ADHD in aesthetics: guidance for practitioners treating patients with ADHD


As part of ADHD awareness month, Kimberley Cairns, Psychologist and psycho-aesthetic consultant, considers ways to increase your awareness of ADHD in aesthetics to make your practice safer. With better understanding, we can be better prepared to offer robust consultations for improved patient selection, informed consent, and collaboration with specialist service providers.

ADHD and body image

Attention-deficit/hyperactivity disorder (ADHD) is a neuro-developmental condition that affects the ability to focus, control impulses and regulate emotions and behaviour. Living with ADHD can be overwhelming and frustrating. People with ADHD may hyperfocus on their body and the way it looks and aspire to change their appearance, which can lead to unhealthy behaviours such as restrictive eating, binge eating, purging and excessive exercise. ADHD can have a negative impact on the body image - a person's attitudes, beliefs, and perceptions about their body as a whole. There is little to no mention of the relationship between body image and ADHD in scientific literature, however there is rich anecdotal evidence that is worth considering.

Hyperfocus on the body

Concentrating on the body as a means of distraction or hyperfocus can offer a stimulating experience to an ADHD brain. This is an unpleasant, compensatory behaviour for managing the routine daily tasks that people with ADHD can lose interest in quickly. Hyperfocus can therefore be experienced as a maladaptive strategy to cope with the mundane, unstimulating and boring environment that someone with ADHD can experience. Hyper focusing is an interesting but unpleasurable behaviour for someone with ADHD and can also promote ‘distraction’ and ‘the thrill of the chase’ i.e. to lose weight or change shape. This can promote a sense of unrealistic expectation as it is usually attached to regaining a sense of control.

People with ADHD may have difficulty sustaining motivation when rewards are mild or linked to a deferred or longer-term gratification. As a result, people with ADHD may search for stimulation that can increase dopamine more quickly and intensely. Ultimately the pursuit of pleasurable rewards may become a potent form of self medication that may be the determinant to the person's overall wellbeing.

People with ADHD can be particularly sensitive to criticism, this is known as ‘Rejection Sensitive Dysphoria (RSD)’. RSD can trigger overwhelming feelings of confusion, failure, betrayal, pain, and sadness. For someone with ADHD, it can be extremely difficult to regulate such emotions as quickly as others without ADHD. Therefore, a pursuit of unrealistic body image expectation can implicate other behaviours such as withdrawal from social interactions due to the perceived negative assumptions about the self. This can further influence an obsessive, toxic pursuit or fixation for perfection to avoid any chance of perceived subjective failure.

People with ADHD may develop skin picking disorder in response to their hyperactivity or low impulse control. People with ADHD may struggle to resist the urge to pick at their skin, especially when feeling restless or overwhelmed. Skin picking may serve as a self-soothing or self-regulating mechanism for people with ADHD, temporarily relieving their core symptoms. There is a significant link between eczema and ADHD. People with eczema have a higher risk of developing ADHD, and vice versa. The relationship between atopic dermatitis and ADHD has been well studied since the 1990s across the world. Sleep disturbance due to itching is very common among those who have been diagnosed with ADHD. Hormonal fluctuations in men and women can also be significant sensitive influencers in the perception of self, emotional regulation, and general wellbeing. People with body dysmorphic disorder (BDD) are more likely than the average person to also have ADHD.

Aesthetic intervention and ADHD

Given the way that ADHD can ‘show up’ in the mind and the body, ADHD can be a clear motivation or catalyst to seek aesthetic or non surgical cosmetic intervention. Key areas for aesthetic practitioners to support a safe psycho-aesthetic pathway include:

  • Transparent pricing for financial investment - People with ADHD are more likely to make impulsive financial decisions
  • Offer a thorough consultation to explore expectations in full - Offer the full risk profile of any treatment intervention to inform decision making and improve the informed consent process
  • Avoid consult and treat on the same day - Honour a minimum of 48 hours’ cooling off period to neutralise dopamine responses to avoid an unhappy patient
  • Avoid using time sensitive offers - Creating a sense of urgency can promote  impulsive decision making and later treatment regret and bad reviews
  • Avoid using BOGOFs - This can perpetuate the reward-benefit imbalance of dopamine which could lead to a patient complaint and a toxic pursuit of hyperfocus and perfection being damaging to mental health
  • Offer clear and concise pre and after care at the point of consultation - Someone with ADHD may typically have difficulty resisting impulses which could compromise aftercare
  • Establish continuity of care – Make sure photographs and follow ups are conditional elements of any treatment plan within any patient journey
  • Use a multi-disciplinary team - Refer for screening, or to a specialist provider to make sure any unmet needs are met
  • Provide ethical finance options - People with ADHD are more likely to have poor financial management skills
  • Use only decent, legal and honest marketing materials - People with ADHD may be more susceptible to unrealistic before and after imagery

Unmanaged or misdiagnosed ADHD has the potential to take a serious toll on someone's quality of life. The influence of ADHD will lead a person to cognitively tune out and may be an invisible motivation driving patients to seek aesthetic intervention which may affect young people and adults alike. If you or a patient is struggling with body image that may be related to ADHD or undiagnosed ADHD, you may want to seek help from a specialist.

Further resources / reading / references

JCCP and me

MH foundation

Mind over mirror

ADHD foundation

About the author

Kimberley Cairns

Kimberley Cairns

Kimberley is an award winning, dynamic, inclusive published wellness expert and member of the British Psychological Society. Her innovative integrated psychological approach to aesthetics encompasses her combined 16 years of acute mental health and aesthetic clinic management experience. Specialising in psycho-aesthetic solutions, Kimberley has numerous key appointments including that of clinical advisory and fitness to practise within the JCCP and more recently as a board member. Her contributions to aesthetics in the interest of public health protection and the promotion of patient safety are extensive.

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