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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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Yang X, Wang X, Li Z, Yi B, Liang C, Liu X, Li Y, He W. The change of state-trait anxiety among patients undergoing orthognathic surgery: A longitudinal study. Am J Orthod Dentofacial Orthop 2024; 165:628-637. [PMID: 38466249 DOI: 10.1016/j.ajodo.2023.12.011] [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: 01/01/2023] [Revised: 12/01/2023] [Accepted: 12/01/2023] [Indexed: 03/12/2024]
Abstract
INTRODUCTION This study aimed to assess state-trait anxiety level changes in Chinese patients with dentofacial discrepancies before and after orthognathic surgery and to explore the feasibility of developing a reference index for the preoperative screening of postoperative patients with high anxiety. METHODS A total of 96 Chinese patients with dentofacial discrepancies who underwent orthognathic surgery were included in this study. Data were collected before orthognathic surgery and at 2 weeks (T2), 3 months, and 6 months (T4) after surgery using the State-Trait Anxiety Inventory. Receiver operating characteristic and linear regression analyses were performed to screen for preoperative indicators of postoperative high-state anxiety. RESULTS State-trait anxiety levels in patients with dentofacial discrepancies decreased after surgery (F = 18.95, P <0.01; F = 6.90, P <0.01). Trait Anxiety Inventory can be used to screen patients with high-state anxiety from T2 to T4 (area under cover 95% confidence interval: T2, 0.74 [0.62-0.86]; 3 months, 0.79 [0.69-0.90]; T4, 0.77 [0.66-0.87], P <0.01), corresponding to cutoff values of 48.5, 46.5, and 45.5, respectively. CONCLUSIONS All participants' state-trait anxiety levels improved after surgery compared with their preoperative levels. Preoperative trait anxiety levels can be used as a reference indicator to screen patients who may have high-state anxiety levels after orthognathic surgery. The creation of a screening scale will assist health care professionals to more pertinently help patients with high anxiety.
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Affiliation(s)
- Xin Yang
- Department of Oral and Maxillofacial Surgery, The affiliated Yantai Stomatological Hospital, Binzhou Medical University, Yantai, Shandong, China
| | - Xiaoxia Wang
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China; National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing, China.
| | - Zili Li
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China; National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing, China
| | - Biao Yi
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China; National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing, China
| | - Cheng Liang
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China; National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing, China
| | - Xiaojing Liu
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China; National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing, China
| | - Yang Li
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China; National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing, China
| | - Wei He
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China; National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing, China
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Pereira IN, Chattopadhyay R, Fitzpatrick S, Nguyen S, Hassan H. Evidence-based review: Screening body dysmorphic disorder in aesthetic clinical settings. J Cosmet Dermatol 2023. [PMID: 36847707 DOI: 10.1111/jocd.15685] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 10/26/2022] [Accepted: 02/02/2023] [Indexed: 03/01/2023]
Abstract
BACKGROUND Body dysmorphic disorder (BDD) is a psychiatric disturbance with high incidence in aesthetic clinical settings. Early recognition may avoid unnecessary elective procedures with ethical and medicolegal consequences. AIMS To identify validated BDD screening tools and critically appraise current literature regarding its implementation and efficacy in aesthetic medicine and surgery scenarios, with the purpose of transposing the findings to the broad clinical settings in the field. METHODS Data was collected using advanced search from PubMed (MEDLINE). Having satisfied the search parameters, 12 studies referring BDD definition according to Diagnostic and Statistical Manual of Mental Disorder (DSM-5) criteria and including a BDD screening tool in clinical aesthetic settings were selected. RESULTS While BDD screening enables the recognition of at-risk individuals, further work is required to uncover the best screening tool for general aesthetic clinical practice. Level III evidence favored BDD Questionnaire (BDDQ)/BDDQ-Dermatology Version (DV), and The Dysmorphic Concern Questionnaire (DCQ) among the limited available validated screening instruments to be used outside the psychiatric environment. Based on level II self-classification, one study selected BDDQ-Aesthetic Surgery (AS) version for rhinoplasty patients. The validation process of both BDDQ-AS and Cosmetic Procedure Screening Questionnaire (COPS) had limitations. For BDD screening potential in avoiding postoperative complications, the limited studies found evaluating the outcomes following aesthetic treatments using validated BDD screening measures showed a trend toward less satisfaction with aesthetic treatment outcome among positive screening population against non-BDD counterparts. CONCLUSION Further research is necessary to establish more effective methods to identify BDD and evaluate the impact of positive findings on aesthetic intervention outcomes. Future studies may elucidate which BDD characteristics best predict a favorable outcome and provide high-quality evidence for standardized protocols in research and clinical practice.
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Affiliation(s)
| | - Rashmi Chattopadhyay
- Barts & The London School of Medicine & Dentistry, Centre for Cutaneous Research, Blizard Institute of Cell and Molecular Science, Queen Mary University, London, UK
| | - Sean Fitzpatrick
- Barts & The London School of Medicine & Dentistry, Centre for Cutaneous Research, Blizard Institute of Cell and Molecular Science, Queen Mary University, London, UK
| | - Sheila Nguyen
- Barts & The London School of Medicine & Dentistry, Centre for Cutaneous Research, Blizard Institute of Cell and Molecular Science, Queen Mary University, London, UK
| | - Haidar Hassan
- Barts & The London School of Medicine & Dentistry, Centre for Cutaneous Research, Blizard Institute of Cell and Molecular Science, Queen Mary University, London, UK
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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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Dons F, Mulier D, Maleux O, Shaheen E, Politis C. Body dysmorphic disorder (BDD) in the orthodontic and orthognathic setting: A systematic review. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2021; 123:e145-e152. [PMID: 34728407 DOI: 10.1016/j.jormas.2021.10.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 10/25/2021] [Indexed: 11/17/2022]
Abstract
General prevalence of Body Dysmorphic Disorder (BDD), a psychiatric disorder in which patients focus on an imagined body defect not visible to others, varies between 0.7 and 2.5%. Up to 86% present with complaints in the area of teeth or face. Patients with BDD pursue an aesthetic rather than functional recovery, making BDD a possible contraindication to treatment. The aim of this systematic review was to review prevalence of BDD within the orthodontic and/or orthognathic population, to describe diagnostic tools for early detection of patients with BDD and to assess the outcome after treatment. A systematic search was conducted up to November 2020 using PubMed, Embase, Web of Science Core Collection and Cochrane Library. Following the screening of 1423 articles, 5 prospective studies were included. Prevalence of BDD within the orthodontic and orthognathic population varied from 5.2% to 13% (average of 6.2%). Literature showed a trend of higher BDD prevalence within younger, female and single patient population, although results are not conclusive. Questionnaires can be useful for preliminary detection of BDD. General anamnesis with questioning medical or psychiatric history, medication and personal expectations remains very important. Red flags could be previous consultations for the same problem or presence of psychiatric comorbidities. Prospective studies are necessary to map satisfaction of these patients and need for re-interventions after treatment.
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Affiliation(s)
- Flore Dons
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium.
| | - Delphine Mulier
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium; Department of Imaging and Pathology, OMFS IMPATH Research Group, Faculty of Medicine, KU Leuven, Leuven, Belgium
| | - Olivia Maleux
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Eman Shaheen
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium; Department of Imaging and Pathology, OMFS IMPATH Research Group, Faculty of Medicine, KU Leuven, Leuven, Belgium
| | - Constantinus Politis
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium; Department of Imaging and Pathology, OMFS IMPATH Research Group, Faculty of Medicine, KU Leuven, Leuven, Belgium
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Psychological symptoms and salivary inflammatory biomarkers in patients with dentofacial deformities: a case-control study. Sci Rep 2021; 11:11083. [PMID: 34040126 PMCID: PMC8155030 DOI: 10.1038/s41598-021-90721-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 05/17/2021] [Indexed: 12/02/2022] Open
Abstract
Individuals with dentofacial deformities often display a low quality of life (QoL) through biological mechanisms that remain unraveled. In this case–control study, the salivary levels of cytokines, glutamate, and kynurenine metabolites were assessed in patients undergoing orthognathic surgery (OS), while correlating these parameters with QoL and psychological symptoms. Thirty-six patients were enrolled in control (under orthodontic treatment) and test (undergoing OS) groups, matched by age and sex. The QoL was assessed through the World Health Organization Quality of Life BREF (WHOQOL-BREF) and the Orthognathic Quality of Life Questionnaire (OQLQ). The psychological symptoms were evaluated by the Satisfaction with Life Scale, the Rosenberg Self-Esteem Scale (RSES), and the Depression, Anxiety, and Stress Scale-21 (DASS-21). The salivary levels of IL-1β, IL-6, IL-10, glutamate, and kynurenine metabolites were evaluated. The OQLQ demonstrated increased QoL scores in the test group, regarding social aspects, facial esthetics, and function domains, without significant differences in respect to the other surveys. These patients displayed higher IL-1β and glutamate levels; conversely, the kynurenine metabolites were unaltered. The glutamate levels positively correlated with the OQLQ function scores. The data brings novel evidence about the psychobiological features of patients with dentofacial deformities, showing salivary variations of inflammatory biomarkers in these individuals.
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Smorthit K, Sawbridge D, Fitzgerald R. Eating disorders and the orthodontist: Diagnosis, considerations and referral. J Orthod 2021; 48:313-322. [PMID: 33611972 DOI: 10.1177/1465312521993491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Eating disorders are relatively common mental health disorders in Western European and North American populations. The peak incidence occurs within the adolescent years, which correlates with the largest orthodontic patient population. The morbidity associated with these psychological conditions is significant, and has a direct impact upon patient well-being, orthodontic outcomes and the success of treatment. Therefore, it is of relevance to the orthodontist to be aware of potential presenting features of these conditions, when and where to seek advice, and how such disorders may impact upon orthodontic outcomes. METHODS Articles published on PUBMED and MEDLINE relevant to orthodontics and eating disorders were reviewed. Key information was extracted, and the relevant evidence for the orthodontist summarised. RESULTS Eating disorders may present to the orthodontist in specialist or hospital practice, either undiagnosed or as a co-morbidity. Orthodontists may benefit from an appreciation of these potential diagnoses, the orthodontic implications and to have the confidence to refer their patients to the necessary services. LIMITATIONS There is little existing research in this area. CONCLUSIONS These conditions have a significant impact on patient morbidity and mortality. This cohort of patients is not suitable for orthodontic treatment while their disease is active. The impact of a developing eating disorder can adversely affect orthodontic treatment.
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Affiliation(s)
- Kelly Smorthit
- Orthodontic Department, Lancashire Teaching Hospitals NHS Trust, Preston, Lancashire, UK
| | - David Sawbridge
- Department of Gastroenterology and Hepatology, Cork University Hospital, Cork, Republic of Ireland
| | - Rhian Fitzgerald
- Orthodontic Department, Alder Hey Children's Hospital, Liverpool, UK
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Casey C, Sharma PK, Ali N, Taylor N, Priestley C, Kingsley M, Royan L. Establishing a clinical psychology team within the orthognathic service: A triad model of orthodontic, maxillofacial and psychological care. J Orthod 2021; 48:190-198. [PMID: 33427022 DOI: 10.1177/1465312520981588] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The importance of psychological support for orthognathic patients has taken an increasing precedence over recent years and is embedded in orthognathic commissioning guidelines. Furthermore, attention towards mental health-related conditions and their management is of prime importance and continues to be a key area of focus within healthcare settings. With this in mind, this paper aims to outline our experience of establishing a need for and subsequently securing funding to establish a clinical psychology service within an existing orthognathic service in the NHS. The information outlined may be of benefit to orthognathic teams seeking to secure such psychological support within their respective units.
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Affiliation(s)
- Christine Casey
- Orthodontic Department, Whipps Cross University Hospital, London, UK.,Centre for Oral Bioengineering, Institute of Dentistry, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Pratik K Sharma
- Centre for Oral Bioengineering, Institute of Dentistry, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Nayeem Ali
- Department of Oral and Maxillofacial Surgery. Royal London Dental Hospital, London, UK
| | - Nicola Taylor
- Dental Psychology Service, Kings College Dental Institute, London, UK
| | - Charlotte Priestley
- Dental, Oral and Trauma Clinical Psychology Service, Royal London Dental Hospital, London, UK
| | - Marc Kingsley
- Clinical Health Psychology Services, North East London Foundation Trust (NELFT), London, UK
| | - Lindsay Royan
- Clinical Health Psychology Services, North East London Foundation Trust (NELFT), London, UK
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Self-Worth and Self-Knowledge in Iranian Patients Seeking Cosmetic Surgery: A Comparative Study. JOURNAL OF PACIFIC RIM PSYCHOLOGY 2021. [DOI: 10.1177/1834490920974761] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Prior research has reported a psychological impairment in patients seeking cosmetic surgery. However, the role of other variables such as contingencies of self-worth and self-knowledge has been ignored. Hence, the aim of this study was to examine new psychological structures, contingencies of self-worth, and self-knowledge among patients seeking cosmetic surgery. Eighty patients (47 female and 33 male; mean age = 28.98, SD = 8.32; 40 seeking cosmetic surgery and 40 seeking surgical treatment) were randomly recruited from the Shahid Motahhari clinic in Shiraz, Iran. The patients completed the Contingencies of Self-Worth Scale, Integrative Self-Knowledge Scale, Subjective Vitality Scale, and Depression Anxiety Stress Scale-21. The results showed that, compared to the surgical treatment group, self-worth in patients seeking cosmetic surgery was found to depend on their appearance and the approval of others. Further, the self-knowledge in patients seeking cosmetic surgery was lower than that of patients seeking surgical treatment. In addition, there were no significant differences between the two groups in vitality, depression, anxiety, and stress. It can be concluded that patients seeking cosmetic surgery have lower self-knowledge and their self-esteem depends on their appearance and the approval of others.
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Body Image Disturbance and Obsessive-Compulsive Disorder Symptoms Improve After Orthognathic Surgery. J Oral Maxillofac Surg 2020; 78:2054-2060. [DOI: 10.1016/j.joms.2020.07.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 07/17/2020] [Accepted: 07/17/2020] [Indexed: 11/30/2022]
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Sinnott PM, Hunt N, Shute J, Cunningham S. Psychological support for orthognathic patients: Who is doing what? J Orthod 2020; 47:205-212. [PMID: 32500802 DOI: 10.1177/1465312520929032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To investigate: (1) orthodontists' training experience in the psychological assessment of orthognathic patients and their wish for training/further training; (2) the availability of psychological support, referral patterns and outcomes after referral; (3) and adverse incidents prompting orthodontists to refer patients for psychological assessment. DESIGN Prospective cross-sectional study. METHODS A 25-item questionnaire was designed to investigate the above mentioned aims. After a pilot study, the questionnaire was distributed to all members of the Consultant Orthodontist Group, British Orthodontic Society. RESULTS Based on a 29.1% response rate (n = 102), 76.5% of respondents had undertaken training in identifying orthognathic patients who may benefit from psychological assessment. However, 90.2% favoured further training. All respondents believed that some orthognathic patients would benefit from referral; however, 31.3% of units referred no patients at all, mostly due to limited/no access (66.7%). Most referrals (68.9%) were to psychiatrists/psychologists with dentofacial deformity expertise, with 28.9% of units having such services onsite (14 different units). Psychological referrals had potentially useful outcomes, with 36.4% of respondents sometimes changing treatment plans following referral. Clinical incidents were experienced by 35.1% of respondents, prompting referral of patients for psychological assessment; such incidents included patient suicides (n = 4). CONCLUSION Most respondents had trained in psychological assessment of orthognathic patients; however there was a large demand for further training. Clinicians value the psychological services available; however, limited availability may affect referrals for some respondents. Adverse incidents are of real concern and highlight the need to ensure that training and resources are provided to support orthognathic patients and teams.
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Affiliation(s)
- Paula Mairead Sinnott
- Department of Orthodontics, Eastman Dental Hospital (University College London Hospitals), London, UK
| | - Nigel Hunt
- Department of Orthodontics, UCL Eastman Dental Institute, Rockefeller Building, London, UK
| | - Justin Shute
- Department of Orthodontics, Eastman Dental Hospital (University College London Hospitals), London, UK
| | - Susan Cunningham
- Department of Orthodontics, UCL Eastman Dental Institute, Rockefeller Building, London, UK
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Mathew P, Mathai PC, David J, Shenoy U, Tiwari R. Current Orthognathic Practice in India: Do We Need to Change? J Maxillofac Oral Surg 2020; 19:1-11. [PMID: 31988555 PMCID: PMC6954926 DOI: 10.1007/s12663-019-01269-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The last decade or so has seen paradigm shifts in the various aspects of orthognathic surgery. A lot of these changes are to do with digitalization of the orthodontic-surgical workflow, optimization of surgery-first protocols, virtual surgical planning-based 3D printing solutions and changing patient-health-care dynamics. The aim of this article is to provide evidence-based recommendations that are both practical and economically viable for the current orthognathic practice in India.
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Affiliation(s)
- Philip Mathew
- Department of Maxillofacial Surgery, Jubilee Mission Medical College, Thrissur, India
| | - Paul C. Mathai
- Department of Maxillofacial Surgery, Jubilee Mission Medical College, Thrissur, India
| | - Jisha David
- Department of Maxillofacial Surgery, Jubilee Mission Medical College, Thrissur, India
| | - Usha Shenoy
- Department of Anesthesiology, Jubilee Mission Medical College, Thrissur, India
| | - Rahul Tiwari
- Department of Maxillofacial Surgery, Jubilee Mission Medical College, Thrissur, India
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Psychological profiles in patients undergoing orthognathic surgery or rhinoplasty: a preoperative and preliminary comparison. Oral Maxillofac Surg 2019; 23:179-186. [PMID: 31016403 DOI: 10.1007/s10006-019-00758-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 04/12/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVE The aim of this study was to assess, identify, and compare the personality traits and psychosocial status of two groups of patients undergoing orthognathic surgery and rhinoseptoplasty respectively. STUDY DESIGN This prospective study recruited patients referred for orthognathic surgery and for rhinoseptoplasty. The research protocol included the administrations of questionnaires to the patients during their last visit before surgery, including the Minnesota Multiphasic Personality Inventory (MMPI-2), the Myers-Briggs Type Indicator (MBTI), the tree drawing test (or Baum test), and the BC Scale. RESULTS As for MMPI-2, the highest (pathological) percentages were encountered in Hypochondriasis and Psychasthenia scales within the Orthognathic Surgery Group, whereas in the rhinoseptoplasty group, the highest scores were obtained in the Hypochondriasis, Psychasthenia, Psychopathic Deviate, and Schizophrenia scales. CONCLUSIONS It would be important to assess some characteristics of the patients' mental health and emotional state prior to surgery, including depression, anxiety, panic, and aggression. The overview of these factors may give an insight into the psychological and emotional capacity of the patients undergoing orthognathic and rhinoseptoplasty surgery.
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Selvaraj AK, Benington PCM, Murphy L, Ayoub AF. Psychology input to an orthognathic clinic: Patients' perception of service quality. Surgeon 2019; 17:340-345. [PMID: 30661952 DOI: 10.1016/j.surge.2018.11.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 07/24/2018] [Accepted: 11/20/2018] [Indexed: 11/17/2022]
Abstract
AIMS The aim of this study was to assess patient satisfaction with a clinical psychology service, integrated within an inter-disciplinary orthognathic planning clinic. METHOD A self-report, custom-designed questionnaire was sent to patients who had completed orthognathic treatment within the last three years. Of the 60 patients approached, 49 responded. RESULTS The great majority of patients agreed that there was a need for a psychological assessment and that its purpose was adequately explained. Most patients were happy with the information given during their appointment and found the experience helpful. A number of patients felt that additional appointments would have been helpful shortly before, and after, surgery. CONCLUSIONS The group of orthognathic patients studied found the pre-treatment psychology assessment, provided for them through the combined clinic, to be very acceptable and beneficial. Some suggested that further appointments, throughout the treatment journey, as well as supportive literature, might also have been helpful.
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Wei L, Ge C, Xiao W, Zhang X, Xu J. Cross-sectional investigation and analysis of anxiety and depression in preoperative patients in the outpatient department of aesthetic plastic surgery in a general hospital in China. J Plast Reconstr Aesthet Surg 2018; 71:1539-1546. [PMID: 30172728 DOI: 10.1016/j.bjps.2018.07.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 06/24/2018] [Accepted: 07/28/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE This study was designed to evaluate anxiety and depression disorders and investigate the prevalence and risk factors in preoperative patients who visited a cosmetic plastic surgery clinic. METHODS The estimate of anxiety and depression in preoperative patients, who were admitted to the outpatient department of plastic surgery in a general hospital from July 2016 to July 2017, was determined by a field survey method using the Hospital Anxiety and Depression Scale. The demographic information of all patients was collected. All data were analyzed by SPSS statistical package. RESULTS A total of 315 patients were enrolled, which included 15 males and 300 females, with an average age of 30 ± 8.4 years. The mean HADS score was 8.2 ± 5.13, HADS-A was 4.7 ± 3.04, and HADS-D was 3.5 ± 2.72. The HADS-A score was significantly higher than the HADS-D score (p = 0.000). There were 34 cases (10.8%) with anxiety, 15 cases (4.8%) with depression, and 6 cases (1.9%) with both anxiety and depression. We found that the education level of these patients (p = 0.001) and the development level of their residence places (p = 0.040) have a negative correlation with the score of anxiety. There was a negative correlation between education level (p = 0.000) and depression score. Education level was associated with the diagnosis of anxiety (p = 0.034). Education level (p = 0.001) and occupation (p = 0.015) were associated with the diagnosis of depression. CONCLUSION In patients seeking cosmetic plastic surgery, the preoperative anxiety is more obvious than depression. There is a negative correlation between education level and anxiety and depressive symptoms.
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Affiliation(s)
- Liyuan Wei
- Department of Plastic Surgery, The First Affiliated Hospital, College of Medicine, Zhejiang University, No.79 Qingchun Road, Shangcheng District, Hangzhou, Zhejiang 310003, PR China.
| | - Chaoyi Ge
- Department of Gastroenterology, The First Hospital of Peking University, No.8 Xishiku Street, Beijing 100034, PR China.
| | - Wei Xiao
- Department of Plastic Surgery, The First Affiliated Hospital, College of Medicine, Zhejiang University, No.79 Qingchun Road, Shangcheng District, Hangzhou, Zhejiang 310003, PR China.
| | - Xiaochen Zhang
- Department of Medical Oncology, the First Affiliated Hospital, College of Medicine, Zhejiang University, No.79 Qingchun Road, Shangcheng District, Hangzhou, Zhejiang 310003, PR China.
| | - Jinghong Xu
- Department of Plastic Surgery, The First Affiliated Hospital, College of Medicine, Zhejiang University, No.79 Qingchun Road, Shangcheng District, Hangzhou, Zhejiang 310003, PR China.
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Valikhani A, Goodarzi MA. Contingencies of Self-Worth and Psychological Distress in Iranian Patients Seeking Cosmetic Surgery: Integrative Self-Knowledge as Mediator. Aesthetic Plast Surg 2017; 41:955-963. [PMID: 28374299 DOI: 10.1007/s00266-017-0853-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2017] [Accepted: 03/03/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Although previous studies have shown that people applying for cosmetic surgery experience high-intensity psychological distress, important variables that function as protective factors have rarely been the subject of study in this population. Therefore, this study aims to investigate the role of low and high self-knowledge in experiencing psychological distress and contingencies of self-worth to appearance and approval from others and to identify the mediatory role of the integrative self-knowledge in patients seeking cosmetic surgery. METHODS Eighty-eight patients seeking cosmetic surgery were selected and completed the contingencies of self-worth and integrative self-knowledge scales, as well as the depression, anxiety and stress scale. Data were analyzed using multivariate analysis of variance (MANOVA) and path analysis using 5000 bootstrap resampling. RESULTS The results of MANOVA showed that patients seeking cosmetic surgery with high self-knowledge had lower levels of depression, anxiety and stress compared to patients with low self-knowledge. They also gained lower scores in contingencies of self-worth to appearance and approval from others. The results of path analysis indicated that self-knowledge is a complete mediator in the relationship between contingencies of self-worth to appearance and approval from others and psychological distress. CONCLUSION Based on the results of this study, it can be concluded that self-knowledge as a protective factor plays a major role in relation to the psychological distress experienced by the patients seeking cosmetic surgery. In fact, by increasing self-knowledge among this group of patients, their psychological distress can be decreased. 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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Affiliation(s)
- Ahmad Valikhani
- Department of Clinical Psychology, College of Education and Psychology, Shiraz University, Shiraz, Iran
| | - Mohammad Ali Goodarzi
- Department of Clinical Psychology, College of Education and Psychology, Shiraz University, Shiraz, Iran.
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Cariati P, Martínez R, Martínez-Lara I. Psycho-social impact of orthogathic sugery. J Clin Exp Dent 2016; 8:e540-e545. [PMID: 27957267 PMCID: PMC5149088 DOI: 10.4317/jced.53007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Accepted: 03/12/2016] [Indexed: 11/25/2022] Open
Abstract
Background Orthognathic surgery is a branch of maxillofacial surgery. It carries out the treatment of the facial skeleton asymmetries and deformities. The patients who ask for this surgery are often young people who usually refer symptoms related to dental malocclusion, difficulty eating and temporo-mandibular pain. These physical symptoms are often accompanied by psychological symptoms triggered by their physical appearance such as low self-esteem, self-confidence and negativism about their social and emotional future. Material and Methods Patients with skeletal malformation of facial bones, consisting in Class II, III, open bite and asymmetries, underwent to orthognathic surgery in our center agreed to participate voluntarily in this study. They answered a questionnaire regarding several psychosocial variables. Results Orthognathic surgery helps to improve patient’s psychosocial well-being. Conclusions Patients with dentofacial deformitiesexperience physical and psychological, oftentimes underestimated by society. A combination of orthodontic treatment and reconstructive surgery is often a necessity to restore function and psychosocial well-being. Key words:Orthogathic surgery, psychosocial consequences, mood, emotions, sense of power, motivation, satisfaction, social changes, satisfaction.
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Affiliation(s)
- Paolo Cariati
- Oral and Maxillofacial surgery resident. Hospital Universitario Virgen de las nieves, Granada, Spain
| | - Rocío Martínez
- Social Psychology Department. University of Granada. Campus Cartuja s/n. 18001, Granada, Spain
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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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Schieber K, Martin A. Die körperdysmorphe Störung: aktuelle Entwicklungen zu Diagnostik, Störungswissen und Therapie. ACTA ACUST UNITED AC 2016. [DOI: 10.1055/s-0041-105934] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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