on an individual with BDD, the potential for legal liability is more likely to arise. Unsurprisingly, each group also has a differing opinion as to the best manner to deal with recalcitrant physicians who negligently or knowingly ignore professional, legal, and ethical norms and standards, and operate on inappropriate surgical candidates who suffer from BDD. This article examines psychiatric research, medical practices, and legal precedent in an effort to uncover a compromise position that will satisfy the interests and address the concerns of the members of all three fields. This article emphasizes, however, that balancing the patient’s interests in both bodily autonomy and protection from unscrupulous doctors must remain the foremost priority.