One special area of medical malpractice concerns patients with body dysmorphic disorder (BDD). This is a psychiatric condition in which the patient is obsessed with his or her physical appearance and often wants repeated cosmetic surgeries or dermatological treatments. Or the patient may demand weight loss surgery even if he or she isn’t morbidly obese.
It is controversial whether a surgeon commits malpractice by operating on such a patient. The defense of the surgeon is that the patient gave voluntary consent after all options were explained. But ethical surgeons will refer a patient to a psychiatrist or psychologist at any hint that the patient has body dysmorphic disorder. For one thing, a patient with BDD is usually unhappy with the results of cosmetic surgery, so a surgeon who agrees to operate on a BDD patient is buying trouble.
Here is an excerpt from a medical article on Medscape that shows how disabling this condition can be (and it also shows how inappropriate it is for surgeons to operate on a patient with BDD):
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Patients with body dysmorphic disorder feel compelled to engage in ritualistic behaviors to confirm the perceived defect or avoid its recognition by others. These behaviors include compulsive mirror checking, compulsive mirror avoidance, compulsive grooming (eg, hair combing, hair plucking, picking skin, applying makeup), and repetitively comparing the perceived defect with the bodies of others.
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Sometimes patients require constant reassurance from others that their defect is “normal” or “not that bad.”
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Thoughts and behaviors relating to the perceived defect generally take up to 1 hour or more per day, and in some cases can take up to 8 hours per day. In a series of adolescent patients, the average amount of time spent in activities related to their perceived defect was as much as 3 hours. These patients had particularly poor insight into their problem.
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Patients with poorer insight are likely to spend more time dealing with the imagined defect. Patients often seek repeated dermatologic or cosmetic referral for correction of the perceived defect.
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Social situations are difficult for these patients, because they fear people may point out their imagined defect or avoid them. They usually have difficulty maintaining relationships with peers, family, and spouses. Some patients skip school or work repeatedly. Many become housebound. About 30% of those with BDD have been housebound at some point for at least 1 week because of their preoccupation.
If you know someone who seems obsessed with a body defect that you cannot even see, they may have BDD. They need psychiatric help. A lawsuit against whoever may have operated on them is usually not the answer.
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