Personal Rant: You Can’t “Spot” BDD. Stop Pretending You Can.

What’s happening right now in the aesthetics industry around Body Dysmorphic Disorder (BDD) awareness isn’t progress. It’s performance.

People are chasing titles, panels and hashtags about “psychological safety” without understanding the first thing about it. Performative “safeguarding” and spreading misinformation does more harm than doing nothing.

I keep seeing “BDD awareness” talks and posts led by people with no background in mental health, no lived experience, and no understanding of what body dysmorphic disorder actually is. These “Key Opinion Leaders" (KOLs) spread misinformation that creates an illusion of safety. They talk about “screening” and “assessments” as if they’re safeguarding tools. They’re not.

The BDDQ and other tools based on the DSM-5 criteria were designed for psychologists and psychiatrists — people who spend years learning how to identify and support people with complex psychiatric conditions like BDD. These tools are not for nurses or aesthetic doctors to use as a shortcut to decide whether someone’s psychologically ready to get filler.

Let’s call it for what it is: the practitioners who insist on “screening” and “assessing” are desperate for control. It’s not about patient safety. It’s about power — about practitioners wanting to decide what a patient should or shouldn’t do, instead of listening to what that patient is actually trying to say.

If you rely on screening and assessments, you’re not working with patients — you’re working against them. The moment you hand someone a form to “check” whether they’re fit for treatment, you’ve already created a divide. You’ve put yourself on the opposing side. You’ve made yourself the gatekeeper — the big, all-knowing practitioner who decides what’s right for someone you’ve just met, while the patient is reduced to ticking boxes. That’s not safeguarding. That’s control. And it kills any chance of trust or honesty in the conversation that actually matters.

Self-report tools do not work in aesthetic settings because, unlike clinical ones, cosmetic patients actively work to “pass” BDD assessments. These tick-box solutions don’t make anyone safer. They just make practitioners feel like they’ve done the bare minimum.

I’ve spent the past year speaking to real patients who’ve lived through BDD — people like me who went through the darkest time in their lives because of an under-diagnosed, often misunderstood mental-health condition. Patients who know how it feels to sit across from a practitioner who thinks they can “spot” emotional distress or BDD.

I’ve been fighting to bring the patient voice into this, and it’s exhausting to watch people with every KOL title under the sun undo that progress just to stay relevant.

Let’s be clear: being in aesthetic practice for decades doesn’t make you qualified to speak about a psychiatric disorder. Experience in aesthetics doesn’t equal expertise in mental health — just like me spending years around practitioners doesn’t make me qualified to give lectures about injecting techniques. That’s exactly what this is: people mistaking proximity for knowledge, and confidence for competence.

BDD is a complex psychiatric condition. With the exception of rare, extreme cases, you cannot spot it in aesthetic patients during consultation. You cannot assess it out of someone. You don’t see it until it’s too late — until someone’s already been harmed.

What would you think about someone claiming they can always spot depression? Or PTSD? Or any other mental-health condition that rarely manifests physically? The arrogance is mind-blowing. 

And here’s the irony: the same healthcare professionals who complain (rightly) about non-medics claiming “injectable expertise” after a weekend course… then take a one-hour webinar on “spotting BDD” and suddenly think they’re qualified to navigate psychiatric risk.

You can’t have it both ways. You can’t shout about protecting patient safety on one hand, and then step straight into another discipline you don’t understand.

So many people are chasing image, titles, and status rather than genuine patient safety. The few I know who actually care don’t shout about it. They do it quietly, in practice. Real safeguarding doesn’t come from being an ambassador or a KOL. It comes from humility. From listening. From knowing when you’re completely out of your depth and referring patients to someone who actually knows what they’re doing.

Until that changes, patients will keep being failed — and no amount of tick-box forms will fix it.