1. Purpose

To ensure all cosmetic and laser patients are psychologically ...s follows the Ahpra 2025 Guidelines for Cosmetic Procedures.¹

2. Step-by-Step Procedure

Step 1: Introduce Screening

Explain: “We ask all patients some wellbeing questions. This...re treatments are safe, appropriate, and in your best interest.”

Why: Normalises the process, reduces stigma, and ensures consent is valid.¹

Step 2: Quick Screen

BDD Concern Screen (5 yes/no): worry about appearance, daily impact, time spent, mirror checking/avoidance, prior unsatisfactory procedures. If ≥2 ‘Yes’ → STOP, do not proceed, refer.^{2 3}

PHQ-2 Depression screen: ask about mood and pleasure over 2 weeks. If total ≥3 → complete PHQ-9.⁴

Step 3: Extended Screening (if flagged)

• PHQ-9: depression severity (mild 5–9; moderate 10–14; moderately severe 15–19; severe ≥20).^{4 5}
• GAD-7: anxiety (mild 5; moderate 10; severe 15).⁶
• K10: distress (low 10–15; moderate 16–21; high 22–29; very high 30–50).⁶
• Administer verbally or written; score with cut-offs.

Step 4: Suicide Risk Check

If PHQ-9 item 9 positive (thoughts of self-harm): ask directly about ideation, plan, intent.

If intent/plan present → activate suicide risk pathway: do not...t, call 000 if imminent, contact GP/mental health triage.^{7 8}

Step 5: Expectations & Consent Check

Ask: “What specific change are you hoping for?” “If the res...fied?” “How do you expect this treatment will affect your life?”

Why: Detects unrealistic or psychologically dependent goals.^{2 4}

3. Red Flags (Do Not Proceed)

1. Preoccupation with minimal flaw — hallmark of BDD; treatments won’t help.^{2 3}
2. Multiple unsatisfactory procedures — suggests unrealistic expectations or BDD.²
3. Unrealistic expectations — “This will fix my life/relationships”.^{2 4}
4. Severe distress — PHQ-9 ≥20, GAD-7 ≥15, K10 ≥30.^{6 7 8}
5. Suicidal ideation — emergency.^{9 10}
6. Coercion/impaired consent — pressured, intoxicated, psychosis.¹

4. Management Pathways

• Negative screen & realistic goals: Proceed with cooling-off and informed consent.¹
• Mild issues: Defer, refer GP/psychology, re-assess later.^{5 6}
• Moderate-severe/BDD/distress: Do not proceed; provide referral.^{2 4 6}
• Suicide risk: Activate emergency pathway.^{9 10}

5. Documentation & Privacy

• Record responses, scores, decisions, referrals.¹
• Store securely under Privacy Act & APPs.¹¹
• Provide written referral if indicated.

Sources

1. Ahpra & National Boards 2025, Guidelines for practitioners performing non-surgical cosmetic procedures, Australian Health Practitioner Regulation Agency, viewed 5 Oct 2025, https://www.ahpra.gov.au/Resources/Cosmetic-surgery-hub/Cosmetic-procedure-guidelines.aspx ↩︎
2. Royal Australian College of General Practitioners (RACGP) 2023, Management of body dysmorphic disorder in general practice, viewed 5 Oct 2025, https://www1.racgp.org.au/ajgp/2023/november/management-of-body-dysmorphic-disorder ↩︎
3. Veale, D & Bewley, A 2015, Body dysmorphic disorder, BMJ, 350:h2278, viewed 5 Oct 2025, https://www.bmj.com/content/350/bmj.h2278 ↩︎
4. National Institute for Health and Care Excellence (NICE) 2005 (updated), Obsessive-compulsive disorder and body dysmorphic disorder: treatment (CG31), viewed 5 Oct 2025, https://www.nice.org.uk/guidance/cg31 ↩︎
5. Department of Health Victoria (HealthVic) n.d., Patient Health Questionnaire (PHQ-9), viewed 5 Oct 2025, https://www.health.vic.gov.au/practice-and-service-quality/patient-health-questionnaire-phq-9 ↩︎
6. Royal Australian College of General Practitioners (RACGP) n.d., Depression in adults — diagnosis and management, viewed 5 Oct 2025, https://www1.racgp.org.au/clinical-resources/clinical-guidelines/key-racgp-guidelines/view-all-racgp-guidelines/depression ↩︎
7. Royal Australian College of General Practitioners (RACGP) n.d., Generalised anxiety disorder (includes GAD-7), viewed 5 Oct 2025, https://www1.racgp.org.au/clinical-resources/clinical-guidelines/handi/indications/generalised-anxiety-disorder ↩︎
8. Australian Bureau of Statistics (ABS) n.d., K10 psychological distress scale, viewed 5 Oct 2025, https://www.abs.gov.au/statistics/health/mental-health/psychological-distress/latest-release ↩︎
9. NSW Health 2020, Suicide Risk Assessment and Management Framework for NSW Health Staff, NSW Ministry of Health, viewed 5 Oct 2025, https://www.health.nsw.gov.au/mentalhealth/resources/Pages/suicide-risk-framework.aspx ↩︎
10. Royal Australian College of General Practitioners (RACGP) n.d., Suicide prevention — risk assessment and management, viewed 5 Oct 2025, https://www.racgp.org.au/clinical-resources/clinical-guidelines/key-racgp-guidelines/view-all-racgp-guidelines/suicide-prevention ↩︎
11. Office of the Australian Information Commissioner (OAIC) 2023, Australian Privacy Principles (APPs), viewed 5 Oct 2025, https://www.oaic.gov.au/privacy/the-privacy-act/australian-privacy-principles ↩︎