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Preventing Litigation With Assessment Procedures

By: Trish Henrie, PhD
Posted: May 3, 2010, from the May 2010 issue of
Physician speaking with a patient

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Recent studies have shown patients with BDD process what they see differently from the normal population. These findings suggest BDD is a neurobiological-based disorder of perception, which may underscore why cosmetic procedures are largely ineffective—and contraindicated—in this population, and why symptoms may worsen post-procedure.2

In addition, patients may exhibit other psychological disorders that often cause undue stress to the physician, including borderline personality disorder, paranoia and narcissism. Individuals with these disorders do not have the ability to self-regulate and often need the attention or adulation of others, especially those in authority. Other disorders, such as depression and anxiety, are not contraindicated for surgery, but they will not necessarily be improved by cosmetic surgery.

According to psychologist Ted Grossbart, PhD, a senior clinical supervisor at the Massachusetts Mental Health Center and the Massachusetts School of Professional Psychology and an assistant clinical professor of psychology at Harvard Medical School, cosmetic surgery patients often look for more than changes in their physical appearance. If these procedures do not lead to improvements in body satisfaction, self-esteem or quality of life, the patient perceives them as a negative surgical outcome.

Patients with BDD, as well as those with other psychological problems, may request repeat procedures or experience depression and adjustment problems, social isolation, family issues and self-destructive behaviors, which can lead to malpractice claims and negative referrals.3 In some cases, the patient may even cause bodily harm to the surgeon or staff, and there are at least four documented cases of surgeons who have been murdered by patients who had symptoms consistent with BDD.4

Research has also shown external factors, such as expectations for improving careers, relationships and life in general, along with dissatisfaction with a previous surgery, as indicative of poor surgical outcomes. If patients regard cosmetic surgery as a life-changing event, they are likely to be upset when physical changes do not lead to the desired social outcome.5

Assess and build rapport