Is Heidi Montag's Plastic Surgery Obsession Really a Mental Disorder?

"Heidi obviously has major self-image problems, which need the care of a psychiatrist, not a plastic surgeon. Any plastic surgeon she goes to next should seriously consider referring her to psychiatric care instead of picking up the scalpel," says Dr. Anthony Youn, a Michigan-based, board-certified plastic surgeon who has been featured on 'Dr. 90210.'

"She appears to be a candidate for Body Dysmorphic Disorder, a psychiatric condition where the person sees their body in a completely unrealistic way," says Dr. Youn. "What we see as massive breasts, she sees as small breasts."

Dr. Roberto Olivardia, clinical instructor of psychology at Harvard Medical School and author of 'The Adonis Complex: How to Identify, Treat and Prevent Body Obsession in Men and Boys,' echoed Dr. Youn's concern for Montag to PopEater. "It is sad and absolutely appalling," he says. "I think she carries a lot of pain and is not aware of the future consequences of these drastic choices."

Individuals suffering from BDD become obsessed with perceived imperfections or "defects" in their physical appearance, which can lead to eating disorders or other extreme means of altering the appearance of the body. It is always accompanied by an extreme, often debilitating fear of judgment by others that can lead those afflicted with the condition to also suffer from severe depression and anxiety. Experts believe that while the causes of BDD vary from person to person, it most likely develops through a combination of biological, psychological and environmental factors.

According to a study by Dr. James Feusner, psychiatrist at the University of California Los Angeles, persons with BDD exhibit abnormal brain function when looking at pictures of their own faces, leading experts to believe that they only see the face's parts individually, resulting in a distorted image. "If you just see the pieces of your face, and not how they fit into the whole, then it's going to look distorted," he told CNN. It's worth noting that Montag has also had multiple surgeries performed on her face, including rhinoplasty and a reported eye brow lift.


In his research, Dr. Feusner found that BDD patients had abnormal brain activity in their visual processing systems when looking at pictures of themselves. In addition, abnormal activation patterns were observed in the areas of the brain that guide behavior and emotions -- the frontostriatal systems -- which may explain the emotional toll BDD has on sufferers.

In fact, the brain patterns observed in BDD patients are not unlike those associated with Obsessive Compulsive Disorder (OCD), however, BDD is most likely not a form of OCD, according to Dr. Feusner. Persons with OCD generally recognize their condition and understand that their behavior is extreme, while BDD patients are mostly unaware that they suffer from any condition at all.

According to Sabine Wilhelm, director of the Body Dysmorphic Disorder Clinic and Research Unit at Massachusetts General Hospital, persons with BDD will often seek out plastic surgery to correct the flaws they believe they have; however, some 81 percent are dissatisfied with the results (via CNN).

Montag may be looking to go to Europe to get further surgery because U.S. manufacturers simply do not make produce implants large enough to meet her needs. "She reportedly has 700cc implants currently, and the U.S. implant manufacturers typically limit their implant size to 800cc," says Dr. Youn. "Therefore, if she would like to go significantly larger, let's say 1000cc or 1200cc, then she would need to have implants custom-made for her, see a surgeon outside the country where larger implants may be produced or have the surgeon place stacked implants into her breasts -- i.e. more than one implant per breast."

But further surgery is not the answer, according to Wilhelm -- a combination of cognitive behavior therapy and medication is often the most effective treatment for the condition. Of course, the only person qualified to diagnose Montag is a psychologist, and Dr. Olivardia agrees: "Obviously, I have never met her and do not know for sure if she has BDD, but she clearly has issues with her body image. I think she needs help and could benefit from therapy."

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