Body image no filter

In the era of social media-driven perfectionism, dental teams should be conscious of a patient’s mental health when asked about cosmetic treatment

Natasha Devon MBE, the writer and activist on mental health and body image issues, once went undercover to investigate a Harley Street cosmetic surgeon. Under an assumed identity, her chosen procedure was liposuction of the stomach. In the waiting room, she filled out an eight-page questionnaire on the medical history of herself and her family. “Not one question was to do with mental health,” recalled Devon.

The consultant said she didn’t need liposuction, but instead a tummy tuck – which was twice the price. As she was about to leave, he asked her to look in the mirror at her “flank” – a word she had only previously heard used in the context of a cow – and said she was carrying excess fat there; if she booked in for the tummy tuck, he would lipo her flank for free. “Not only was I getting a buy-one-get-one-free offer,” she said, “but a new neurosis as well.”

Devon tours schools and colleges throughout the UK, delivering talks – an average of three a week – as well as conducting research on mental health, body image, gender and social equality. “I ask 14 to 18–year olds about their school experience, challenges to their wellbeing, changes they would like to see in their community,” she said. “But I always begin with the same question,” she told the Faculty of Dentistry, RCSI, Annual Scientific Meeting last November. “If you could have a PSHE (personal, social, health and economic) lesson on anything, what would you choose? And they are absolutely related to mental health … exam anxiety, bullying, consent … but, in the 12 years that I have been doing this, the one that comes up consistently is body image.”

More than half of 11 to 14-year-old girls avoid normal school activities because of poor body image, according to the organisation Girlguiding. Not just sport, drama, or public speaking – 11 per cent said it prevented them from raising their hand in class. The organisation’s research also found that girls as young as seven feel that society judges them more on their looks than their ability. According to the Mental Health Foundation, one in eight adults in the UK has experienced suicidal thoughts because of concerns about body image.

Almost a third of men have felt anxious because of their body image and a tenth have felt suicidal, according to a study published last November. The research, also by the Mental Health Foundation, found that 28 per cent of men said they had experienced anxiety due to body image while more than a third said it had a negative impact on their self-esteem in the past year. Almost a quarter said that they had avoided taking part in social activities that would require them to show their body, such as sports or beach holidays.

Surgery, said Devon, is a common response – but it does not address the underlying issue. Only two per cent of people with body dysmorphic disorder (BDD) who underwent surgery found their psychological health was improved and the severity of their BDD reduced (Annals of Plastic Surgery, 2010). A 13-year study of 1,500 teenage girls found that 78 per cent of those who underwent plastic surgery were more likely to be depressed and/or anxious in later life (Psychology Today, 2012). The desire for surgery can be a symptom of poor mental health, said Devon, and any subsequent procedure will not assuage the underlying psychological problem.

A study published in 2017 (2) by Thomas Curran, of the Centre for Motivation and Health Behaviour Change, at Bath University, and Andrew P. Hill, of the School of Sport at York St John University, was the first to examine generational differences in perfectionism at a cohort level. Its findings suggested that “self-oriented perfectionism, socially prescribed perfectionism, and other-oriented perfectionism” have increased over the last 27 years.

“Not only was I getting a buy-one-get-one-free offer, but a new neurosis as well”

Natasha Devon

“We speculate that this may be because, generally, American, Canadian, and British cultures have become more individualistic, materialistic, and socially antagonistic over this period,” said the authors, “with young people now facing more competitive environments, more unrealistic expectations, and more anxious and controlling parents than generations before.”

Devon said that the higher someone scores on this measure, the more vulnerable they are to a mental health issue. The era of smartphones and social media has seen people being sold two narratives, she said; never be content with what you have and consume constantly in order to prove yourself. In researching her forthcoming book, Yes You Can: Ace Your Exams Without Losing Your Mind, Devon asked teachers who they thought created stress among people over exams. They blamed parents. The parents blamed teachers. But when she spoke to young people, they blamed neither; it came from within and that “from an early age they have internalised this idea that they have to measure their value through exam results. The other way this phenomenon manifests itself is through body image; they believe their body is something that can be sculptured to their will”.

It is a public health issue, said Devon, and as practitioners dentists are in a position to help change the cultural and social environment in which young people develop. “If young people constantly chase an ideal,” she said, “they will never find the solution to any underlying psychological problem. I hope that practitioners can play a part in understanding how body image impacts mental health and provide the appropriate care for people who might be vulnerable.”

More information

  1. You can find more advice and references on Natasha’s website:
  2. Perfectionism is increasing over time, Curran, T., & Hill, A. P., Psychological Bulletin, 145(4), 410–429 (2019),


Published: 13 January, 2020 at 07:30
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