Abstract
Borderline personality disorder (BPD) is a common axis II disorder associated with a high risk of impulsivity and self-injury. Several authors have suggested that individuals with BPD are poor candidates for plastic surgery. Recent changes in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria for BPD may be confusing to surgeons. This article reviews the literature on BPD and discusses how important it is to recognize this condition and how difficult it is to treat patients, highlighting features and signs of this condition in plastic surgery settings. Illustrative case examples from our experience are also described. Our careful search of the literature revealed that individuals with BPD may seek treatment from plastic surgeons in two different patterns: as treatment for self-injury or as insatiable requests for aesthetic procedures. Individuals with BPD tend to request corrections of multiple body parts to avoid abandonment by the surgeon or due to their impulsivity, but such preoccupation with appearance is less profound and shifts from one body part to another over time. While flexible and individualized psychological approaches are required to minimize the patient’s impulsivity and abandonment fears, surgeons should be inflexible to any unrealistic requests. It is best to avoid surgery on patients with BPD. Surgeons should be aware of the nuances of this condition so as not to miss the proper timing for a psychiatric referral.
Level of Evidence V
This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
Similar content being viewed by others
References
Honigman RJ, Phillips KA, Castle DJ (2004) A review of psychosocial outcomes for patients seeking cosmetic surgery. Plast Reconstr Surg 113:1229–1237
Groenman NH, Sauer HC (1983) Personality characteristics of the cosmetic surgical insatiable patient. Psychother Psychosom 40:241–245
Sarwer DB, Wadden TA, Pertschuk MJ, Whitaker LA (1998) The psychology of cosmetic surgery: a review and conceptualization. Clin Psychol Rev 18:1–22
Ishigooka J, Iwao M, Suzuki M, Fukuyama Y, Murasaki M, Miura S (1998) Demographic features of patients seeking cosmetic surgery. Psychiatry Clin Neurosci 52:283–287
Hayashi K, Miyachi H, Nakakita N, Akimito M, Aoyagi K, Miyaoka H, Uchinuma E (2007) Importance of a psychiatric approach in cosmetic surgery. Aesthet Surg J 27:396–401
Sykes JM (2009) Managing the psychological aspects of plastic surgery patients. Curr Opin Otolaryngol Head Neck Surg 17:321–325
Edgerton MT, Jacobson WE, Meyer E (1961) Surgical-psychiatric study of patients seeking plastic (cosmetic) surgery: ninety-eight consecutive patients with minimal deformity. Br J Plast Surg 13:136–145
Connolly FH, Gipson M (1978) Dysmorphobia: a long-term study. Br J Psychiatry 132:568–570
Napoleon A (1993) The presentation of personalities in plastic surgery. Ann Plast Surg 31:193–208
Edgerton MT, Langman MW, Pruzinsky T (1991) Plastic surgery and psychotherapy in the treatment of 100 psychologically disturbed patients. Plast Reconstr Surg 88:594–608
Shridharani SM, Magarakis M, Manson PN, Rodriguez ED (2010) Psychology of plastic and reconstructive surgery: a systematic clinical review. Plast Reconstr Surg 126:2243–2251
Gorney M (2010) Recognition and management of the patient unsuitable for aesthetic surgery. Plast Reconstr Surg 126:2268–2271
Picavet V, Gabriels L, Jorissen M, Hellings PW (2011) Screening tools for body dysmorphic disorder in a cosmetic surgery setting. Laryngoscope 121:2535–2541
Hodgekinson DJ (2005) Identifying the body-dysmorphic patient in aesthetic surgery. Aesthetic Plast Surg 29:503–509
Jakubietz M, Jakubietz RJ, Kloss DF, Gruenert JJ (2007) Body dysmorphic disorder: diagnosis and approach. Plast Reconstr Surg 119:1924–1930
Pavan C, Simonato P, Marini M, Pavan L, Vindigni V (2008) Psychopathologic aspects of body dysmorphic disorder: a literature review. Aesthetic Plast Surg 32:473–484
Knorr NJ, Edgerton MT, Hoopes JE (1967) The “insatiable” cosmetic surgery patient. Plast Reconstr Surg 40:285–289
Nurnberg HG, Raskin M, Levine PE, Pollack S, Siegel O, Prince R (1991) The comorbidity of borderline personality disorder and other DSM-III axis II personality disorders. Am J Psychiatry 148:1371–1377
Trull TJ, Distel MA, Carpenter RW (2011) DSM-5 borderline personality disorder: at the border between a dimensional and a categorical view. Curr Psychiatry Rep 13:43–49
American Psychiatric Association (2013) Diagnostic and statistical manual of mental disorders, 5th edn. American Psychiatric Association, Washington, DC
Wright MR (1980) Management of patient dissatisfaction with results of cosmetic procedures. Arch Otolaryngol 106:466–471
Ambro BT, Wright RJ (2008) Psychological considerations in revision rhinoplasty. Facial Plast Surg 24:288–292
Davis RE, Bublik M (2012) Psychological considerations in the revision rhinoplasty patient. Facial Plast Surg 28:374–379
Gunderson JG (2010) Revising the borderline diagnosis for DSM-V: an alternative proposal. J Pers Disord 24:694–708
Constantian MB (2013) The new criteria for body dysmorphic disorder: who makes the diagnosis? Plast Reconstr Surg 132:1759–1762
Kirnberg O (1967) Borderline personality organization. J Am Psychoanal Assoc 15:641–685
Gunderson JG, Singer MT (1975) Defining borderline patients: an overview. Am J Psychiatry 132:1–10
American Psychiatric Association (1980) Diagnostic and Statistical Manual of Mental Disorders, 3rd edn. American Psychiatric Association, Washington, DC
Gunderson JG (2011) Borderline personality disorder. N Engl J Med 364:2037–2042
Leichsenring F, Leibing E, Kruse J, New AS, Leweke F (2011) Borderline personality disorder. Lancet 377:74–84
Lieb K, Zanarini MC, Schmahl C, Linehan MM, Bohus M (2004) Borderline personality disorder. Lancet 364:453–461
Raspa RF, Cusack J (1990) Psychiatric implications of tattoos. Am Fam Physician 41:1481–1486
Favazza AR (1998) The coming of age of self-mutilation. J Nerv Ment Dis 186:259–268
Gunderson JG, Links PS (2008) Borderline personality disorder: A clinical guide, 2nd edn. American Psychiatric Press, Washington, DC
Coifman KG, Berenson KR, Rafaeli E, Downy G (2012) From negative to positive and back again: polarized affective and relational experience in borderline personality disorder. J Abnorm Psychol 121:668–679
Ruggero CJ, Zimmerman M, Chelminiski I, Young D (2010) Borderline personality disorder and the misdiagnosis of bipolar disorder. J Psychiatric Res 44:405–408
Lenzenweger MF, Lane MC, Loranger AW, Kessler RC (2007) DSM-IV personality disorders in the National Comorbidity Survey Replication. Biol Psychiatry 62:553–564
Zanarini MC, Frankenburg FR, Reich DB, Fitzmaurice G (2010) The 10-year course of psychosocial functioning among patients with borderline personality disorder and axis II comparison subjects. Acta Psychiatr Scand 122:103–109
Grant BF, Chou SP, Goldstein RB, Huang B, Stinson FS, Saha TD, Smith SM, Dawson DA, Pulay AJ, Pickering RP, Ruan WJ (2008) Prevalence, correlates, disability, and comorbidity of DSM-IV borderline personality disorder: results from the Wave 2 National Epidemiologic Survey on Alcohol and Related Conditions. J Clin Psychiatry 69:533–545
Phillips KA, Coles ME, Menard W, Yen S, Fay C, Weisberg RB (2005) Suicidal ideation and suicidal attempts in body dysmorphic disorder. J Clin Psychiatry 66:717–725
Bjornsson AS, Didie ER, Grant JE, Menard W, Stalker E, Phillips KA (2013) Age at onset and clinical correlates in body dysmorphic disorder. Compr Psychiatry 54:893–903
Zimmerman M, Morgan TA (2013) The relationship between borderline personality disorder and bipolar disorder. Dialog Clin Neurosci 15:155–169
Castor B, Ursing J, Aberg M, Palsson N (1990) Infected wounds and repeated septicemia in a case of factitious illness. Scand J Infect Dis 22:227–232
Marcoux GS, Valnicek SM (2000) Another idea for the treatment of patients with borderline personality disorder. Can J Psychiatry 45:395–396
Henderson A, Wijewardena A, Treimer J, Vandervord J (2013) Self-inflicted burns: a case series. Burns 39:335–340
Morioka D, Ohkubo F, Amikura Y (2014) Self-mutilation in a patient with borderline personality disorder. Aesthetic Plast Surg 38(4):812–814
Nock MK, Joiner TE Jr, Gordon KH, Lloyd-Richardson E, Prinstein MJ (2006) Non-suicidal self-injury among adolescents: diagnostic correlates and relation to suicide attempts. Psychiatry Res 144:65–72
In-Albon T, Ruf C, Schmid M (2013) Proposed diagnostic criteria for the DSM-5 of nonsuicidal self-injury in female adolescents: diagnostic and clinical correlates. Psychiatry J 2013:159208
Todd J, Ud-Din S, Bayat A (2012) Extensive self-harm scarring: successful treatment with simultaneous use of a single layer skin substitute and split-thickness skin graft. Eplasty 12:e23
Nabeta Y (2011) Shintai Shukei Shogai [body dysmorphic disorder]. Kodansha, Tokyo [in Japanese]
Stevens L, McGrath MH (2006) Psychological aspects of plastic surgery. In: Mathes SJ (ed) Plastic surgery, 2nd edn. Saunders, Philadelphia, pp 72–73
Chatham DR (2012) Avoiding and correcting complications in facial plastic surgery: patient selection. Facial Plast Surg 28:253–259
Zimmerman M, Dalrymple K, Young D, Chelminski I, Martinez J (2012) An empirical examination of Gunderson’s proposed revision of the diagnostic algorithm for borderline personality disorder. J Pers Disord 26:880–889
Ericksen WL, Billick SB (2012) Psychiatric issues in cosmetic plastic surgery. Psychiatr Q 83:343–352
Conflict of interest
The authors have no financial interests to disclose.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Morioka, D., Ohkubo, F. Borderline Personality Disorder and Aesthetic Plastic Surgery. Aesth Plast Surg 38, 1169–1176 (2014). https://doi.org/10.1007/s00266-014-0396-1
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00266-014-0396-1