Aesthetics explores the prevalence of appearance anxiety within clinical environments in aesthetics
It is an unfortunate fact that preoccupations surrounding appearance are a common occurrence in the aesthetics specialty.
While it is widely recognised that aesthetic patients can become vulnerable to these complexes, a lesser discussed issue is aesthetic practitioners themselves facing challenges with their appearance.1
With a report published by BBC News on the topic in the past few weeks, Aesthetics is diving deeper into the issue to find out how the specialty feels from the inside.
A hidden problem
Psychologist Kimberley Cairns explains that ‘appearance anxiety’ is a term used to describe a sense of unease about aspects of one’s own physical appearance, as well as how others may evaluate one’s physical appearance.2 “This apprehension is often driven by cognitive and behavioural factors and can be rooted in the early onset beliefs that can be related to unhelpful appearance assumptions,” she explains. “Appearance anxieties can be linked to certain facial or body features and can also include weight, height, colour and shape.”
The aesthetic practitioner may find themselves in a place of increased exposure to potential ‘triggers’ that may drive or maintain a sense of anxiety. Some examples outlined by Cairns include:
Direct or indirect negative comments about appearance (e.g. ‘you look different’)
Perceived or actual rejection by others (such as a patient choosing another practitioner)
Daily evaluation of appearance by others (patient interaction during consultation)
Having others’ attention on you consistently and for long periods of time
Being exposed to attractive people on a regular basis
Frequently reviewing unflattering images of others or yourself
Appearance anxiety can be regarded as a subclinical indicator for body dysmorphic disorder (BDD). BDD is a mental health condition whereby people’s perception of themselves becomes distorted, impacting the way they relate to themselves and the world around them.3 Cairns explains that it is possible to experience the symptoms related to BDD, even when there is no significant clinical indication of it.4 This is because associated symptoms – including body checking, comparing, hiding or fixing perceived appearance flaws – may not be severe enough to clinically diagnose, but still have an impact on individuals’ lives.4
The National Institute for Health and Care Excellence (NICE) provides five questions which can be a good option for assessing whether patients and practitioners alike may be suffering with BDD symptoms:5
Do you worry a lot about the way you look and wish you could think about it less?
What specific concerns do you have about your appearance?
On a typical day, how many hours is your appearance on your mind? (More than one hour is considered excessive)
What effect does it have on your life?
Does it make it hard to do your work or be with friends?
Feeling a mild response to these questions may indicate a degree of appearance anxiety, even if a clinical diagnosis of BDD would not be applicable. Cairns highlights that if any affirmative response to these questions is recorded, a skilled consultation will be required to ensure the respondent is of good physical and/or mental health before receiving treatment.
Experiences within the community
Aesthetics conducted new research into aesthetic practitioners’ experiences with appearance anxiety and BDD, both within their patient cohorts and as individuals. A total of 62 respondents shared their thoughts in the survey: 27 doctors, 18 nurses, seven dentists, six surgeons and four identified as others who work within aesthetic clinics.
Only four of the respondents said they had never experienced a patient with BDD coming into their clinic (6.5%), showing just how widespread the condition is in the specialty. When asked if they had a screening and/or referral process in place for potential BDD patients, 42 responded positively (68%) and eight said they did not (13%), while 12 confirmed they had plans to implement such a process (19%). This indicates that awareness of the condition within the industry is high.
While only four respondents reported that they have suffered from BDD as a result of their work in aesthetics (6.5%), 24 said they felt the nature of their job as an aesthetic practitioner had a negative impact on how they viewed themselves (39%). Furthermore, over half of respondents felt that aesthetic practitioners in general are more susceptible to experiencing symptoms of BDD because of their job (58%), while 10 said they were unsure (16%).6
A study conducted by Dr Steve Harris and Dr Neetu Johnson in 2017 found that of 51 respondents to a survey on the topic of BDD in aesthetics, 29% reported attempting to camouflage or alter their appearance.7 When analysing the results, this particular study determined that the prevalence of BDD among practitioners was higher than aesthetic patients (16% versus 9-15%).7
Research on this topic has been limited to date, and further studies is necessary to discover more interesting trends.
Analysing industry pressure
Sharon Bennett, aesthetic nurse prescriber and clinical lead of the Aesthetics Clinical Advisory Board, comments that she feels appearance anxiety in the industry is evident, affecting both male and female practitioners. Aesthetic treatments are always on hand in aesthetic clinics, with never-ending opportunities to trial treatments, or become models for case studies or training courses. The constant exposure to the importance of appearance which practitioners are subject to may become problematic and, as Bennett explains, can lead to widespread pressure to look a certain way.
“Aesthetics is an environment surrounded by beauty ideals,” she says, adding, “We attend conferences and events where we might be on stage presenting, teaching and surrounded by glamorous colleagues. Our appearance is observed by patients who may judge our skills on our own aesthetic results. There is a perception that we are judged on our appearance – it’s very easy to be self-critical.”
She goes on to emphasise that many practitioners feel an ever-present pressure to look their best, saying, “With the never-ending opportunities to trial treatments, become models for company training days or studies and self-treat in privacy, we can see that people are often having treatments they don’t require or are poorly executed. It’s hard to feel when that line has been crossed.”
Cairns states that work, relationships or life’s other pressures do not directly cause appearance anxiety, but can worsen the symptoms. “From my experiences working with aesthetic practitioners,” she reflects, “I often see a deep sense of worry regarding appearance as a sign of status or success. People can feel a constant need to keep up appearances for their patients, peers and even family or friends. There becomes an unspoken yet implied external attribution of worth. This is something I don’t hear being discussed often, but which I feel is prevalent in the sector.”
Addressing the issue
Conversations around appearance can be hard enough to have as it is, let alone when anxieties are involved. Bennett shares, “I wish more practitioners would openly talk to others and reach out, and that we could feel comfortable in highlighting these issues. I believe we are a product of our specialty in that we look to improve the flaws which we are so good at finding in our patients. When treating those so-called flaws is so easy, we can lose sight of the normal in ourselves.”
Cairns concludes that the lack of openness surrounding appearance anxiety is largely down to stigma. She says that obsessive thoughts about one’s appearance are commonly misconstrued as vanity, which is highly stigmatised, leading people to keep quiet about their concerns. Moreover, she says, “I think in this industry, people are expected to be critical about their appearance and search for how to enhance it, meaning people don’t always have the space to explore their feelings about making changes to their bodies. This can also drive self-stigma because it can be extremely hard to break away from self-doubt or challenge shame when trapped in behavioural and cognitive cycles that may be rooted in self-criticism.”
There are multiple avenues of support practitioners can pursue to help vulnerable patients, colleagues and themselves. These include going to see your GP, seeking further information from organisations like the BDD Foundation8 or even looking further into research around the issue – Cairns recommend the University of Bristol’s Centre for Appearance Research as a great source for this.9
Ultimately, Cairns shares that self-compassion has been shown as a buffer against the negative effects of appearance anxiety, and that being open about your concerns can be the first step.10 Personal and professional networks can be a great avenue for this support, perhaps within your clinic, group of peers or associations like BCAM or BACN.
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