Cosmetic surgery, imagined defects and mental disorder

As part of a class exercise each term, I give my female psychology students two essays to grade. The essays are identical, except that they are attributed to different authors and contain photos of the purported authors, Laith and Aziz.

Laith is a classically handsome male (so I am told), while Aziz is often described as a geeky nerd. And each term, the women grading handsome Laith's essay give him on average a B, while poor Aziz gets a C for the exact same work. Once the truth of the situation is made known, the students start to rationalise their beauty bias. But the point is very clear: beauty matters and, more troubling, it matters in contexts where it really shouldn't. This issue was recently touched upon in an article in M magazine, which explored the growing demand for cosmetic surgery in the UAE.

Perhaps a nip, tuck and some hair plugs might just shift your college grades in the right direction. They shouldn't, but they might. Certainly, research in other countries has repeatedly found that beauty bias is at work in various important contexts.

In the criminal justice system, for instance, attractive defendants are more likely to be acquitted or given lighter sentences than their less attractive counterparts. One of my students recounted how a police officer had ripped up a parking ticket after he saw her, gallantly declaring that he would never give a "girl like her" a ticket. So, looking good might just save you a fine or even a jail sentence.

Perhaps it's this idea, that beautiful people get a better deal, that is driving the demand for cosmetic surgery. After all, it's handsome princes who get to marry beautiful princesses, rescuing them from ugly stepsisters and even uglier stepmothers. Perhaps if our beauty bias were not so obvious and so pervasive, people might start to feel more comfortable in their own skins.

The pursuit of cosmetic enhancement is not without costs, which can far exceed mere money. Some people imagine their blemishes, finding fault where there is none. Such individuals might repeatedly pursue cosmetic interventions, always hoping to find respite in their newly acquired beauty, only to meet fresh disappointment and renewed appearance anxiety.

Psychiatrists have a term for this: body dysmorphic disorder (BDD), or the distress associated with imagined ugliness and slight physical defects. The disorder can interfere with important areas of a person's social and professional life.

Imagining herself hideously ugly, a modestly attractive young woman might avoid virtually all social interaction for fear of humiliation or embarrassment. So extreme is this distress that 50 per cent of BDD sufferers pursue cosmetic surgery in - mostly futile - attempts to improve upon their imagined defects.

Another statistic is that 28 per cent of sufferers seek solace in suicide; twice the attempted suicide rate of severely depressed people, and far exceeding the rate expected in the general population.

Epidemiological studies suggest that between 6 and 15 per cent of people seeking elective cosmetic or aesthetic dermatology surgeries can be diagnosed as experiencing BDD. In spite of the prevalence of elective surgery, the evidence suggests that cosmetic interventions offer very little hope of relieving appearance anxiety and in many cases actually make the situation worse. With the correction of one imagined defect, BDD sufferers are quick to become preoccupied with another imagined or exaggerated blemish. This is obviously good for business, but very bad for the patient.

Those offering cosmetic surgery and related elective treatments should screen their patients for BDD to avoid unnecessary and generally unsatisfying outcomes. Existing screening tools are highly sensitive and specific in their ability to identify individuals experiencing BDD. Effective treatment options include psychotherapy and pharmacotherapy, both of which are far more clinically and cost effective than going under the knife.

At a far more basic level however, we seriously need to address our societal beauty bias. Similarly, we need to encourage people to embrace and accept ageing, rather than wage protracted wars against an invincible non-enemy. The prevention of psychological disorder is possible, but the prevention of ageing is not.

Justin Thomas is an assistant psychology professor at Zayed University in Abu Dhabi