Restricted accessResearch articleFirst published online 2024-06
Prevalence and Characteristics Associated with Positive Body Dysmorphic Disorder Screening Among Patients Presenting for Cosmetic Facial Plastic Surgery
Many patients with body dysmorphic disorder (BDD) seek out cosmetic surgery to alleviate their symptoms of distress related to a perceived defect in their appearance; however, the prevalence and risk factors for BDD among patients with cosmetic concerns have not been well characterized.
Methods:
We screened adult patients presenting to the clinic from June 2021 through September 2022 for BDD using the BDD Questionnaire—Aesthetic Surgery (BDDQ-AS) who were seen in consultation for rhinoplasty, aging face, and injectables.
Results:
Among 488 patients, the prevalence of screening positive for BDD was 41.0%. The prevalence of a positive BDD screen was highest among patients who were younger (p = 0.02), and those who had a positive self-reported psychiatric history (p = 0.02). Among rhinoplasty patients, those with aesthetic/cosmetic motivations, and those seeking revision rhinoplasty had higher rates of positive BDD screen. Higher scores on the Standardized Cosmesis and Health Nasal Outcomes Survey—Nasal Obstruction Score (SCHNOS-O) (p = 0.01) and Standardized Cosmesis and Health Nasal Outcomes Survey—Nasal Obstruction Score—Nasal Cosmesis Score (SCHNOS-C) (p < 0.0001) were predictive of a positive BDD screen, while question 5 of the SCHNOS was highly predictive of positive BDD screening (p < 0.0001).
Conclusions:
Our study characterizes relationships between positive BDD screening and age, gender, self-reported psychiatric history, and motivations for consultation, among patients seen for cosmetic surgery evaluation in a facial plastic and reconstructive surgery setting.
GreenbergJL, WeingardenH, WilhelmS. A practical guide to managing body dysmorphic disorder in the Cosmetic Surgery Setting. JAMA Facial Plast Surg. 2019; 21(3):181–182.
3.
HigginsS, WysongA. Cosmetic surgery and body dysmorphic disorder—an update. Int J Womens Dermatol. 2018; 4(1):43–48.
4.
OttoMW, WilhelmS, CohenLS, HarlowBL. Prevalence of body dysmorphic disorder in a Community Sample of Women. Am J Psychiatry. 2001; 158(12):2061–2063.
5.
PicavetVA, ProkopakisEP, GabriëlsL, JorissenM, HellingsPW. High prevalence of body dysmorphic disorder symptoms in patients seeking rhinoplasty. Plast Reconstr Surg. 2011; 128(2):509–517.
6.
BienvenuOJ, SamuelsJF, RiddleMA, et al.The relationship of obsessive–compulsive disorder to possible spectrum disorders: results from a family study. Biol Psychiatry. 2000; 48(4):287–293.
7.
VealeD. Outcome of cosmetic surgery and ‘DIY’ surgery in patients with body dysmorphic disorder. Psychiatr Bull. 2000; 24(6):218–221.
8.
von SoestT, KvalemIL, RoaldHE, SkolleborgKC. The effects of cosmetic surgery on body image, self-esteem, and psychological problems. J Plast Reconstr Aesthet Surg. 2009; 62(10):1238–1244.
9.
PhillipsKA, GrantJ, SiniscalchiJ, AlbertiniRS. Surgical and nonpsychiatric medical treatment of patients with body dysmorphic disorder. Psychosomatics. 2001; 42(6):504–510.
10.
SahraianA, JanipourM, TarjanA, ZareizadehZ, HabibiP, BabaeiA. Body dysmorphic and narcissistic personality disorder in Cosmetic Rhinoplasty Candidates. Aesthetic Plast Surg. 2022; 46(1):332–337.
11.
LekakisG, PicavetVA, GabriëlsL, GrietensJ, HellingsPW. Body dysmorphic disorder in aesthetic rhinoplasty: validating a new screening tool. Laryngoscope. 2016; 126(8):1739–1745.
12.
De BritoMJA, NahasFX, CordásTA, TavaresH, FerreiraLM. Body dysmorphic disorder in patients seeking abdominoplasty, rhinoplasty, and rhytidectomy. Plast Reconstr Surg. 2016; 137(2):462–471
13.
De SouzaTSC, PatrialMTCRDO, MeneguettiAFC, De SouzaMSC, MeneguettiME, RossatoVF. Body dysmorphic disorder in rhinoplasty candidates: prevalence and functional correlations. Aesthetic Plast Surg. 2021; 45(2):641–648.
14.
SpataroEA, KandathilCK, SaltychevM, OldsCE, MostSP. Correlation of the standardized cosmesis and health nasal outcomes survey with Psychiatric Screening Tools. Aesthet Surg J. 2020; 40(12):1373–1380.
15.
SarwerD. Awareness and identification of body dysmorphic disorder by aesthetic surgeons: results of a survey of American Society for aesthetic plastic surgery members. Aesthet Surg J. 2002; 22(6):531–535.
16.
DeyJK, IshiiM, PhillisM, ByrnePJ, BoaheneKDO, IshiiLE. Body Dysmorphic disorder in a facial plastic and reconstructive surgery clinic: measuring prevalence, assessing comorbidities, and validating a Feasible Screening Instrument. JAMA Facial Plast Surg. 2015; 17(2):137–143.
17.
JosephAW, IshiiL, JosephSS, et al.Prevalence of body dysmorphic disorder and surgeon diagnostic accuracy in facial plastic and oculoplastic surgery clinics. JAMA Facial Plast Surg. 2017; 19(4):269–274.
18.
McGrathLR, OeyL, McDonaldS, BerleD, WoottonBM. Prevalence of body dysmorphic disorder: a systematic review and meta-analysis. Body Image. 2023; 46:202–211.
19.
WilliamsJ, HadjistavropoulosT, SharpeD. A meta-analysis of psychological and pharmacological treatments for Body Dysmorphic Disorder. Behav Res Ther. 2006; 44(1):99–111.
20.
PhillipsKA, HollanderE. Treating body dysmorphic disorder with medication: evidence, misconceptions, and a suggested approach. Body Image. 2008; 5(1):13–27.
21.
MoubayedSP, IoannidisJPA, SaltychevM, MostSP. The 10-Item Standardized Cosmesis and Health Nasal Outcomes Survey (SCHNOS) for functional and cosmetic rhinoplasty. JAMA Facial Plast Surg. 2018; 20(1):37–42.
22.
AbdelwahabM, SaltychevM, ElkholyNA, ElsisiH, MoubayedSP, MostSP. Arabic Validation of the Standardized Cosmesis and Health Nasal Outcome Survey (SCHNOS) for Arabic-speaking Rhinoplasty Patients [published online December 2018]. Plast Reconstr Surg. 1. doi:10.1097/00006534-900000000-97687
23.
AtallahMR, MiladD, BenamerYH, SaltychevM, MostSP, MoubayedSP. Translation, cultural adaptation and validation of the SCHNOS in French. J Otolaryngol Head Neck Surg. 2019; 48(1):17.
24.
Rahavi-EzabadiS, MostSP, SaltychevM, SazgarAA, MoubayedSP, SaediB. Validation of the Persian Language Version of the Standardized Cosmesis and Health Nasal Outcomes Survey (SCHNOS). JAMA Facial Plast Surg. 2018; 20(6):521–523.
25.
Perez-GarciaIC, PeñarandaA, CoboR, HernandezAV, MoubayedSP, MostSP. Spanish translation, cultural adaptation, and validation of the Standardized Cosmesis and Health Nasal Outcomes Survey Questionnaire. Plast Reconstr Surg Glob Open. 2019; 7(3):e2153.
26.
KandathilCK, SaltychevM, PatelPN, MostSP. Natural history of the standardized cosmesis and health nasal outcomes survey after rhinoplasty. Laryngoscope. 2021; 131(1):E116–E123.
27.
SaltychevM, KandathilCK, AbdelwahabM, SpataroEA, MoubayedSP, MostSP. Psychometric properties of the Standardized Cosmesis and Health Nasal Outcomes Survey: item response theory analysis. JAMA Facial Plast Surg. 2018; 20(6):519–521.
28.
KandathilCK, SaltychevM, AbdelwahabM, SpataroEA, MoubayedSP, MostSP. Minimal clinically important difference of the Standardized Cosmesis and Health Nasal Outcomes Survey. Aesthet Surg J. 2019; 39(8):837–840.
29.
TunesRS, PatrocinioLG, SaltychevM, MoubayedSP, MostSP. Validation of the Portuguese Language Version of the Standardized Cosmesis and Health Nasal Outcomes Survey. Facial Plast Surg Aesthetic Med. 2020; 22(2):114–116.
30.
OklandTS, PatelP, LiuGS, MostSP. Using nasal self-esteem to predict revision in cosmetic rhinoplasty. Aesthet Surg J. 2021; 41(6):652–656.
31.
Himanshu, KaurA, KaurA, SinglaG. Rising dysmorphia among adolescents: a cause for concern. J Fam Med Prim Care. 2020; 9(2):567.
32.
RydingFC, KussDJ. The use of social networking sites, body image dissatisfaction, and body dysmorphic disorder: a systematic review of psychological research. Psychol Pop Media. 2020; 9(4):412–435.
33.
AhmadpanahM, ArjiM, ArjiJ, et al.Sociocultural attitudes towards appearance, self-esteem and symptoms of body-dysmorphic disorders among young adults. Int J Environ Res Public Health. 2019; 16(21):4236.
34.
ErolRY, OrthU. Self-esteem development from age 14 to 30 years: a longitudinal study. J Pers Soc Psychol. 2011; 101(3):607–619.
35.
HakimRF, AlrahmaniDA, AhmedDM, AlharthiNA, FidaAR, Al-RaddadiRM. Association of body dysmorphic disorder with anxiety, depression, and stress among university students. J Taibah Univ Med Sci. 2021; 16(5):689–694.
36.
SarwerDB, CashTF, MageeL, et al.Female college students and cosmetic surgery: an investigation of experiences, attitudes, and body image. Plast Reconstr Surg. 2005; 115(3):931–938.
37.
BohneA, WilhelmS, KeuthenNJ, FlorinI, BaerL, JenikeMA. Prevalence of body dysmorphic disorder in a German college student sample. Psychiatry Res. 2002; 109(1):101–104.
38.
CanseverA, Uzun Ö, DönmezE, ÖzşahinA. The prevalence and clinical features of body dysmorphic disorder in college students: a study in a Turkish sample. Compr Psychiatry. 2003; 44(1):60–64.
39.
PhillipsKA, DiazSF. Gender differences in body dysmorphic disorder. J Nerv Ment Dis. 1997; 185(9):570–577.
40.
TaquiAM, ShaikhM, GowaniSA, et al.Body dysmorphic disorder: gender differences and prevalence in a Pakistani medical student population. BMC Psychiatry. 2008; 8(1):20.
41.
EndeKH, LewisDL, KabakerSS. Body dysmorphic disorder. Facial Plast Surg Clin N Am. 2008; 16(2):217–223.
42.
BjornssonAS, DidieER, GrantJE, MenardW, StalkerE, PhillipsKA. Age at onset and clinical correlates in body dysmorphic disorder. Compr Psychiatry. 2013; 54(7):893–903.
43.
TignolJ, Biraben-GotzamanisL, Martin-GuehlC, GrabotD, AouizerateB. 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. 2007; 22(8):520–524.
44.
PicavetVA, GabriëlsL, GrietensJ, JorissenM, ProkopakisEP, HellingsPW. Preoperative symptoms of body dysmorphic disorder determine postoperative satisfaction and quality of life in aesthetic rhinoplasty. Plast Reconstr Surg. 2013; 131(4):861–868.
45.
RabaioliL, OppermannPDO, PilatiNP, et al.Evaluation of postoperative satisfaction with rhinoseptoplasty in patients with symptoms of body dysmorphic disorder. Braz J Otorhinolaryngol. 2022; 88(4):539–545.
46.
FelixGAA, De BritoMJA, NahasFX, et al.Patients with mild to moderate body dysmorphic disorder may benefit from rhinoplasty. J Plast Reconstr Aesthet Surg. 2014; 67(5):646–654.
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