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More than just filler: an empirically informed ethical analysis of non-surgical cosmetic procedures in body dysmorphic disorder
  1. Natalie M Lane1,2
  1. 1 Department of Psychiatry, NHS Lanarkshire Mental Health Services, Glasgow, Scotland, UK
  2. 2 Department of Global Health & Social Medicine, King’s College London, London, UK
  1. Correspondence to Dr Natalie M Lane, Department of Psychiatry, NHS Lanarkshire Mental Health Services, Glasgow G71 8BB, UK; natalie.lane{at}


Objectives To identify and analyse ethical considerations raised when individuals with body dysmorphic disorder (BDD) consult for non-surgical cosmetic procedures.

Methods Ethical analysis was conducted addressing the issues of best interests and capacity to consent for non-surgical cosmetic procedures in individuals with BDD. Analysis was informed by the findings of semistructured interviews with non-surgical cosmetic practitioners and mental health professionals.

Findings Non-surgical cosmetic interventions were viewed not to be in the best interests of individuals with BDD, as they fail to address core psychological issues, result in dissatisfaction post-procedure, and risk harm. Referral to mental health services was advocated, however numerous obstacles to this were perceived. The issue of capacity to consent to non-surgical cosmetic procedures raised questions regarding whether standard capacity assessment is sensitive to the manner in which BDD may influence decision-making processes. In addition, concerns were voiced that decisions made by individuals with BDD in this context may be judged foolish, and thus wrongly equated with lack of capacity.

Discussion/conclusions Ethical analysis, informed by the available evidence base, suggests that it is generally not in the best interests of individuals with BDD to undergo non-surgical cosmetic intervention, and referral to mental health services is indicated. Analysis of capacity draws parallels between BDD and anorexia nervosa, as decision-making capacity in both conditions can be impaired by pathological values derived from the disorder. Means of differentiating clinical assessment of pathological values from inappropriate value judgements are advocated, in order to safeguard against the latter encroaching into capacity assessment.

  • psychiatry
  • applied and professional ethics
  • capacity
  • informed consent

Data availability statement

All data relevant to the study are included in the article.

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Data availability statement

All data relevant to the study are included in the article.

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  • Contributors NML developed the research idea; planned and designed the study; carried out data collection and analysis; conducted the ethical analysis; wrote the initial manuscript; and revised the final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.