Distorted Reflections: Adolescent Vulnerability and the Future of Integrated Clinical Care for Body Dysmorphic Disorder: A Modern Expansion of Philips’ (2000) Foundational Guide for Dermatologists and Cosmetic Surgeons

Abstract

Since the publication of Katherine Phillips’ landmark 2000 guide for dermatologists and cosmetic surgeons, the clinical understanding of Body Dysmorphic Disorder (BDD) has undergone significant transformation. This thesis revisits and expands Phillips’ foundational work, offering novel insights that address the dramatic sociocultural shifts of the past two decades—most notably, the meteoric rise of social media, the growing prevalence of BDD in adolescents and young adults, and the increasing normalization of cosmetic enhancement. These contemporary forces have reshaped how BDD manifests, is perceived, and is (often inadequately) treated. By synthesizing current psychiatric, dermatologic, and psychological literature, this thesis highlights the limitations of aesthetic interventions in treating BDD and reinforces the importance of early psychiatric recognition. It introduces new data on neurobiological correlates of the disorder, demographic shifts in onset and severity, and emerging digital treatment modalities such as app-based cognitive behavioral therapy (CBT). The work uniquely contextualizes BDD within a modern ecosystem of algorithmically curated beauty ideals, digital avoidance behaviors, and growing mental health stigma, particularly among younger, gender-diverse, and neurodivergent populations. Crucially, this thesis offers a novel framework for integrating psychiatric screening tools and interdisciplinary collaboration into dermatologic and cosmetic care. It provides practical clinical recommendations, an updated ethical lens for aesthetic practitioners, and a forward-looking call to action for systemic reform. In doing so, it advances the field beyond Phillips’ original scope—bridging psychological and aesthetic medicine to more effectively recognize, prevent, and treat BDD in the 21st century.