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Losorelli S, Kimura KS, Wei EX, Abdelhamid AS, El Abany A, Green A, Karki S, Stephanian BA, Kandathil CK, Most SP. Rhinoplasty Outcomes in Patients With Symptoms of Body Dysmorphia. Aesthet Surg J 2024; 44:797-804. [PMID: 38452148 DOI: 10.1093/asj/sjae045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 02/05/2024] [Accepted: 02/21/2024] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND Patients with symptoms of body dysmorphia often seek consultation for aesthetic rhinoplasty. While body dysmorphic disorder is a formal psychiatric diagnosis, recent evidence indicates that patients with symptoms of this condition who seek rhinoplasty may experience increased satisfaction with their appearance following surgery. OBJECTIVES To determine the psychological impact of rhinoplasty in patients screened preoperatively and postoperatively with a body dysmorphia screening questionnaire. METHODS Retrospective chart review was performed of patients who underwent aesthetic and/or functional rhinoplasty by a single surgeon from June 2021 to April 2023. Adult patients with a complete preoperative and postoperative Body Dysmorphic Disorder-Aesthetic Surgery questionnaire (BDDQ-AS), Standardized Cosmesis and Health Nasal Outcomes Survey-Obstruction and Cosmesis (SCHNOS), and visual analog scale (VAS) were included. Patient characteristics and outcomes were analyzed, stratifying by BDDQ-AS screen. RESULTS One-hundred fifteen patients (88% female) met criteria for inclusion. There was an 83% resolution rate of BDDQ-AS positive screening following rhinoplasty. Positive BDDQ-AS screening status preoperatively and postoperatively correlated with worse aesthetic satisfaction (all P < .002). No patient-reported outcome measures were indicative of which patients with a BDDQ-AS positive screen preoperatively would experience "resolution" postoperatively. CONCLUSIONS Body dysmorphia screening resolution following surgical intervention correlated with improved patient aesthetic satisfaction, pointing to a potential positive psychological impact of undergoing rhinoplasty. LEVEL OF EVIDENCE: 3
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Kaleeny JD, Janis JE. Body Dysmorphic Disorder in Aesthetic and Reconstructive Plastic Surgery-A Systematic Review and Meta-Analysis. Healthcare (Basel) 2024; 12:1333. [PMID: 38998867 PMCID: PMC11241264 DOI: 10.3390/healthcare12131333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2024] [Revised: 06/18/2024] [Accepted: 07/02/2024] [Indexed: 07/14/2024] Open
Abstract
(1) Background: Body dysmorphic disorder (BDD) presents significant challenges in aesthetic and reconstructive plastic surgery, impacting patient outcomes and well-being. Understanding its prevalence and associated factors is crucial for effective patient care. (2) Methods: A systematic review of national and international databases on body dysmorphic disorder, plastic surgery, cosmetic surgery, reconstructive surgery, and prevalence yielded 999 studies between 1878 and April 2024. Inclusion criteria focused on studies reporting prevalence while excluding those with small sample sizes (<20 participants), unclear diagnostic criteria for BDD, and non-English accessibility. (3) Results: A meta-analysis using a random effects model was conducted on 65 studies involving 17,107 patients to estimate the prevalence of BDD. The overall estimated prevalence of BDD was 18.6%; 10,776 (62.9%) were females, with a mean age of 35.5 ± 11.7 years. Subgroup meta-analysis found significant variability in effect sizes across countries and types of specialty, of which Brazil showed the highest proportion and dermatology exhibited the smallest. Meta-regression analysis found no significant relationship between the year of publication and prevalence rates. (4) Conclusions: Our findings update the current literature on BDD prevalence in aesthetic and reconstructive plastic surgery. We emphasize the importance of proactive screening and multidisciplinary care approaches to address the complex challenges posed by patients with BDD. Further research is needed to explore evolving trends in BDD prevalence and factors influencing its expression across different cultural contexts.
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Affiliation(s)
| | - Jeffrey E. Janis
- Department of Plastic and Reconstructive Surgery, The Ohio State University Wexner Medical Center, 915 Olentangy River Road Suite 2100, Columbus, OH 43212, USA;
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Berjaoui A, Chahine B. Body dysmorphic disorder among Lebanese females: A cross-sectional study. J Cosmet Dermatol 2024; 23:591-599. [PMID: 37743744 DOI: 10.1111/jocd.16003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 08/09/2023] [Accepted: 09/11/2023] [Indexed: 09/26/2023]
Abstract
BACKGROUND Body dysmorphic disorder (BDD) is a mental health disorder characterized by an excessive preoccupation with perceived flaws or defects in one's appearance. This study aimed to assess the prevalence of BDD, identify the predictors of BDD, explore the associations of BDD with social anxiety and social phobia, and examine the effect of social media on BDD. METHODS In this cross-sectional study that was conducted between January and March 2023, Lebanese adult females completed an online survey that included questions about sociodemographic characteristics, cosmetic interventions, BDD, social media use, and Social Interaction Anxiety Scale (SISA-6)/Social Phobia Scale (SPS-6). The collected information was analyzed using descriptive statistics and regression analysis. Statistical significance was set at p value <0.05. RESULTS A sample of 1048 were eligible for analysis and the mean age was 29.94 ± 10.01 years. It was shown that 141 (13.5%) participants were BDD positive. The results of the multivariable logistic regression showed that only females living in urban areas (aOR = 2.351 [95% CI 1.502-3.680], p < 0.001), unmarried (aOR = 1.672 [95% CI 1.041-2.684], p = 0.033), reporting higher social media use score (aOR = 1.526 (95% CI 1.401-1.661), p < 0.001), and higher SIAS/SPS score (aOR = 1.040 (95% CI 1.022-1.060), p < 0.001) were significantly positively associated with BDD. CONCLUSION This study found a high BDD prevalence (13.5%) among Lebanese adult females compared with other regions and was associated with anxiety and increased social media platforms use. This highlights the need for a comprehensive approach in the assessment of BDD, along with preventive measures to address the negative impacts of social media on well-being and promote healthy body image.
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Affiliation(s)
- Aya Berjaoui
- Lebanese International University, School of Pharmacy, Beirut, Lebanon
| | - Bahia Chahine
- Lebanese International University, School of Pharmacy, Beirut, Lebanon
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Sobouti F, Elyasi F, Navaei RA, Rayatnia F, Kalantari NR, Dadgar S, Rakhshan V. Associations between body dysmorphic disorder (BDD) with the dental health component of the index of orthodontic treatment need (IOTN-DHC) and other BDD risk factors in orthodontic patients: A preliminary study. Korean J Orthod 2023; 53:3-15. [PMID: 36597665 PMCID: PMC9877362 DOI: 10.4041/kjod22.155] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 08/26/2022] [Accepted: 08/29/2022] [Indexed: 01/05/2023] Open
Abstract
Objective Body dysmorphic disorder (BDD) is a form of obsessive-compulsive disorder that may be negatively associated with the self-image. It might be associated with orthodontic treatment demand and outcome, and therefore is important. Thus, this study was conducted. Methods The Yale-Brown Obsessive-Compulsive Scale modified for Body Dysmorphic Disorder (BDD-YBOCS) questionnaire was used in 699 orthodontic patients above 12 years of age (222 males, 477 females), at seven clinics in two cities (2020-2021). BDD diagnosis and severity were calculated based on the first 3 items and all 12 items of the questionnaire. The dental health component of the index of orthodontic treatment need (IOTN-DHC) was assessed by orthodontists. Multivariable and bivariable statistical analyses were performed on ordinal and dichotomized BDD diagnoses to assess potentially associated factors (IOTN-DHC, age, sex, marital status, education level, and previous orthodontic consultation) (α = 0.05). Results IOTN-DHC scores 1-5 were seen in 13.0%, 39.9%, 29.8%, 12.4%, and 4.9% of patients. Age/sex/marital status/education were not associated with IOTN-DHC (p > 0.05). Based on 3-item questionnaire, 17.02% of patients had BDD (14.02% mild). Based on 12-item questionnaire, 2.86% had BDD. BDD was more prevalent or severer in females, married patients, patients with a previous history of orthodontic consultation, and patients with milder IOTN-DHCs (p < 0.05). Conclusions IOTN-DHC was negatively/slightly associated with BDD in orthodontic patients. Being female and married may increase BDD risk.
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Affiliation(s)
- Farhad Sobouti
- Dental Research Center, Mazandaran University of Medical Sciences, Sari, Iran,Orthodontic Department, Faculty of Dentistry, Mazandaran University of Medical Sciences, Sari, Iran
| | - Foruzan Elyasi
- Sexual and Reproductive Health Research Center, Addiction Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Reza Alizadeh Navaei
- Gastrointestinal Cancer Research Center, Non-communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Farbod Rayatnia
- Student Research Committee, Faculty of Dentistry, Mazandaran University of Medical Sciences, Sari, Iran
| | | | - Sepideh Dadgar
- Dental Research Center, Mazandaran University of Medical Sciences, Sari, Iran,Orthodontic Department, Faculty of Dentistry, Mazandaran University of Medical Sciences, Sari, Iran,Corresponding author: Sepideh Dadgar. Associate Professor, Orthodontic Department, Faculty of Dentistry, Mazandaran University of Medical Sciences, Khazar Blvd, Khazar Square, Sari 4815838594, Iran., Tel +981133244894 e-mail
| | - Vahid Rakhshan
- Department of Dental Anatomy, Dental School, Azad University of Medical Sciences, Tehran, Iran
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Prevalence of Body Somatic Deformities in Plastic Surgery Patients: A Systematic Review with Meta-analysis. Aesthetic Plast Surg 2023; 47:1217-1224. [PMID: 36596920 DOI: 10.1007/s00266-022-03237-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Accepted: 12/14/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND Plastic surgery is a surgical specialty that focuses on restoring, reconstructing, or changing the human body. Somatic deformities (SD) are defined by a distorted impression of one's own body image and are rather frequent. The majority of people with SD have some level of social and vocational impairment, with obsessive concerns about appearance leading to compulsive behaviors and, in more severe situations, suicidal thoughts. OBJECTIVE The current study aims to confirm the prevalence of SD in plastic surgery patients using a systematic review of the literature and a meta-analysis. METHODOLOGY We have searched for electronic databases with MeSH terms, and the studies for analysis were selected based on inclusion and exclusion criteria and quality assessment. The study was conducted as per the PRISMA guidelines. The pooled prevalence was calculated using fixed and random effect model. The publication bias was assessed qualitatively (funnel plot) as well as quantitatively (Begg, Egger and Harbord tests). All analysis was done using Stats Direct (version 3). RESULTS The pooled prevalence of somatic deformities in plastic surgery with 95% confidence interval using random effect model was found to be 0.19 [0.12, 0.27] which indicates a significant association of somatic deformities in plastic surgery. The heterogeneity among studies was found to be high as indicated by Cochran Q (P < 0.0001) and I2 tests (98.6%). The qualitative and quantitative analysis has also shown significant involvement of publication bias. CONCLUSION Based on available evidence, there is a significant association of somatic deformities in plastic surgery. LEVEL OF EVIDENCE III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Joint Report on Terminology for Cosmetic Gynecology. Female Pelvic Med Reconstr Surg 2022; 28:351-366. [PMID: 35608063 DOI: 10.1097/spv.0000000000001182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The current terminology used to describe cosmetic gynecologic procedures includes many nondescriptive, trademarked, or informal names, which contributes to substantial ambiguity about their aims and specific techniques. The development of clear, uniform descriptive terminology for cosmetic gynecology is needed for patients, researchers, and practitioners across multiple specialties. METHODS This document was developed from a collaboration of selected members from the International Urogynecological Association (IUGA) and the American Urogynecologic Society (AUGS). Wide-ranging literature reviews were performed to identify the breadth of currently used terms and tools for measuring efficacy and safety. After extensive internal review the adoption of each definition was ratified by group consensus. RESULTS A terminology report for elective cosmetic gynecology procedures, anatomical classification, outcome metrics, and reporting of complications has been developed. This document seeks to provide clear descriptive guidance for patients, researchers, and practitioners across multiple specialties. This document will be subject to internal review by IUGA and AUGS to incorporate and adopt evidence-based changes in the field. CONCLUSIONS A consensus-based document establishing clear terminology for cosmetic gynecology procedures has been created. Use of these terms should be encouraged to provide clarity to patients seeking these procedures and to facilitate future research to establish the safety and efficacy of these procedures.
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Joint Report on Terminology for Cosmetic Gynecology. Int Urogynecol J 2022; 33:1367-1386. [PMID: 35604421 DOI: 10.1007/s00192-021-05010-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 10/13/2021] [Indexed: 10/18/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The current terminology used to describe cosmetic gynecologic procedures includes many nondescriptive, trademarked, or informal names, which contributes to substantial ambiguity about their aims and specific techniques. The development of clear, uniform descriptive terminology for cosmetic gynecology is needed for patients, researchers, and practitioners across multiple specialties. METHODS This document was developed from a collaboration of selected members from the International Urogynecological Association (IUGA) and the American Urogynecologic Society (AUGS). Wide-ranging literature reviews were performed to identify the breadth of currently used terms and tools for measuring efficacy and safety. After extensive internal review the adoption of each definition was ratified by group consensus. RESULTS A terminology report for elective cosmetic gynecology procedures, anatomical classification, outcome metrics, and reporting of complications has been developed. This document seeks to provide clear descriptive guidance for patients, researchers, and practitioners across multiple specialties. This document will be subject to internal review by IUGA and AUGS to incorporate and adopt evidence-based changes in the field. CONCLUSIONS A consensus-based document establishing clear terminology for cosmetic gynecology procedures has been created. Use of these terms should be encouraged to provide clarity to patients seeking these procedures and to facilitate future research to establish the safety and efficacy of these procedures.
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Salari N, Kazeminia M, Heydari M, Darvishi N, Ghasemi H, Shohaimi S, Mohammadi M. Body dysmorphic disorder in individuals requesting cosmetic surgery: A systematic review and meta-analysis. J Plast Reconstr Aesthet Surg 2022; 75:2325-2336. [PMID: 35715310 DOI: 10.1016/j.bjps.2022.04.098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 04/14/2022] [Accepted: 04/26/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Body dysmorphic disorder (BDD) is known as a mental disorder in which a person suffers from concern and distress with the perceived defects in their appearance and subsequently can experience significant impairment in social, occupational, and interpersonal functioning. Various studies have reported different BDD prevalence rates in patients with cosmetic surgery. However, there has been no comprehensive study that has examined the results of these studies. Therefore, this study aims to determine BDD prevalence in individuals requesting cosmetic surgery in a systematic review and meta-analysis. METHODS In this review study, a search was conducted in national and international databases of Cochrane, Embase, ScienceDirect, Scopus, PubMed, and Web of Science (WoS) between 1878 and January 2020. A random-effects model was used to analyze the data, and heterogeneity of studies was examined with the I2 index. Data analysis was done using comprehensive meta-analysis (Version 2). RESULTS BDD prevalence in individuals requesting cosmetic surgery in 48 articles with a sample size of 14,913 was 19.2% (95% CI: 15.8-23%). Regarding heterogeneity based on meta-regression, a significant difference between the sample size (p<0.001) and BDD prevalence in patients with cosmetic surgery was observed. CONCLUSION The results of this study showed that BDD prevalence in individuals requesting cosmetic surgery is high. Therefore, with the provision of feedback at hospitals, appropriate interventions, such as pre-screening for body image disturbance, should be mandated.
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Affiliation(s)
- Nader Salari
- Department of Biostatistics, School of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mohsen Kazeminia
- Student Research Committee of Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mohammadbagher Heydari
- Department of General Surgery, Faculty of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Niloofar Darvishi
- Student Research Committee of Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Hooman Ghasemi
- Student Research Committee of Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Shamarina Shohaimi
- Department of Biology, Faculty of Science, University Putra Malaysia, Serdang, Selangor, Malaysia
| | - Masoud Mohammadi
- Cellular and Molecular Research Center, Gerash University of Medical Sciences, Gerash, Iran.
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Kallianta A, Bacopoulou F, Vlachakis D, Kokka I, Chrousos GP, Darviri C. Validation of the Cosmetic Procedure Screening (COPS) Questionnaire in the Greek language. ACTA ACUST UNITED AC 2021; 26. [PMID: 34621635 DOI: 10.14806/ej.26.1.971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Practitioners in cosmetic and aesthetic treatment practices are likely to unknowingly work with patients with Body Dysmorphic Disorder (BDD). Screening questionnaires to identify the disorder in Greece are lacking. The purpose of this study was to validate a Greek version of the Cosmetic Procedure Screening (COPS) questionnaire, a self-report measure of how the respondents feel about their appearance, before an aesthetic intervention. The COPS was translated into Greek and was completed by 216 adult females from several areas of Attica (four private beauty centers, three dermatology clinics, five plastic surgery clinics, and Thriasio General Hospital of Elefsina) who pursued a cosmetic procedure. Participants also completed the Perceived Stress Scale (PSS-14). The Greek version of the COPS questionnaire demonstrated high internal consistency (Cronbach's α of 0.856) with corrected item's total range 0.468 to 0.687. Two of the factors explained 58.98% of total variance. Twenty (9.26%) women had a possible diagnosis of BDD (80% were unmarried, 95% had no children, 80% had university education). An increase in perceived stress levels was associated with an increase in the likelihood of being diagnosed with BDD (Pearson's r=0.726). The Greek version of the COPS questionnaire is a valid instrument that can be used by professionals to screen adult women for BDD.
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Affiliation(s)
- Athina Kallianta
- Postgraduate Course of Science of Stress and Health Promotion, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Flora Bacopoulou
- University Research Institute of Maternal and Child Health & Precision Medicine and UNESCO Chair on Adolescent Health Care, National and Kapodistrian University of Athens, Aghia Sophia Children's Hospital, Athens, Greece
| | - Dimitrios Vlachakis
- University Research Institute of Maternal and Child Health & Precision Medicine and UNESCO Chair on Adolescent Health Care, National and Kapodistrian University of Athens, Aghia Sophia Children's Hospital, Athens, Greece.,Laboratory of Genetics, Department of Biotechnology, School of Applied Biology and Biotechnology, Agricultural University of Athens, Athens, Greece.,Lab of Molecular Endocrinology, Center of Clinical, Experimental Surgery and Translational Research, Biomedical Research Foundation of the Academy of Athens, Athens, Greece
| | - Ioulia Kokka
- Postgraduate Course of Science of Stress and Health Promotion, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - George P Chrousos
- University Research Institute of Maternal and Child Health & Precision Medicine and UNESCO Chair on Adolescent Health Care, National and Kapodistrian University of Athens, Aghia Sophia Children's Hospital, Athens, Greece
| | - Christina Darviri
- Postgraduate Course of Science of Stress and Health Promotion, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
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Rabaioli L, Oppermann PDO, Pilati NP, Klein CFG, Bernardi BL, Migliavacca R, Lavinsky-Wolff M. Evaluation of postoperative satisfaction with rhinoseptoplasty in patients with symptoms of body dysmorphic disorder. Braz J Otorhinolaryngol 2020; 88:539-545. [PMID: 32978118 PMCID: PMC9422649 DOI: 10.1016/j.bjorl.2020.07.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 07/07/2020] [Accepted: 07/23/2020] [Indexed: 11/02/2022] Open
Abstract
INTRODUCTION The prevalence of body dysmorphic disorder among candidates for plastic surgery may vary from 6% to 54%. Some studies report discrete benefits with the surgical results, while others show symptomatic exacerbation. Some authors even affirm that body dysmorphic disorder would be a surgical contraindication, against others who suggest satisfactory results. OBJECTIVE To describe the prevalence of body dysmorphic disorder in rhinoseptoplasty candidates and to compare outcomes among patients with and without body dysmorphic disorder symptoms. METHODS Cohort study. Individuals ≥ 16 years, candidates for aesthetic and/or functional rhinoseptoplasty were recruited at a university hospital in Brazil. The prevalence of body dysmorphic disorder was assessed through the Body Dysmorphic Disorder Examination (BDDE) and the patients divided into groups: no symptoms of body dysmorphic disorder, mild-moderate and severe symptoms. The specific quality of life outcomes, Nasal Obstruction Symptom Evaluation (NOSE) and Rhinoplasty Outcome Evaluation (ROE) were evaluated before and after 90 and 180 days of the procedure. RESULTS 131 individuals were included, 59.5% female. The prevalence of preoperative symptoms of body dysmorphic disorder was 38%. There was a reduction in the symptoms of body dysmorphic disorder in the preoperative body dysmorphic disorder examination versus 3 and 6 months in all groups (78.94 ± 2.46 vs. 33.63 ± 6.41 and 35.51 ± 5.92, respectively, p < 0.002). Among patients with severe body dysmorphic disorder symptoms, rhinoplasty outcome evaluation ranged from 21.24 ± 3.88 to 58.59 ± 5.83 at 3 months and 52.02 ± 5.41 at 6 months postoperatively (p < 0.001); while NOSE from 71 ± 8.47 to 36.11 ± 12.10 at 6 months postoperatively (p < 0.01). CONCLUSION The prevalence of body dysmorphic disorder symptoms in our sample was high. Rhinoseptoplasty was associated with an improvement in quality of life outcomes related to nasal function and aesthetic outcome in all groups, irrespective of the presence and intensity of body dysmorphic disorder symptoms. Rhinoseptoplasty in body dysmorphic disorder symptomatic patients was also associated with a reduction in postoperative body dysmorphic disorder symptoms, even in severe cases.
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Affiliation(s)
- Luísi Rabaioli
- Universidade Federal do Rio Grande do Sul (UFRGS), Programa de Pós-Graduação em Medicina, Ciências Cirúrgicas, Porto Alegre, RS, Brazil; Hospital de Clínicas Porto Alegre (HCPA), Departamento de Otorrinolaringologia, Porto Alegre, RS, Brazil.
| | | | - Natália Paseto Pilati
- Universidade Federal do Rio Grande do Sul (UFRGS), Faculdade de Medicina, Porto Alegre, RS, Brazil
| | - Cássia Feijó Gomes Klein
- Universidade Federal do Rio Grande do Sul (UFRGS), Faculdade de Medicina, Porto Alegre, RS, Brazil
| | - Bárbara Luiza Bernardi
- Universidade Federal do Rio Grande do Sul (UFRGS), Faculdade de Medicina, Porto Alegre, RS, Brazil
| | - Raphaella Migliavacca
- Hospital de Clínicas Porto Alegre (HCPA), Departamento de Otorrinolaringologia, Porto Alegre, RS, Brazil
| | - Michelle Lavinsky-Wolff
- Universidade Federal do Rio Grande do Sul (UFRGS), Programa de Pós-Graduação em Medicina, Ciências Cirúrgicas, Porto Alegre, RS, Brazil; Hospital de Clínicas Porto Alegre (HCPA), Departamento de Otorrinolaringologia, Porto Alegre, RS, Brazil
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Sathyanarayana HP, Padmanabhan S, Balakrishnan R, Chitharanjan AB. Prevalence of Body Dysmorphic Disorder among patients seeking orthodontic treatment. Prog Orthod 2020; 21:20. [PMID: 32743673 PMCID: PMC7396409 DOI: 10.1186/s40510-020-00322-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Accepted: 05/24/2020] [Indexed: 12/05/2022] Open
Abstract
Background Body Dysmorphic Disorder (BDD) is a psychiatric disorder with delusions about defects in appearance for which patients seek various treatments. Patients with BDD often seek cosmetic procedures, and orthodontic treatment is one among them. This is the first Indian study to determine the prevalence of BDD in an orthodontic outpatient department. Materials and method A total of 1184 patients with varying degrees of malocclusion completed the BDD-YBOCS questionnaire, while an experienced orthodontist assessed the severity of malocclusion with a rating scale. Results Sixty-two patients (5.2%) were screened positive for BDD. Most of the BDD-positive patients were single (p value of 0.02) and had multiple previous consultations for orthodontic treatment (p value of < 0.00**) with a gender predilection toward males (p value of 0.00**), and age was not statistically significant with a p value of 0.3. Conclusion From our study, the prevalence of BDD among orthodontic patients was 5.2%. The orthodontist should be aware of the high prevalence of BDD among orthodontic patients and identify the expectations of the patient at the time of history taking and refer the patient to a psychiatrist for diagnosis and appropriate management.
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Affiliation(s)
- Haritha Pottipalli Sathyanarayana
- Department of Orthodontics, Sri Ramachandra Dental College, Sri Ramachandra Institute of Higher Education and Research, Porur, Chennai, Tamil Nadu, 600116, India.
| | - Sridevi Padmanabhan
- Department of Orthodontics, Sri Ramachandra Dental College, Sri Ramachandra Institute of Higher Education and Research, Porur, Chennai, Tamil Nadu, 600116, India
| | - R Balakrishnan
- Sri Ramachandra Medical Centre, Porur, Chennai, Tamil Nadu, 600116, India
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Tignol J, Biraben-Gotzamanis L, Martin-Guehl C, Grabot D, Aouizerate B. Body dysmorphic disorder and cosmetic surgery: Evolution of 24 subjects with a minimal defect in appearance 5 years after their request for cosmetic surgery. Eur Psychiatry 2020; 22:520-4. [PMID: 17900876 DOI: 10.1016/j.eurpsy.2007.05.003] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2006] [Revised: 05/18/2007] [Accepted: 05/30/2007] [Indexed: 01/16/2023] Open
Abstract
AbstractObjectivesTo evaluate the effect of cosmetic surgery and the stability of body dysmorphic disorder (BDD) diagnosis in patients with a minimal defect in appearance, with and without BDD, 5 years after their request for plastic surgery.Subjects and methodsThirty patients requesting cosmetic surgery with minimal defect in appearance, of whom 12 had BDD and 18 did not, were re-evaluated 5 years later by telephone interview regarding their cosmetic surgery interventions, satisfaction with the intervention, BDD diagnosis, handicap, and psychiatric comorbidity.ResultsOf the 30 patients, we were able to re-evaluate 24 subjects (80%), 10 with BDD and 14 non-BDD. Seven BDD subjects had undergone cosmetic surgery vs 8 non-BDD. Patient satisfaction with the intervention was high in both groups. Nevertheless at follow-up, 6 of the 7 operated BDD patients still had a BDD diagnosis and exhibited higher levels of handicap and psychiatric comorbidity compared to their non-BDD counterparts. Moreover, 3 non-BDD patients had developed a BDD at follow-up.ConclusionThis prospective study confirms that cosmetic surgery is not efficient on BDD despite declared patient satisfaction. Cosmetic surgery had no significant effects on BDD diagnosis, handicap or psychiatric comorbidity in BDD patients at 5-year follow-up. Furthermore, BDD appeared at follow-up in some initially non-BDD diagnosed subjects. Patients' declared satisfaction with surgery may contribute to explain why some plastic surgeons may not fully adhere to the contraindication of cosmetic surgery in BDD.
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Affiliation(s)
- Jean Tignol
- Victor Segalen University School of Medicine and Charles Perrens Hospital, 121 rue de la Béchade, 33076 Bordeaux Cedex, France.
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Di Rosa L, Cerulli G, De Pasquale A. Psychological Analysis of Non-surgical Rhinoplasty. Aesthetic Plast Surg 2020; 44:131-138. [PMID: 31768580 DOI: 10.1007/s00266-019-01538-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Accepted: 10/31/2019] [Indexed: 11/29/2022]
Abstract
The aim of this study is to analyze the psychological outcomes for patients undergoing non-surgical correction of nasal defects using injections of cross-linked hyaluronic acid. We assessed changes in the subjective perception of nasal appearance after non-surgical rhinoplasty using the Rhinoplasty Outcomes Evaluation (ROE) questionnaire, which is validated and widely used in the literature. One hundred adult subjects without prior history of surgical or non-surgical rhinoplasty underwent non-surgical recontouring using the hyaluronic acid filler from December 2016 to December 2018. The points of inoculation have been standardized by the authors and are divided according to the aesthetic subunits of the nose. A final 74 patients (65 females and 9 males) completed a one-year follow-up and were included in the present study. The ROE questionnaire consists of six questions and assesses the way patients perceive the appearance of their nose and the way they think the people around them view the appearance of their nose. The results of each question were analyzed for each patient, comparing the preoperative results over a 12-month time-frame. Candidates for rhinoplasty, either medical or surgical, are among the most difficult to treat and, interestingly, there is substantial literature showing that among these patients, there is a higher rate of psychiatric disorders. Many of these patients seek aesthetic surgery and are often dissatisfied with the outcome of their surgery. The authors suggest that the use of ROE is not only a valid method of assessing patient satisfaction, but it could also be used as a tool to highlight some of the psychological characteristics of patients long before performing any treatment and could help identify potentially problematic patients.Level of Evidence IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
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14
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Sarwer DB. Body image, cosmetic surgery, and minimally invasive treatments. Body Image 2019; 31:302-308. [PMID: 30704847 DOI: 10.1016/j.bodyim.2019.01.009] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 01/21/2019] [Accepted: 01/21/2019] [Indexed: 12/20/2022]
Abstract
Over the past 60 years, a growing body of research has investigated the psychological aspects of cosmetic surgery and related minimally-invasive treatments. While the earliest studies were influenced by psychoanalytic thinking, much of the work over the past several decades has been influenced by Thomas Cash's cognitive-behavioral theory of body image and has focused on the appearance concerns of patients who seek these procedures. The majority of individuals interested in the procedures report heightened dissatisfaction typically focused on the feature being considered for treatment. Studies from around the world also have suggested that between 5-15% of patients who present for cosmetic procedures meet diagnostic criteria for body dysmorphic disorder (BDD). While individuals with BDD typically do not report a reduction in their BDD symptoms following a cosmetic procedure, the great majority of patients without the disorder do report improvement in body image. The paper reviews this literature and also discusses the role of body image in three newer areas of plastic surgery-body contouring after massive weight loss, genital procedures (either for cosmetic purposes or as part of gender reassignment), and vascularized composite allotransplantation, including face and hand transplantation.
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Affiliation(s)
- David B Sarwer
- College of Public Health, Temple University, United States.
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15
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Crépaux V, Legendre G. [Labiaplasty: Motivations and post-surgery satisfaction]. ACTA ACUST UNITED AC 2019; 47:489-496. [PMID: 31003016 DOI: 10.1016/j.gofs.2019.04.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Indexed: 11/16/2022]
Abstract
OBJECTIVES In France, the number of labiaplasty increased by 57% between 2008 and 2016. To date, only one prospective study with low-power evaluated postoperative satisfaction has been performed. This observational prospective study aims to evaluate the motives and post-surgery satisfaction of patients who had a labiaplasty. METHODS This observational prospective study include all patients over 18 years old operate at the hospital of Angers during an 18-month period. The exclusion criterion was a positive screening test to the Body Dysmorphic Disorder Questionnaire. Patients were interviewed by a written questionnaire on the day of the surgery and by phone 3 and 6 months after the surgery. RESULTS A total of thirty patients were included in the study, with an average age of 31.5 (± 10.58). Twenty-three patients answered 3 months after and 19 answered 6 months after. Eighteen patients (95%) expressed satisfaction at 6 months and 16 (84%) "extremely" satisfied. Functional discomfort improved in 18 patients (94%) at 6 months. Eighty-four percent have felt an improvement regarding esthetical discomfort. All patients would recommend the surgery. The main motive was the discomfort when getting dressed for 27 patients (90%). CONCLUSION The patients expressed a real functional discomfort and are mostly very satisfied with their surgery at 3 and 6 months after.
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Affiliation(s)
- V Crépaux
- Service de gynécologie-obstétrique, 4, rue Larrey, 49933 Angers cedex 9, France.
| | - G Legendre
- Service de gynécologie-obstétrique, 4, rue Larrey, 49933 Angers cedex 9, France.
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Guyot L, Saint-Pierre F, Bellot-Samson V, Chikhani L, Garmi R, Haen P, Jammet P, Meningaud JP, Savant J, Thomassin JM, Thiery G. Facial surgery for cosmetic purposes: Practice guidelines. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2019; 120:122-127. [PMID: 30685344 DOI: 10.1016/j.jormas.2019.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 01/11/2019] [Accepted: 01/20/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVES Facial surgery for cosmetic purposes aims to improve the physical appearance and self-image of normal individuals. The aim of the guidelines is to answer questions related to legislation, patient evaluation and motivations, relevance and risk assessment, patient information and patient follow-up. METHODOLOGY Analysis and synthesis of the medical literature through research of bibliographic databases in French and English from 2000 to 2017. Research and use of guidelines from evaluation agencies and academic societies. Drafting of guidelines with indications on levels of evidence. RESULTS 24 guidelines with levels of evidence B (scientific presumption), C (low level of evidence) or EO (expert opinion) were selected to answer the questions. Cosmetic facial surgery must be performed by certified, qualified professionals in authorized structures. It must follow certain specific rules as well as a charter and code of ethics so as to enforce the rules of practice.
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Affiliation(s)
- L Guyot
- Maxillofacial surgery unit, North university hospital, 13015 Marseille, France.
| | | | - V Bellot-Samson
- Maxillofacial surgery Private practice, 13008 Marseille, France
| | - L Chikhani
- Maxillofacial surgery, Private practice, 75016 Paris, France
| | - R Garmi
- Maxillofacial surgery unit, Caen university hospital, Caen, 14000 France
| | - P Haen
- Maxillofacial surgery unit, armed forces health Laveran Hospital, 13013 Marseille, France
| | - P Jammet
- Maxillofacial surgery unit, Lapeyronie university hospital, 34000 Montpellier, France
| | - J-P Meningaud
- Maxillofacial and plastic surgery unit, 94000 Creteil, France
| | - J Savant
- Maxillofacial surgery Private practice, 84000 Avignon, France
| | | | - G Thiery
- Maxillofacial surgery Private practice, 38043 Marseille, France
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17
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Pérez Rodríguez C, Judge RB, Castle D, Phillipou A. Body dysmorphia in dentistry and prosthodontics: A practice based study. J Dent 2018; 81:33-38. [PMID: 30579858 DOI: 10.1016/j.jdent.2018.12.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 12/10/2018] [Accepted: 12/12/2018] [Indexed: 11/27/2022] Open
Abstract
The prevalence of Body Dysmorphic Disorder (BDD) and dysmorphic concern in dentistry and prosthodontics have not been properly assessed, yet the mouth and the teeth are amongst the top preoccupation for these individuals. OBJECTIVES To evaluate the prevalence of dysmorphic symptoms and BDD using validated tools in patients presenting to general and specialist prosthodontic practice. METHODS Patients were recruited by two prosthodontics practices and three general dentist practices. Patients were given a Dysmorphic Concern Questionnaire (DCQ) integrated into a medical history form. Treating clinicians also completed a Baseline Rating Form assessing the patients´ reason for presentation. Two DCQ score cut-offs were used (9 and 12). RESULTS Two hundred and thirteen patients were recruited, the majority of patients showed DCQ scores below 9 (84%). The prevalence of BDD was 7% (cut-off ≥ 9) or 4% (cut-off ≥12). Women were more likely to present with high DCQ scores as well as people with a history of mental health problems. The cosmetic practice, the implant clinic, and the prosthodontic practice received a higher proportion of patients with high DCQ scores when compared with the general family practice. The type of procedure was not related to DCQ scores. The defect severity assessment and whether this was amenable to correction was moderately correlated with DCQ scores. CONCLUSIONS The DCQ seems to be a suitable tool to be used by dentists as part of history taking and patient examination due to its brevity, simplicity and the good sensitivity/specificity reported in the literature. CLINICAL SIGNIFICANCE Identifying patients with dysmorphia is important before irreversible treatment is carried out due to high levels of dissatisfaction, poor patient centred outcomes and the question of whether these individuals have the capacity to consent.
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Affiliation(s)
- Carolina Pérez Rodríguez
- Melbourne Dental School, The University of Melbourne, Melbourne, 720 Swanston Street, Carlton, VIC, 3010, Australia.
| | - Roy B Judge
- Melbourne Dental School, The University of Melbourne, Melbourne, 720 Swanston Street, Carlton, VIC, 3010, Australia.
| | - David Castle
- St Vincent's Hospital and The University of Melbourne, St Vincent´s Mental Health Research Unit. 46 Nicholson St, Fitzroy VIC 3065, Australia.
| | - Andrea Phillipou
- Centre for Mental Health, Swinburne University of Technology, Hawthorn VIC 3122, Australia.
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Joseph AW, Ishii L, Joseph SS, Smith JI, Su P, Bater K, Byrne P, Boahene K, Papel I, Kontis T, Douglas R, Nelson CC, Ishii M. Prevalence of Body Dysmorphic Disorder and Surgeon Diagnostic Accuracy in Facial Plastic and Oculoplastic Surgery Clinics. JAMA FACIAL PLAST SU 2017; 19:269-274. [PMID: 27930752 DOI: 10.1001/jamafacial.2016.1535] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Body dysmorphic disorder (BDD) is a relative contraindication for facial plastic surgery, but formal screening is not common in practice. The prevalence of BDD in patients seeking facial plastic surgery is not well documented. Objective To establish the prevalence of BDD across facial plastic and oculoplastic surgery practice settings, and estimate the ability of surgeons to screen for BDD. Design, Setting, and Participants This multicenter prospective study recruited a cohort of 597 patients who presented to academic and private facial plastic and oculoplastic surgery practices from March 2015 to February 2016. Methods All patients were screened for BDD using the Body Dysmorphic Disorder Questionnaire (BDDQ). After each clinical encounter, surgeons independently evaluated the likelihood that a participating patient had BDD. Validated instruments were used to assess satisfaction with facial appearance including the FACE-Q, Blepharoplasty Outcomes Evaluation (BOE), Facelift Outcomes Evaluation (FOE), Rhinoplasty Outcomes Evaluation (ROE), and Skin Rejuvenation Outcomes Evaluation (SROE). Results Across participating practices (9 surgeons, 3 sites), a total of 597 patients were screened for BDD: 342 patients from site 1 (mean [SD] age, 44.2 [16.5] years); 158 patients, site 2 (mean [SD] age, 46.0 [16.2] years), site 3, 97 patients (mean [SD] age, 56.3 [15.5] years). Overall, 58 patients [9.7%] screened positive for BDD by the BDDQ instrument, while only 16 of 402 patients [4.0%] were clinically suspected of BDD by surgeons. A higher percentage of patients presenting for cosmetic surgery (37 of 283 patients [13.1%]) compared with those presenting for reconstructive surgery (21 of 314 patients [6.7%]) screened positive on the BDDQ (odds ratio, 2.10; 95% CI, 1.20-3.68; P = .01). Surgeons were only able to correctly identify 2 of 43 patients (4.7%) who screened positive for BDD on the BDDQ, and the positive likelihood ratio was only 1.19 (95% CI, 0.28-5.07). Patients screening positive for BDD by the BDDQ had lower satisfaction with their appearance as measured by the FACE-Q, ROE, BOE, SROE, and FOE. Conclusions and Relevance Body dysmorphic disorder is a relatively common condition across facial plastic and oculoplastic surgery practice settings. Patients who screen positive on the BDDQ have lower satisfaction with their facial appearance at baseline. Surgeons have a poor ability to screen for patients with BDD when compared with validated screening instruments such as the BDDQ. Routine implementation of validated BDD screening instruments may improve patient care. Level of Evidence NA.
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Affiliation(s)
- Andrew W Joseph
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Lisa Ishii
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Shannon S Joseph
- Division of Oculoplastic Surgery, Kellogg Eye Center, University of Michigan Medical School, Ann Arbor
| | - Jane I Smith
- Division of Oculoplastic Surgery, Kellogg Eye Center, University of Michigan Medical School, Ann Arbor
| | - Peiyi Su
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Kristin Bater
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Patrick Byrne
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Kofi Boahene
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ira Papel
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland4Facial Plastic Surgicenter, Baltimore, Maryland
| | - Theda Kontis
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland4Facial Plastic Surgicenter, Baltimore, Maryland
| | - Raymond Douglas
- Division of Oculoplastic Surgery, Kellogg Eye Center, University of Michigan Medical School, Ann Arbor
| | - Christine C Nelson
- Division of Oculoplastic Surgery, Kellogg Eye Center, University of Michigan Medical School, Ann Arbor
| | - Masaru Ishii
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Ribeiro RVE. Prevalence of Body Dysmorphic Disorder in Plastic Surgery and Dermatology Patients: A Systematic Review with Meta-Analysis. Aesthetic Plast Surg 2017; 41:964-970. [PMID: 28411353 DOI: 10.1007/s00266-017-0869-0] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Accepted: 03/26/2017] [Indexed: 11/25/2022]
Abstract
The aim of the present study was to evaluate the prevalence of body dysmorphic disorder in plastic surgery and dermatology patients, by performing a systematic review of the literature and meta-analysis. The most relevant studies published originally in any language were analyzed. The literature search was performed using the PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), and Scielo databases. The final sample comprised 33 publications that were submitted to meta-analysis. The study verified that 15.04% of plastic surgery patients had body dysmorphic disorder (range 2.21-56.67%); patient mean age was 34.54 ± 12.41 years, and most were women (74.38%). Among dermatology patients, 12.65% (range 4.52-35.16%) had body dysmorphic disorder; patient mean age was 27.79 ± 9.03 years, and most were women (76.09%). Both plastic surgeons and dermatologists must adequately assess their patients to identify those with a higher likelihood of body dysmorphic disorder and should arrange multidisciplinary care for such individuals. LEVEL OF EVIDENCE V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Rafael Vilela Eiras Ribeiro
- Sociedade Brasileira de Cirurgia Plástica, São Paulo, Brazil.
- Faculty of Medical Sciences of Juiz de Fora (SUPREMA), Therezinha de Jesus Hospital and Maternity - Juiz de Fora, Rua Marechal Deodoro no. 852/600 Centro, Juiz de Fora, MG, CEP: 36.015-460, Brazil.
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Ghotbi N, Khalili M. Cultural Values Influence the Attitude of Chinese, Japanese, and Korean College Students towards Cosmetic Surgery. Asian Bioeth Rev 2017. [DOI: 10.1007/s41649-017-0004-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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21
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Abstract
BACKGROUND Preoccupation with a perceived appearance flaw is the main feature of body dysmorphic disorder. The majority of these patients seek and often receive some sort of cosmetic procedure, although this condition is considered to be a contraindication. This study evaluates cosmetic professionals' recognition of body dysmorphic disorder and the way they act on this. METHOD Members of Dutch professional associations for aesthetic plastic surgery, dermatology, and cosmetic medicine received an online survey by means of their association's digital mailing lists; the survey was completed by 173 respondents. RESULTS Most participants indicated being more or less familiar with the diagnostic criteria and clinical picture of body dysmorphic disorder. Approximately two-thirds of the participants reported that they had encountered between one and five of these patients in their practice over the past year, a percentage that is significantly lower than the estimated prevalence of body dysmorphic disorder. The majority of professionals sometimes or often address body image problems during consultation, most of them collaborate with psychologists or psychiatrists when encountering a patient with body dysmorphic disorder, and approximately 70 percent had refused to perform a procedure in such a patient. CONCLUSIONS Our results converge with those of previous studies, showing that most cosmetic professionals have some degree of awareness of body dysmorphic disorder, although the number they report encountering in clinical practice departs from prevalence figures. When a patient is identified as having body dysmorphic disorder, the professionals use this knowledge to guide their decision to perform a cosmetic procedure.
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22
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Locatelli K, Boccara D, De Runz A, Fournier M, Chaouat M, Villa F, Mimoun M. A qualitative study of life events and psychological needs underlying the decision to have cosmetic surgery. Int J Psychiatry Med 2017; 52:88-105. [PMID: 28486875 DOI: 10.1177/0091217417703287] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective A thorough psychological assessment of patients requesting cosmetic surgery can help to protect them from the risk of postoperative dissatisfaction and the onset and/or aggravation of psychiatric disorders. This study seeks to shed more light on why people desire cosmetic surgery and thus help surgeons, psychiatrists, and psychologists to conduct assessments before surgery. Methods In-depth interviews were conducted with 35 subjects who requested cosmetic surgery. The interviews were recorded and transcribed and then analyzed qualitatively with Grounded Theory. Themes and categories were identified and compared in logical order, to build a consistent theoretical model. Results In each interview, we identified one or more recent events that the subjects considered to be contributing factors in their decisions to have cosmetic surgery. We observed that 33 of 35 patients said they sought cosmetic surgery at a time when they were experiencing, or had just experienced, one or more major changes in their bodies or their relationships. Recent life events triggered or strengthened specific psychological needs in the subjects: to cope with the past and with change, attain a consistent identity, find or regain a positive self-image, alter others' perceptions, define themselves in relation to others, or please themselves or others. Patients said that they chose plastic surgery to fulfill one or more of these needs. Conclusions This study identifies the role of recent events in inciting individuals to resort to cosmetic surgery. This factor provides new perspectives for surgeons to understand those patients and opens new avenues for research.
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Affiliation(s)
- Katia Locatelli
- 1 Centre de Recherches Psychanalyse, Médecine et Société, Sorbonne Paris Cité, Université Paris Diderot, Paris, France
- 2 Plastic, Reconstructive, and Cosmetic Unit, Hôpital Saint Louis, Paris, France
| | - David Boccara
- 2 Plastic, Reconstructive, and Cosmetic Unit, Hôpital Saint Louis, Paris, France
| | - Antoine De Runz
- 2 Plastic, Reconstructive, and Cosmetic Unit, Hôpital Saint Louis, Paris, France
- 3 Pratiques Professionnelles: Aspects Méthodologiques Ethiques et Juridiques, Université de Lorraine, France
| | - Mathilde Fournier
- 2 Plastic, Reconstructive, and Cosmetic Unit, Hôpital Saint Louis, Paris, France
| | - Marc Chaouat
- 2 Plastic, Reconstructive, and Cosmetic Unit, Hôpital Saint Louis, Paris, France
| | - François Villa
- 1 Centre de Recherches Psychanalyse, Médecine et Société, Sorbonne Paris Cité, Université Paris Diderot, Paris, France
| | - Maurice Mimoun
- 2 Plastic, Reconstructive, and Cosmetic Unit, Hôpital Saint Louis, Paris, France
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Wang Q, Cao C, Guo R, Li X, Lu L, Wang W, Li S. Avoiding Psychological Pitfalls in Aesthetic Medical Procedures. Aesthetic Plast Surg 2016; 40:954-961. [PMID: 27761610 DOI: 10.1007/s00266-016-0715-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Accepted: 09/23/2016] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To assess the prevalence of body dysmorphic disorder (BDD) in an aesthetic surgery setting in the region of Southwest China, and to ascertain the differences in terms of body images between patients in the aesthetic setting and general Chinese population. This study tracked patient satisfaction with their body image changes while undergoing aesthetic medical procedures to identify whether the condition of patients who were presenting with BDD symptoms or their psychological symptoms could be improved by enhancing their appearance. Additionally, this study explored whether there was improvement in quality of life (QoL) and self-esteem after aesthetic medical procedures. METHODS A total of 106 female patients who were undergoing aesthetic medical procedures for the first time (plastic surgery, n = 26; minimally invasive aesthetic treatment, n = 42; and aesthetic dermatological treatment, n = 38) were classified as having body dysmorphic disorder symptoms or not having body dysmorphic disorder symptoms, based on the body dysmorphic disorder examination (BDDE), which was administered preoperatively. These patients were followed up for 1 month after the aesthetic procedures. The multidimensional body self-relations questionnaire-appearance scales (MBSRQ-AS) and rosenberg self-esteem scale (RSE-S) were used to assess patients' preoccupation with appearance and self-esteem pre-procedure and 1 month post-procedure. Additionally, 100 female healthy control participants were recruited as a comparative group into this study and they were also assessed using BDDE, MBSRQ-AS, and RSE-S. RESULTS A total of 14.2 % of 106 aesthetic patients and 1 % of 100 healthy controls were diagnosed with BDD to varying extents. BDDE scores were 72.83 (SD ± 30.7) and 68.18 (SD ± 31.82), respectively, before and after the procedure for the aesthetic patient group and 43.44 (SD ± 15.65) for the healthy control group (F = 34.28; p < 0.001). There was a significant difference between the groups in subscales of MBSRQ-AS, i.e. appearance evaluation (F = 31.31; p < 0.001), appearance orientation (F = 31.65; p < 0.001), body areas satisfaction (F = 27.40; p < 0.001), and RSE-S scores (F = 20.81; p < 0.001). There was no significant difference, however, in subscales of MBSRQ-AS, i.e. overweight preoccupation (F = 1.685; p = 0.187), self-classified weight (F = 0.908; p = 0.404) between groups. All the subscales of MBSRQ-AS showed significant differences between the aesthetic patients (pre-procedure) and female adult norms from Dr. Cash's result given in Table 4 (p < 0.001). The study also showed that there were no significant differences in the scores of BDDE, MBSRQ-AS, and RSE-S of those fifteen aesthetic patients diagnosed with BDD after aesthetic procedures lasting one month. CONCLUSION There was a high prevalence rate (14.2 %) of body dysmorphic disorder in aesthetic procedure seekers, and it seemed that those patients suffering from BDD were more likely to be dissatisfied with the results of the aesthetic medical procedures. However, general aesthetic patients showed improvement in most assessments which indicated that aesthetic medical procedures could not only enhance patient appearance, but also patient low self-esteem and QoL. Self-satisfaction could also be promoted. A screening procedure for BDD including suitable screening questionnaires might be considered for routine use in aesthetic clinical settings to minimize dissatisfaction and complaints. LEVEL OF EVIDENCE IV This journal requires that the authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors. www.springer.com/00266 .
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Affiliation(s)
- Qiuyu Wang
- Department of Plastic Surgery, Southwest Hospital, Third Military Medical University, Chongqing, 400038, China
| | - Chuan Cao
- Department of Plastic Surgery, Southwest Hospital, Third Military Medical University, Chongqing, 400038, China
| | - Rui Guo
- Department of Plastic Surgery, Southwest Hospital, Third Military Medical University, Chongqing, 400038, China
| | - Xiaoge Li
- Department of Plastic Surgery, Southwest Hospital, Third Military Medical University, Chongqing, 400038, China
| | - Lele Lu
- Department of Plastic Surgery, Southwest Hospital, Third Military Medical University, Chongqing, 400038, China
| | - Wenping Wang
- Department of Plastic Surgery, Southwest Hospital, Third Military Medical University, Chongqing, 400038, China
| | - Shirong Li
- Department of Plastic Surgery, Southwest Hospital, Third Military Medical University, Chongqing, 400038, China.
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Body dysmorphic disorder in different settings: A systematic review and estimated weighted prevalence. Body Image 2016; 18:168-86. [PMID: 27498379 DOI: 10.1016/j.bodyim.2016.07.003] [Citation(s) in RCA: 168] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2015] [Revised: 06/30/2016] [Accepted: 07/18/2016] [Indexed: 11/24/2022]
Abstract
Our aim was to systematically review the prevalence of body dysmorphic disorder (BDD) in a variety of settings. Weighted prevalence estimate and 95% confidence intervals in each study were calculated. The weighted prevalence of BDD in adults in the community was estimated to be 1.9%; in adolescents 2.2%; in student populations 3.3%; in adult psychiatric inpatients 7.4%; in adolescent psychiatric inpatients 7.4%; in adult psychiatric outpatients 5.8%; in general cosmetic surgery 13.2%; in rhinoplasty surgery 20.1%; in orthognathic surgery 11.2%; in orthodontics/cosmetic dentistry settings 5.2%; in dermatology outpatients 11.3%; in cosmetic dermatology outpatients 9.2%; and in acne dermatology clinics 11.1%. Women outnumbered men in the majority of settings but not in cosmetic or dermatological settings. BDD is common in some psychiatric and cosmetic settings but is poorly identified.
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Dey JK, Ishii M, Phillis M, Byrne PJ, Boahene KDO, Ishii LE. Body dysmorphic disorder in a facial plastic and reconstructive surgery clinic: measuring prevalence, assessing comorbidities, and validating a feasible screening instrument. JAMA FACIAL PLAST SU 2016; 17:137-43. [PMID: 25654334 DOI: 10.1001/jamafacial.2014.1492] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Body dysmorphic disorder (BDD) is underrecognized and underdetected among patients undergoing facial plastic and reconstructive surgery. Patients with BDD require psychiatric care, not cosmetic surgery. OBJECTIVES To measure the prevalence of BDD in a facial plastic and reconstructive surgery clinic, to validate the Body Dysmorphic Disorder Questionnaire (BDDQ) in that setting, to assess the feasibility of implementing a standardized process for identifying patients with BDD accurately in a busy clinical practice, and to assess the comorbidity of BDD, depression, and anxiety in our patient population. DESIGN, SETTING, AND PARTICIPANTS We performed a prospective prevalence and instrument validation study in an academic facial plastic and reconstructive surgery clinic. We included 234 consecutive patients 18 years or older presenting to the clinic from March 3 to June 30, 2014. MAIN OUTCOMES AND MEASURES Prevalence of BDD as determined by the BDDQ and the criterion-standard BDD Structured Clinical Interview for DSM-IV (BDD SCID). The BDD SCID and a defect severity scale were used to confirm the BDD diagnosis and to validate the BDDQ finding. We also assessed demographic characteristics, depression, and anxiety in all patients. RESULTS As confirmed by the BDD SCID, 13.1% of patients undergoing cosmetic surgery and 1.8% of those undergoing reconstructive surgery had BDD. We found the BDDQ to be an accurate (91.7%), sensitive (100%), and specific (90.3%) screening instrument for BDD. Patients with a positive BDD finding were most commonly concerned with their nose (10 of 18 [56%]), skin (5 of 18 [28%]), hair (1 of 18 [6%]), chin (1 of 18 [6%]), and ears (1 of 18 [6%]), that is, areas commonly addressed by facial plastic surgeons. Furthermore, compared with patients who did not have BDD, patients with BDD had elevated depression scores (mean [SD], 12.6 [10.8] vs 3.2 [4.2]). In the non-BDD population, mean (SD) state and trait anxiety scores resembled the norm (30.0 [7.7] and 30.3 [7.7], respectively, for men; 31.7 [10.0] and 32.1 [8.7], respectively, for women); in the BDD population, these scores were elevated (53.8 [23.4] and 50.4 [19.5], respectively, for men; 47.8 [12.7] and 49.0 [11.6], respectively, for women). Depression and anxiety scores were highly correlated in patients with BDD (r = 0.84 for patients with a BDDQ-positive screen result; r = 0.94 for patients with a positive BDD SCID finding) compared with those who did not have BDD (r = 0.51). CONCLUSIONS AND RELEVANCE Patients with BDD often seek cosmetic treatment. Given the documented risks and harms of surgery for patients with BDD, a systematic process for identifying such patients who seek cosmetic surgery is imperative. We found a BDD screening instrument (BDDQ) followed by the BDD SCID for patients with a BDDQ-positive screen result to be a feasible and effective way to identify patients with BDD. LEVEL OF EVIDENCE NA.
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Affiliation(s)
- Jacob K Dey
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Masaru Ishii
- Division of Rhinology, Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Maria Phillis
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Patrick J Byrne
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Kofi D O Boahene
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Lisa E Ishii
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Body Dysmorphic Disorder et chirurgie esthétique : une revue de la littérature. ANN CHIR PLAST ESTH 2015; 60:512-7. [DOI: 10.1016/j.anplas.2015.06.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Accepted: 06/09/2015] [Indexed: 11/19/2022]
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Sethi N. Ethics and the facial plastic surgeon. Eur Arch Otorhinolaryngol 2015; 273:2323-7. [PMID: 26254909 DOI: 10.1007/s00405-015-3745-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Accepted: 07/31/2015] [Indexed: 10/23/2022]
Abstract
The facial plastic surgeon potentially has a conflict of interest when confronted with the patients requesting surgery, due to the personal gain attainable by agreeing to perform surgery. The aim of this review is to discuss the potential harm the surgeon can inflict by carrying out facial plastic surgery, beyond the standard surgical complications of infection or bleeding. It will discuss the desire for self-improvement and perfection and increase in the prevalence facial plastic surgery. We address the principles of informed consent, beneficence and non-maleficence, as well as justice and equality and how the clinician who undertakes facial plastic surgery is at risk of breaching these principles without due care and diligence.
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Affiliation(s)
- Neeraj Sethi
- Leeds Institute of Cancer and Pathology, St James' University Hospital, Leeds, West Yorkshire, LS6 9TF, UK.
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Identification and management of mental health issues by dermatologic surgeons: a survey of American Society for Dermatologic Surgery members. Dermatol Surg 2015; 41:352-7. [PMID: 25742557 DOI: 10.1097/dss.0000000000000279] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Dermatologists have long been interested in mental health issues of their patients. Some psychosocial distress likely motivates the pursuit of cosmetic dermatologic treatments. However, a percentage of patients seeking treatment suffer from significant psychopathology, such as body dysmorphic disorder (BDD), which may contraindicate treatment. OBJECTIVE To assess dermatologic surgeons' strategies for identification and management of mental health issues among patients seeking cosmetic procedures. MATERIALS AND METHODS A survey was sent to 2,855 practicing members of the American Society for Dermatologic Surgery by e-mail. RESULTS Two hundred sixty members completed the survey (9.1%). Approximately, 60% of respondents indicated that they ask new patients about psychiatric treatment history, and 92% reported that they have declined to provide a cosmetic treatment because of concerns about mental health status. Most (94%) indicated that they were aware of BDD, and 62% indicated that they refused to treat a patient believed to have BDD. Respondents estimated that 13% of new patients had BDD and 63% considered BDD to be a contraindication to treatment. CONCLUSION Approximately 60% of dermatologic surgeons inquire about the mental health issues of their cosmetic patients. Most are aware of BDD, but less than two-thirds consider it a contraindication to treatment.
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Metcalfe DB, Duggal CS, Gabriel A, Nahabedian MY, Carlson GW, Losken A. Prevalence of Body Dysmorphic Disorder Among Patients Seeking Breast Reconstruction. Aesthet Surg J 2014; 34:733-7. [PMID: 24809358 DOI: 10.1177/1090820x14531775] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2013] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Body dysmorphic disorder (BDD) is characterized by a preoccupation with a slight or imagined defect in physical appearance. It has significant implications for patients who desire breast reconstruction, because patient satisfaction with the aesthetic outcome is a substantial contributor to the success of the procedure. OBJECTIVES The authors estimated the prevalence of BDD among women seeking breast reconstruction by surveying patients with the previously validated Dysmorphic Concerns Questionnaire (DCQ). METHODS One hundred eighty-eight women who presented for immediate or delayed breast reconstruction completed the DCQ anonymously, during initial consultation with a plastic surgeon. Two groups of respondents were identified: those who desired immediate reconstruction and those who planned to undergo delayed reconstruction. The prevalence of BDD among breast reconstruction patients was compared between the 2 groups, and the overall prevalence was compared with published rates for the general public. RESULTS Body dysmorphic disorder was significantly more prevalent in breast reconstruction patients than in the general population (17% vs 2%; P < .001). It also was much more common among patients who planned to undergo delayed (vs immediate) reconstruction (34% vs 13%; P = .004). CONCLUSIONS Relative to the general public, significantly more women who sought breast reconstruction were diagnosed as having BDD. Awareness of the potential for BDD will enable clinicians to better understand their patients' perspectives and discuss realistic expectations at the initial consultation. Future studies are warranted to examine the implications of BDD on patient satisfaction with reconstructive surgery. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- Drew B Metcalfe
- Drs Metcalfe and Duggal are residents, Dr Carlson is the Chair, and Dr Losken is Program Director for Plastic Surgery, Division of Plastic and Reconstructive Surgery, Emory University Hospital, Atlanta, Georgia
| | - Claire S Duggal
- Drs Metcalfe and Duggal are residents, Dr Carlson is the Chair, and Dr Losken is Program Director for Plastic Surgery, Division of Plastic and Reconstructive Surgery, Emory University Hospital, Atlanta, Georgia
| | - Allen Gabriel
- Dr Gabriel is a plastic surgeon in private practice in Vancouver, Washington
| | - Maurice Y Nahabedian
- Dr Nahabedian is a Professor of Surgery, Department of Plastic Surgery, Georgetown University, Washington, DC
| | - Grant W Carlson
- Drs Metcalfe and Duggal are residents, Dr Carlson is the Chair, and Dr Losken is Program Director for Plastic Surgery, Division of Plastic and Reconstructive Surgery, Emory University Hospital, Atlanta, Georgia
| | - Albert Losken
- Drs Metcalfe and Duggal are residents, Dr Carlson is the Chair, and Dr Losken is Program Director for Plastic Surgery, Division of Plastic and Reconstructive Surgery, Emory University Hospital, Atlanta, Georgia
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Felix GAA, de Brito MJA, Nahas FX, Tavares H, Cordás TA, Dini GM, Ferreira LM. Patients with mild to moderate body dysmorphic disorder may benefit from rhinoplasty. J Plast Reconstr Aesthet Surg 2014; 67:646-54. [PMID: 24508222 DOI: 10.1016/j.bjps.2014.01.002] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Revised: 12/30/2013] [Accepted: 01/03/2014] [Indexed: 11/28/2022]
Abstract
Body dysmorphic disorder (BDD) is one of the most common psychiatric conditions found in patients seeking cosmetic surgery. BDD is also a challenge for plastic surgeons because it is still an underdiagnosed mental disorder. The aims of this study were to prospectively investigate whether patients with mild to moderate BDD are suitable for rhinoplasty, and to assess BDD severity and patient satisfaction with the surgical outcome 1 year after the intervention. All women (n = 116) seeking rhinoplasty at a university hospital between September 2009 and August 2010 were recruited for the study and assessed for BDD. The final sample consisted of 31 patients aged 32 (standard deviation (SD), 10) years with mild to moderate BDD who underwent rhinoplasty. The participants were assessed preoperatively (baseline) and 1 year postoperatively with the Body Dysmorphic Disorder Examination (BDDE). Most patients (22/31, 71%) were of African descent. Socio-demographic variables and the extent of the nasal deformities had no effect on the severity of BDD symptoms and patient satisfaction with surgery outcome. At the 1-year postoperative follow-up, there was a significant decrease from baseline in BDDE scores and time spent by patients worrying about their appearance; 25 (25/31, 81%) patients experienced complete remission from BDD and 28 (28/31, 90%) were satisfied with the results of surgery. Rhinoplasty may be indicated in the treatment of female patients with mild to moderate BDD.
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Affiliation(s)
| | - Maria José Azevedo de Brito
- Division of Plastic Surgery, Federal University of São Paulo (UNIFESP), São Paulo, Brazil; Sapucaí Valley University (UNIVÁS), Pouso Alegre, Minas Gerais, Brazil
| | - Fabio Xerfan Nahas
- Division of Plastic Surgery, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Hermano Tavares
- Department of Psychiatry, University of São Paulo (USP), São Paulo, Brazil
| | | | - Gal Moreira Dini
- Division of Plastic Surgery, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Lydia Masako Ferreira
- Division of Plastic Surgery, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
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Mr F, Tabrizi A G, Bafghi A F, Sa N, A M. Body dysmorphic disorder in aesthetic rhinoplasty candidates. Pak J Med Sci 2013; 29:197-200. [PMID: 24353539 PMCID: PMC3809162 DOI: 10.12669/pjms.291.2733] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2012] [Accepted: 11/26/2012] [Indexed: 12/03/2022] Open
Abstract
Objective: Body Dysmorphic Disorder (BDD) is a psychiatric disorder defined as obsessive ideas about distorted physical appearance, leading to social, professional and personal dysfunction. Many of these patients seek aesthetic surgery and are generally dissatisfied with the outcome of their surgery. In the present study patients coming to the otolaryngology clinic of Thaleghani Hospital in Tehran seeking rhinoplasty were evaluated. Methodology: Between October 2010 and October 2011, 130 patients seeking rhinoplasty were recruited in a cross-sectional study. These patients were consecutively interviewed in the otolaryngology clinic of Taleghani Hospital, Tehran, Iran. Questionnaires were filled containing demographic data. BDD was evaluated by a separate questionnaire. Hospital Anxiety and Depression Scale (HADS) questionnaire was filled to evaluate depression and anxiety. Data were analyzed by using SPSS software. The frequency and standard deviations were calculated. Differences between groups were evaluated by using the chi-square, and t-tests. Results: Ninety nine (76.2%) of rhinoplasty candidates were female and thirty one (23.8%) were male. Eighty five (65.4%) were single and thirty eight (29.2%) were married while seven were divorced. About 63.8% were University students or University graduates. Mean age was 26.43±6.29 years old. 41 patients (31.5%) had BDD. Among BDD patients 12 (29.3%) had concurrent depression and 11 (26.8%) had concurrent anxiety. No statistically significant correlation was found between the presence or severity of BDD and age, gender, marital status, level of education and profession. Conclusion: Considering the high prevalence of Body Dysmorphic Disorder (BDD) among rhinoplasty candidates, psychiatric evaluation is advisable before surgery to avoid unnecessary operations and patient dissatisfaction.
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Affiliation(s)
- Fathololoomi Mr
- Fathololoomi MR, MD, Associate Professor, ENT Department, Taleghani Hospital, Shaheed Beheshti University of Medical Sciences, Tehran, Iran
| | - Goljanian Tabrizi A
- Goljanian Tabrizi A, MD, Assistant Professor, ENT Department, Taleghani Hospital, Shaheed Beheshti University of Medical Sciences, Tehran, Iran
| | - Fattahi Bafghi A
- Fattahi Bafghi A, MD, Associate Professor, ENT Department, Taleghani Hospital, Shaheed Beheshti University of Medical Sciences, Tehran, Iran
| | - Noohi Sa
- Noohi SA, MD, Assistant Professor, ENT Department, Taleghani Hospital, Shaheed Beheshti University of Medical Sciences, Tehran, Iran
| | - Makhdoom A
- Makhdoom A, MD, General Practitioner, ENT Department, Taleghani Hospital, Shaheed Beheshti University of Medical Sciences, Tehran, Iran
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Preoperative Symptoms of Body Dysmorphic Disorder Determine Postoperative Satisfaction and Quality of Life in Aesthetic Rhinoplasty. Plast Reconstr Surg 2013; 131:861-868. [DOI: 10.1097/prs.0b013e3182818f02] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Colson MH. Que penser de la génitoplastie cosmétique féminine aujourd’hui ? ACTA ACUST UNITED AC 2012; 40:445-8. [DOI: 10.1016/j.gyobfe.2012.05.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2012] [Accepted: 04/17/2012] [Indexed: 10/28/2022]
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Psychopathology symptoms in a sample of female cosmetic surgery patients. J Plast Reconstr Aesthet Surg 2012; 65:321-7. [DOI: 10.1016/j.bjps.2011.09.038] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2011] [Revised: 09/22/2011] [Accepted: 09/23/2011] [Indexed: 11/20/2022]
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Picavet V, Gabriëls L, Jorissen M, Hellings PW. Screening tools for body dysmorphic disorder in a cosmetic surgery setting. Laryngoscope 2011; 121:2535-41. [DOI: 10.1002/lary.21728] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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High prevalence of body dysmorphic disorder symptoms in patients seeking rhinoplasty. Plast Reconstr Surg 2011; 128:509-517. [PMID: 21788842 DOI: 10.1097/prs.0b013e31821b631f] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Nasal aesthetic deformities may be associated with significant body image dissatisfaction. The only diagnostic category in the current list of psychiatric disorders that directly addresses these concerns is body dysmorphic disorder. This large-scale study determined the prevalence of body dysmorphic disorder and its symptoms in patients seeking rhinoplasty and evaluated the clinical profile of these patients. METHODS Two hundred twenty-six patients were given questionnaires including demographic characteristics, visual analogue scales for nasal shape, the Yale-Brown Obsessive Compulsive Scale modified for body dysmorphic disorder to assess severity of symptoms, a generic quality-of-life questionnaire, and the Derriford Appearance Scale 59, to assess appearance-related disruption of everyday living. Independent observers scored the nasal shape. RESULTS Thirty-three percent of patients showed at least moderate symptoms of body dysmorphic disorder. Aesthetic goals (p < 0.001), revision rhinoplasty (p = 0.003), and psychiatric history (p = 0.031) were associated with more severe symptoms. There was no correlation between the objective and subjective scoring of the nasal shape. Yale-Brown scale modified for body dysmorphic disorder scores correlated inversely with the subjective nasal scoring (n = 210, p < 0.001), without relation to the objective deformity of the nose. Body dysmorphic disorder symptoms significantly reduced the generic quality of life (n = 160, p < 0.001) and led to significant appearance-related disruption of everyday living (n = 161, p < 0.001). CONCLUSIONS The prevalence of moderate to severe body dysmorphic disorder symptoms in an aesthetic rhinoplasty population is high. Patients undergoing revision rhinoplasty and with psychiatric history are particularly at risk. Body dysmorphic disorder symptoms significantly reduce the quality of life and cause significant appearance-related disruption of everyday living. CLINICAL QUESTION/LEVEL OF EVIDENCE Risk, III.
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Tignol J, Martin-Guehl C, Aouizerzate B. [Body dysmorphic disorder (BDD)]. Presse Med 2011; 41:e22-35. [PMID: 21831574 DOI: 10.1016/j.lpm.2011.05.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2010] [Revised: 05/22/2011] [Accepted: 05/30/2011] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Body Dysmorphic Disorder (BDD) has replaced the old and ill-defined concept of dysmorphophobia since its introduction as a full-blown disorder in DSM-III-R in 1987. Since then, the body of knowledge on BDD has considerably increased. At the same time, cosmetic medicine and surgical procedures, for which the indications and outcomes of BDD should be taken into account, have become common. Hence, we decided to undertake a review of the literature on BDD aimed at French speaking practitioners. METHOD We searched Medline for the literature on BDD and dysmorphophobia in English and in French and made a critical examination of findings resulting from those studies where the methodology was sound. RESULTS BDD is frequent in the general population with a point prevalence between 1.7 and 2.4% and often severe. Delusive and non-delusive forms of BDD likely belong to the same entity and both respond to the same treatment. Serotonin reuptake inhibitors and cognitive behavioral therapies have demonstrated their efficacy in randomized controlled studies. Esthetic, medical and surgical treatments, which are very often sought after by BDD patients, have been shown to be ineffective and potentially harmful. DISCUSSION Our review confirms the progress in knowledge on BDD. The most interesting results concern clinical characteristics, epidemiology in the general population, and treatment. The prevalence of BDD in the general population should prompt every practitioner to take this disorder into account when faced with the increasing demand for medical and surgical cosmetic procedures. Nevertheless, further research is needed, particularly on the demand of non psychiatric treatments by BDD patients and the way medical or surgical specialists manage it.
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Affiliation(s)
- Jean Tignol
- Faculté de médecine de l'université de Bordeaux, 33000 Bordeaux, France.
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Lai CS, Lee SS, Yeh YC, Chen CS. Body dysmorphic disorder in patients with cosmetic surgery. Kaohsiung J Med Sci 2011; 26:478-82. [PMID: 20837344 DOI: 10.1016/s1607-551x(10)70075-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2010] [Accepted: 04/16/2010] [Indexed: 10/19/2022] Open
Abstract
Body dysmorphic disorder (BDD) refers to a preoccupation with an imagined or grossly exaggerated minor physical defect. Those with BDD might seek medical help (cosmetic surgery) rather than attend a psychiatric clinic. Therefore, it is often underdiagnosed. To investigate the prevalence of BDD, we reviewed the medical records of 817 individuals who sought cosmetic surgery during a 3-year period. The outcome after surgery was described for those with BDD. Our results showed that 63 (7.7%) patients had BDD, of which 54 (85.7%) were diagnosed at preoperative evaluation. However, nine (14.3%) patients went undiagnosed and all had a bad outcome after cosmetic surgery. BDD was not uncommon at the cosmetic surgery clinic. Our results support the idea that cosmetic surgery should be avoided for patients with BDD. The development of a more effective diagnostic procedure could help address this issue.
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Affiliation(s)
- Chung-Sheng Lai
- Department of Plastic Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
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Sarwer DB, Crerand CE, Magee L. Body dysmorphic disorder in patients who seek appearance-enhancing medical treatments. Oral Maxillofac Surg Clin North Am 2011; 22:445-53. [PMID: 20970710 DOI: 10.1016/j.coms.2010.07.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Most patients who seek appearance-enhancing medical treatments report some degree of body image dissatisfaction, which is believed to motivate the pursuit of these treatments. However, patients with extreme body image dissatisfaction may be suffering from a psychiatric disorder known as body dysmorphic disorder (BDD). This article reviews BDD, including its clinical features and prevalence in medical settings. Although patients with BDD frequently seek cosmetic treatments to address their appearance-related distress, such treatments are rarely beneficial. The article concludes with recommendations for patient and provider safety.
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Affiliation(s)
- David B Sarwer
- Division of Plastic Surgery, Department of Surgery, The Edwin and Fannie Gray Hall Center for Human Appearance, The University of Pennsylvania School of Medicine, 10 Penn Tower, 3400 Spruce Street, Philadelphia, PA 19104, USA.
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Feusner JD, Bystritsky A, Hellemann G, Bookheimer S. Impaired identity recognition of faces with emotional expressions in body dysmorphic disorder. Psychiatry Res 2010; 179:318-23. [PMID: 20493560 PMCID: PMC2928412 DOI: 10.1016/j.psychres.2009.01.016] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2008] [Revised: 01/07/2009] [Accepted: 01/20/2009] [Indexed: 11/15/2022]
Abstract
Individuals with body dysmorphic disorder (BDD) are preoccupied with perceived physical defects or flaws, often facial features, which may be due to distorted perception. Previous studies have demonstrated abnormalities in visual processing of faces and figures, and misinterpretations of emotional expressions. The objective of this study was to determine in BDD how viewing faces with emotional expressions affects perception on an identity-matching task. Twelve BDD subjects and 11 healthy controls matched identities of faces with emotional expressions, neutral expressions, and a control task of ovals and circles. The BDD group made twice as many errors relative to controls for identity-matching of faces with emotional expressions but not for neutral faces or ovals/circles. Mean reaction times were slower for the BDD relative to the control group for emotional faces in general, but there was no effect of specific emotion type. These data suggest that individuals with BDD have abnormalities in facial identification for faces with emotional expressions. This could reflect fundamental abnormalities in visual information processing that are more pronounced for emotional expressions in general, and may relate to their perceptual disturbances.
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Affiliation(s)
- Jamie Donald Feusner
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA.
| | - Alexander Bystritsky
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute of Neuroscience and Human Behavior, University of California, Los Angeles, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Gerhard Hellemann
- Biostatistics Core, Semel Institute of Neuroscience and Human Behavior, University of California, Los Angeles, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Susan Bookheimer
- Center for Cognitive Neuroscience, Semel Institute of Neuroscience and Human Behavior, University of California, Los Angeles, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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Surgical and minimally invasive cosmetic procedures among persons with body dysmorphic disorder. Ann Plast Surg 2010; 65:11-6. [PMID: 20467296 DOI: 10.1097/sap.0b013e3181bba08f] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Persons with body dysmorphic disorder (BDD) frequently seek surgical and minimally invasive (MI) treatments to improve their appearance, but few studies have evaluated patient characteristics and outcomes. Surgical/MI treatment histories of 200 persons with BDD were cross-sectionally/retrospectively evaluated. Clinical and demographic characteristics of persons who received such treatments (n = 42) were compared to those who had not (n = 158). Outcomes and reasons for nonreceipt of requested procedures were examined. Receivers of surgical/MI treatments reported less severe current BDD symptoms and delusionality than persons who did not receive such treatments. Surgical/MI treatments were more likely than other cosmetic procedures to decrease preoccupation with the treated body part; however, overall BDD severity improved with only 2.3% of treatments. Cost and physician refusal were the most common reasons requested treatment was not received. However, physicians were more likely to provide requested surgical/MI treatment than other types of requested cosmetic treatment, despite the poor longer-term outcome.
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Abstract
Body dysmorphic disorder (BDD) is a relatively common disorder that consists of a distressing or impairing preoccupation with imagined or slight defects in appearance. BDD is commonly considered to be an obsessive-compulsive spectrum disorder, based on similarities it has with obsessive-compulsive disorder. It is important to recognize and appropriately treat BDD, as this disorder is associated with marked impairment in psychosocial functioning, notably poor quality of life, and high suicidality rates. In this review, we provide an overview of research findings on BDD, including its epidemiology, clinical features, course of illness, comorbidity, psychosocial functioning, and suicidality. We also briefly review recent research on neural substrates and cognitive processing. Finally, we discuss treatment approaches that appear efficacious for BDD, with a focus on serotonin-reuptake inhibitors and cognitive-behavioral therapy.
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Affiliation(s)
- Andri S Bjornsson
- Rhode Island Hospital and Alpert Medical School of Brown University, Providence, Rhode Island 02903, USA.
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Body Dysmorphic Disorder among Diverse Racial/Ethnic and Sexual Orientation Groups: Prevalence Estimates and Associated Factors. SEX ROLES 2010. [DOI: 10.1007/s11199-010-9831-1] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Conrado LA. [Body dysmorphic disorder in dermatology: diagnosis, epidemiology and clinical aspects]. An Bras Dermatol 2010; 84:569-81. [PMID: 20191168 DOI: 10.1590/s0365-05962009000600002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2009] [Accepted: 09/21/2009] [Indexed: 11/22/2022] Open
Abstract
Cosmetic concerns are becoming increasingly common in view of the obsession with the perfect body and skin. Dermatologists are often seen to evaluate and treat these conditions. Therefore, it is important to acknowledge the existence of Body Dysmorphic Disorder, also known as dysmorphophobia. Despite being relatively common, this disorder has not been well researched. Sometimes causing impairment, the disease involves a distorted body image perception characterized by excessive preoccupation with a perceived defect. Most of the patients experience some degree of impairment in social or occupational functioning and, as a result of their obsessive concerns, they may develop compulsive behaviors. In severe cases, there is a risk of suicide. Most individuals do not acknowledge that their defect is minimal or nonexistent and seek out cosmetic treatments for a psychiatric disorder. The prevalence of this disorder among the general population ranges from 1 to 2 % and in dermatological and cosmetic surgery patients, from 2.9 to 16%. The training of professionals to systematically investigate, diagnose, and refer these patients to adequate psychiatric treatment is essential, considering the high prevalence of Body Dysmorphic Disorder in dermatological patients and the fact that cosmetic treatments rarely improve their condition.
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Abstract
The use of cosmetic surgery and procedures has sharply increased in recent years. This paper outlines an object-relational framework for understanding the unconscious fantasies that may drive the pursuit of body modification and proposes three categories of such fantasies. For some individuals, the pursuit of "beauty" through cosmetic surgery provides a psychic retreat from the reality of dependency as the self retreats into believing that it can create itself (the self-made fantasy). For others, it is a means for creating a felt-to-be ideal self, thereby averting the pain of the loss of an object that would love and desire the self (the perfect-match fantasy). For still others, it may be the only means of expelling an object felt to be alien or polluting that is unconsciously identified with the body (the reclaiming fantasy).
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Körperdysmorphe Störung. PSYCHOTHERAPEUT 2010. [DOI: 10.1007/s00278-009-0719-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Abstract
Within the past decade, the popularity of cosmetic breast augmentation has surged and, with it, the interest in the psychological aspects of the procedure. Investigations of women who seek cosmetic breast augmentation have examined both their psychosocial characteristics and their motivations for surgery. Dissatisfaction both with body image and with breast size and/or shape are thought to be primary motivators for surgery. It is common for women seeking cosmetic breast augmentation to have some body image dissatisfaction. However, a considerable minority may suffer from excessive dissatisfaction consistent with the psychiatric diagnosis of body dysmorphic disorder, which is believed to contraindicate cosmetic surgery. Following breast augmentation, most women report satisfaction with the aesthetic result and improvements in body image. The impact of the procedure on other areas of functioning, such as self-esteem and quality of life, is less clear. These positive outcomes have been tempered by recent epidemiological studies that have identified a relationship between cosmetic breast implants and suicide. This article reviews this literature and provides recommendations to plastic surgical nurses regarding the psychological assessment and management of patients seeking breast augmentation.
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Biraben-Gotzamanis L, Aouizerate B, Martin-Guehl C, Grabot D, Tignol J. [Body dysmorphic disorder and cosmetic surgery: assessment of 24 subjects with a minimal defect in appearance 5 years after their request for cosmetic surgery]. Presse Med 2009; 38:1062-7. [PMID: 19359130 DOI: 10.1016/j.lpm.2008.07.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2008] [Revised: 07/07/2008] [Accepted: 07/15/2008] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES To evaluate the effect of cosmetic surgery in patients with a minimal defect in appearance, with and without body dysmorphic disorder (BDD), 5 years after their request for plastic surgery. METHODS Thirty patients requesting cosmetic surgery with a minimal defect in appearance, 12 diagnosed with BDD and 18 not, were contacted 5 years later for a telephone interview about their cosmetic surgery, their satisfaction with it, BDD diagnosis, handicap, and psychiatric comorbidity. RESULTS Of the 30 patients, we were able to re-evaluate 24 subjects (80%), 10 with BDD and 14 without. Seven BDD subjects had undergone cosmetic surgery compared with 8 without BDD. Patient satisfaction with the intervention was high in both groups. Nevertheless at follow-up, 6 of the 7 BDD patients who had surgery still had a BDD diagnosis and showed higher levels of handicap and psychiatric comorbidity than their non-BDD counterparts. Moreover, 3 non-BDD patients had developed BDD at follow-up. DISCUSSION The high level of satisfaction with their surgery expressed by BDD patients was surprising and in contrast to the literature. It may explain, together with the patients' strong insistence, why plastic surgeons do not fully agree with psychiatrists on the contraindication of plastic surgery for BDD patients. Nevertheless in our study, most of the BDD patients were still diagnosed with BDD 5 years after surgery, with a significant handicap. The BDD diagnosis at follow-up in patients initially without BDD might be related to the presence of sub-threshold symptoms at the initial evaluation. CONCLUSION This prospective study confirms that cosmetic surgery is not effective against BDD despite patients' reported satisfaction. Cosmetic surgery had no significant effects on BDD diagnosis, handicap or psychiatric comorbidity in BDD patients 5 years after surgery. Furthermore, BDD appeared at follow-up in some subjects not initially diagnosed. Patients' reported satisfaction with surgery may help explain why some plastic surgeons do not consider BDD a complete contraindication to cosmetic surgery.
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Affiliation(s)
- Louise Biraben-Gotzamanis
- Université Victor Segalen et CHU de Bordeaux, Hôpital Charles Perrens, F-33076 Bordeaux Cedex, France
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Vulink N, Rosenberg A, Plooij J, Koole R, Bergé S, Denys D. Body dysmorphic disorder screening in maxillofacial outpatients presenting for orthognathic surgery. Int J Oral Maxillofac Surg 2008; 37:985-91. [DOI: 10.1016/j.ijom.2008.06.005] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2007] [Revised: 01/08/2008] [Accepted: 06/06/2008] [Indexed: 10/21/2022]
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