Home' Spa and Clinic : Volume 62 July 2015 Contents Patients with BDD have significantly poorer insight than those
with OCD and are more likely to be delusional and have major
These people will often seek out unnecessary cosmetic surgery,
which is why at this year’s Cosmetex conference in Melbourne in
May for cosmetic surgeons and associated practitioners, being
mindful of BDD was a key topic.
In his talk How People See Themselves: How Media Drive the
Aesthetic Patient World, Dr David Castle, Chair of Psychiatry at St
Vincent’s Health and the University of Melbourne, discussed the
global, relentless pursuit of a perfect body image.
With no gender, nationality or age group seemingly immune to
media’s impact on perception of self, Dr Castle highlighted not only
the growing number of cases of BDD but that, more than ever, the
industry needed to be equipped to deal with them.
“How we make and manufacture beauty, how we talk about
appearance is important,” he said. “The images we are subjected
to daily have ver y likely been doctored through programs like
Photoshop and this is increasingly intimidating for young people
who, despite being technology-sav v y, are in an ‘editing haze’.
“We thrive off a culture of celebrity worship and a yet there exists a
counter-culture that picks on their very body faults. We have then, on the
whole, culturally become uncomfortable w ith the age we have earned,
the self, yet this continued connection of image and happiness persists.”
Dr Castle cited shows such as Extreme Makeover that distort
our notion of inner and outer beauty, where appearance has the
power to dictate personality traits and an assumed way of living.
A powerful combination that could be headed right through your
salon, spa or clinic door.
“Rates of body dissatisfaction are on the rise in both men
and women,” he said. “ We need to be careful and aware of the
expectation of clients. And just as practitioners are equipped to say
yes to client procedures, they also have the power to say no.”
It of course takes a specially qualified and experienced medico
to formally diagnose and treat BDD, but aesthetics and wellbeing
professionals who treat clients on a regular basis to enhance their
appearance (and thus self-esteem) may be the first to recognise a
client has a problem that is way more than skin deep.
As such professionals, who see clients at often their most
vulnerable, you are in a unique position to recognise the difference
between someone who is just ver y conscious of maintaining their
appearance and a woman or man who is unhealthily obsessed with
it in negative, even delusional ways. Ergo, is v ulnerable to desperate
measures to cure or camouflage their perceived problem(s).
Unfortunately these measures rarely satisfy a BDD sufferer and,
indeed, may make things worse.
At a salon, spa or clinic level, the way you communicate with
clients who have body image issues is all-important - what you
DON’T say as much as you DO.
In the late 1980s-early 90s, I suffered Post-Viral Fatigue (aka
Chronic Fatigue) Syndrome that went undiagnosed for several years.
In a nutshell, I felt and looked dreadful and became increasingly
self-conscious about my appearance – even more than that, how I
perceived other people perceived how I looked.
During those years I developed a phobia about skincare pur veyors
at department stores and beauty/dermal therapists who would take it
upon themselves (when I had gone to them hoping some pampering
would help me to feel better about myself) to volunteer how appalling
I looked - SO much older than my chronological age - and what I
needed to do and buy so I could be seen in public without a paper
bag over my head. That made me feel SO much better!
A few times I was “shamed” into buying a queen’s ransom’s
worth of “miracle” products that of course worked no miracles and
subsequently collected dust on the bathroom shelf.
Worse than anything, this kind of “advice” made me even more
depressed, self- conscious and considering a facelift at age 33 (I was
extremely lucky to have consulted a ver y ethical plastic surgeon who
told me “definitely not”).
So it is important for staff of salons, spas and clinics – from
the front line at the front desk and apprentices to the most senior
of therapists - to learn how to artfully and discreetly suggest
what products and treatments might help a client, while similarly
dissuading them from things they might want, but actually don’t
need. This, all the while being careful not to crush their already
delicate self- esteem, or feed irrational fears or delusional insecurities.
“The focus of a therapist must be on helping clients to
understand how to update or improve their ‘look’, downplay any
weaknesses with correcting skills and highlight their best features,”
says Maureen Bartlett, CEO of Sydney’s Encore Beauty, distributors
in Australia of Serge Louis Alvarez cosmetics. “But all done in a way
that boosts their self-esteem, not crush it. Language is key.”
According to Julie Hyne, salon image/etiquette expert, business
coach and founder of Business4Beauty, if a therapist senses a client
has “issues” that are beyond the expertise of their business, they
should consider referring the client on to someone who can help.
“This situation calls for the salon, spa or clinic owner to have an
extended network of people she or he can refer clients to,” says Julie.
“It’s a customer ser vice element to be able to know when you are out
of your depth and to provide a personal referral to another professional
without expecting anything in return except a well and happy client.
“If it is done in a confidential way and with the utmost integrity
and sincerity, so that the client feels she or he or is being `heard’.
“Acknowledging that you have listened and `heard’ and
suggesting that another professional’s view would be worth
investigating is a ver y valuable service you are providing.
“It’s best if you have seen results of what these other professionals
do, or at least have heard from others whose opinions you trust that
the work said professionals do is to the standard required.”
Leading Sydney cosmetic physician Dr Naomi McCullum says that
when a patient comes to her obsessing about certain aspects of their
appearance, wanting her to `fix’ it, but actually can’t see their `issue’,
“I am always very straight up, but at the same time, gentle with them.
“I always try to make them aware that I am on their side. With
patients who don’t have BDD but just focus on the wrong things too
much, I will try to give them a more realistic perspective about their
appearance. Sometimes that is all it takes to stop them worrying about it.
“However, if I think that the patient needs to see a psychiatrist/
psychologist, I will discuss this with them.
“In my practice, it is all about knowing whether our clinic can make
patients happy. With BDD patients it is unlikely that they will be satisfied.
“From our first point of contact - i.e. from when my staff answer
the first enquiry via email or phone - we are actually interviewing
the person to see whether we are willing to accept them as a patient.
“I always take the long term view in business. There is nothing
in it for us to take on patients who are not going to be happy; it is
just a headache.
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