It is often dismissed as a "first world" problem and a "bad case of vanity" caused by today's obsession with appearance and celebrity.
But, writes Susanna Jolly, Body Dysmorphic Disorder (BDD) affects up to one in 50 people and many with the condition "self-medicate" by undergoing frequent and repeated plastic surgery procedures
Vanity? Not fair
People with BDD delay seeking help for fear of being dismissed as vain.
Dr David Veale, one of the foremost BDD experts, specialised in this area 20 years ago following the suicide of a BDD patient under his care.
He says: "Ideally, we want to try and diagnose people with BDD early, as treating them is easier than once the thoughts and anxieties have really become entrenched.
"The most important message is that BDD is a treatable illness."
BDD treatment is typically a combination of an anti-depressant medication and cognitive behavioural therapy - but the wait for diagnosis and treatment can be lengthy.
Dr Veale, who also works with the Body Dysmorphic Disorder Foundation, acknowledges this higher risk: and reports that a third of his patients have had at least one cosmetic procedure.
Crucially, fewer than 10% of BDD patients will be satisfied with the results.
Their anxieties are often transferred to another aspect of their appearance, sometimes leading to multiple procedures.
Around 15% of people seeking plastic surgery are thought to have BDD.
Mr Simon Withey, a consultant plastic surgeon, said: "BDD is extremely complicated and surgeons will never be experts.
"However, you get a sixth sense that something is not right if you ask the right questions. For me, one of the signs is if the patient is 'over-prepared'.
"If I sense something is not right, I won't operate".
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