The so-called body-modification industry in NSW is facing a crackdown after a Central Coast man was charged with genital mutilation over an allegedly botched procedure.
Health Minister Brad Hazzard, who is in discussions with the health ministry about tighter regulations, on Monday said people who underwent extreme procedures had "some major issues going on in their head".
"It's not just the issue of infection or nerve damage, you can actually die when you have items inserted into you in various parts of your body," the minister told ABC radio.
Body Dysmorphic Disorder was a recognised condition that could drive people to undergo body modification, Mr Hazzard said.
The ministry has so far recommended tighter qualification requirements, a prohibition on minors undergoing modification and compulsory record-keeping of consent.
However, Mr Hazzard believes "far more severe" controls are needed.
"My view is that people should be required to have some sort of psychological assessment before they go and have any of these major things done to their body that puts themselves at risk," he said.
According to psychiatrist Dr Nick Babidge, people with BDD experience disproportionate distress linked to a perceived flaw in their body.
The clinical director of mental health at Sydney's St Vincent's Hospital says those who undergo body modification are usually more interested in "carving out a sense of their own identity".
Dr Babidge told AAP plastic surgeons may seek a psychiatric opinion if they suspect a repeat client is returning due to BDD.
"In terms of body modification and people who aren't plastic surgeons, I don't know if they would think of that or do that," he said.
"Maybe there's some sort of sliding scale of how radical and permanent the procedure is going to be that whoever is the person doing it has a higher index of caution to assess that person's commitment and their understanding of the permanency of things."
The flagged changes come after a 37-year-old man was charged with mutilating the genitals of a 33-year-old woman who underwent a procedure at a Newcastle business in 2016.
The man's Instagram profile, which was deleted on Monday, included images of split tongues, implants under the skin and "scarification" - etching or burning permanent designs into the skin.
A linked YouTube account shows procedures including nipple and belly button removal.
The man will face Gosford Local Court on May 15.