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Rate of Body Dysmorphic Disorder Among Patients Seeking Facial Plastic Surgery
Abstract
Results suggest that 8% of patients who sought cosmetic medical treatments and 7% of those who sought non-cosmetic medical treatments met diagnostic criteria for BDD. Coupled with the evidence that suggests that the vast majority of patients do not experience improvement in their BDD symptoms following cosmetic treatments,2 the results further illustrate the need for the assessment of BDD in medical settings that offer appearance-related treatments.
... 9,10 The prevalence of BDD is approximately 2.4% in the general population. 1 The reported prevalence of BDD in patients presenting for facial plastic and oculoplastic surgery varies significantly, likely owing to varying patient populations and inconsistent screening methods. [11][12][13][14][15][16][17][18] Furthermore, because formal and routine screening for BDD is uncommon in these practices, there is often an underdetection of BDD. 2,3,6,18 More recent studies suggest that the prevalence of BDD is up to 13% in the facial plastic surgery setting and 6.9% in the oculoplastic surgery practice. ...
... [11][12][13][14][15][16][17][18] Furthermore, because formal and routine screening for BDD is uncommon in these practices, there is often an underdetection of BDD. 2,3,6,18 More recent studies suggest that the prevalence of BDD is up to 13% in the facial plastic surgery setting and 6.9% in the oculoplastic surgery practice. 19,20 The Body Dysmorphic Disorder Questionnaire (BDDQ) was developed in the psychiatric setting for BDD screening. ...
... These findings are consistent with those that were recently reported elsewhere. 17, 18,20 There was no significant difference in the proportion of patients screening positive on BDDQ across the various practice settings (academic vs private practice, facial plastic vs oculoplastic surgery). The BDDQ-positive patients were also shown to have significantly lower baseline satisfaction on all outcome measures tested (FACE-Q, ROE, BOE, FOE, SROE). ...
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.
... [10][11][12][13] Moreover, due to the uncommon and unusual screening of patients with BDD, there is usually an underdetection of patients with BDD. 6,8,18 Body dysmorphic disorder patients who undergo cosmetic surgery usually consume the surgeon's effort and time with multiple requests for multiple procedures and consultations. ...
... Moreover, patients with BDD are also more prone to consider lawsuits against their surgeons or even become physically violent. [18][19][20] These major concerns emphasize the importance of accurately diagnosing patients with BDD attending cosmetic management. Cross-sectional studies are required to offer data on the prevalence of BDD in plastic surgery and oculoplastic surgery clinics. ...
Objectives:
To determine the prevalence of positive screening of body dysmorphic disorder (BDD) among patients seeking cosmetic surgeries in plastic surgery and oculoplastic surgery clinics.
Methods:
The survey of this cross-sectional study was self-administrated and distributed among adults pursuing cosmetic surgeries in plastic surgery and oculoplastic surgery clinics at King Abdulaziz University Hospital, Jeddah, Saudi Arabia, between March 2019 and March 2020. The BDD questionnaire was validated, and a highly sensitive and specific tool was used to identify patients with BDD. Ethical approval was granted by the Research Ethics Committee. All analytic studies were performed using IBM SPSS, version 24. Results: A total of 344 patients participated in this study with a mean age of 39.66 ± 13.76 years. Of these, 296 (86%) were women and 298 (86.6%) were Saudi. The prevalence of positive screening for BDD was 19.2%. The most commonly requested procedures were abdominoplasty (21.2%) and skin lesion removal (21.2%). Smoking was found to be significantly associated with BDD with 21.2% of smokers having it (p less than 0.010).
Conclusion:
Body dysmorphic disorder was unrecognized among patients pursuing cosmetic surgeries. One-fifth of patients requesting cosmetic procedures are potential cases of BDD requiring psychiatric evaluation and treatment. We recommend implementing screening protocols to identify cases before surgical plans.
... 49 Due to infrequent screening, the rate of BDD is underestimated and underdetected, and there are no guidelines for proper identification of BDD in patients seeking aesthetic surgery. 4,32,[50][51][52] The ability of surgeons to detect BDD in their patients is very poor, as evidenced by Joseph et al, who found that of 597 patients surveyed, 58 (9.7%) screened positive on a BDD questionnaire; however, only 2 of these patients were correctly identified by cosmetic surgeons. 53 Thus, it is recommended that validated screening tools for BDD be used to assess for this diagnosis at the time of initial consultation. ...
... Despite the relatively short nature of validated BDD screening tools such as body dysmorphic disorder questionnaire (BDDQ) or BDDQ-Aesthetic Surgery (BDDQ-AS) available for utilization in the rhinoplasty patient population, many surgeons do not employ these, because added patient questionnaires become time-consuming to manage for both the patient and the physician. 4,32,50,51 Therefore, it would be useful if a patient questionnaire already being utilized to assess rhinoplasty outcomes could also serve as an initial screening tool for the important diagnosis of BDD or other mental health disorders. One such screening tool recently validated for both cosmetic and functional rhinoplasty is the Standardized Cosmesis and Health Nasal Outcomes Survey (SCHNOS). ...
Background
Identifying mental health disorders, including body dysmorphic disorder (BDD), is important prior to rhinoplasty surgery, however, these disorders are underdiagnosed, and screening tools are underutilized in clinical settings.
Objective
To evaluate the correlation of a rhinoplasty outcomes tool (SCHNOS) with psychiatric screening tools.
Methods
Patients presenting for rhinoplasty consultation were prospectively enrolled and administered mental health instruments to assess depression (PHQ-9), anxiety (GAD-7) and BDD (BDDQ-AS), as well as the SCHNOS rhinoplasty outcomes scale. Convergent validity of SCHNOS scores with these mental health instruments were assessed, as well as calculation of an optimal SCHNOS-C score to screen for BDD.
Results
76 patients were enrolled in the study. The average SCHNOS-O score (SD) was 46.1 (34.0) and average SCHNOS-C score was 61.1 (27.0). Five (7%) patients screened positive for depression, while 24 (32%) patients screened positive for mild, 5 (7%) for moderate, and 4 (5%) for severe anxiety. 24 (32%) patients screened positive for BDD by BDDQ-AS scores. SCHNOS-O and SCHNOS-C did not correlate with PHQ-9 or GAD-7 scores; SCHNOS-C did correlate with BDDQ-AS. A score of 73 or greater on SCHNOS-C maximized the sensitivity and specificity of also screening positive for BDD with BDDQ-AS. This score correlated with a sensitivity of 62.5%, specificity of 80.8%, and number needed to diagnose of 2.3, meaning for every 2 patients with a score of ≥73 on SCHNOS-C, one will have a positive BDDQ-AS score.
Conclusions
SCHNOS-C correlates with BDDQ-AS and may help screen rhinoplasty patients at higher risk for BDD.
... Studies indicate that the prevalence of BDD is significantly higher among individuals seeking aesthetic surgeries compared to the general population [17][18][19]. The rate of BDD in cosmetic surgery patients ranges from 2.21% to 56.67%, with a notable predominance in females (approximately 74-76%) [20]. ...
Objective: Body dysmorphic disorder (BDD) is a mental health disorder in which a person believes that their actual physical features appear worse than they truly are. The aim of this study is to examine the presence of BDD and its comorbidity with anxiety, depression, and obsessive-compulsive disorder (OCD) in patients with planned orthognathic surgery for dentofacial deformities. Methods: In this study conducted on patients scheduled for orthognathic surgery, the presence of BDD, OCD, depression, anxiety, and stress was determined by administering the Florida Obsessive-Compulsive Inventory (FOCI), Depression, Anxiety, and Stress Scale-21 (DASS-21), and Body Image Disturbance Questionnaire (BIDQ) prior to the surgery. An independent samples t-test evaluated differences between group means, Pearson's correlation coefficient demonstrated the linear relationship between two variables, and the chi-square test assessed the relationship between two categorical variables. A p-value below 0.05 was deemed statistically significant. A total of 108 patients were included in the study, with 54 patients Class 2 and 54 patients Class 3. Results: BIDQ, FOCI, depression, anxiety, and stress, males showed statistically significant higher results compared to females (p <0.05). There were no statistically significant differences in BIDQ, FOCI, depression, and stress between Class 2 and Class 3 patients (p>0.05). Of the 108 patients included in the study, a total of 20.4% (n=22) were found to be BDD positive. Among the female patients, 10% (n=6) were BDD positive, while among the male patients, 33.3% (n=16) were BDD positive. When evaluated in terms of skeletal classification, 14.8% (n=8) of Class 2 patients were BDD positive, while 25.9% (n=14) of Class 3 patients were BDD positive. Conclusions: Surgeons performing orthognathic surgery should be familiar with common and often severe body image disturbances. When evaluating patients seeking orthognathic surgery, their psychological conditions should be carefully considered.
... The study's focus on a specific demographic group (young, female participants) limits its generalisability to male populations. Previous research has indeed suggested that women show higher interest in cosmetic surgery and are more likely to report having had a procedure [24,25,52]. Data from the American Society for Aesthetic Plastic Surgery [53] show an overwhelming majority of cosmetic surgery patients are female. ...
People naturally exhibit a self-serving bias which can be observed in their tendency to judge their own physical attractiveness more favourably than that of others. Despite this positive self-perception, minimally invasive cosmetic injectable procedures for facial rejuvenation and enhancement are becoming increasingly common. It remains unclear, however, whether recognizing an altered version of one’s own face, enhanced cosmetically, correlates with a positive view of cosmetic surgery and excessive preoccupations about physical characteristics perceived as defects (body dysmorphic concerns). In this study, 30 healthy female participants, aged 18–24 years (Mage = 21.1 years, SD = 1.6), engaged in a face recognition task during which their faces were digitally morphed with that of gender-matched unfamiliar women who had undergone cosmetic enhancements, specifically lip and cheek fillers. The duration of exposure to these modified faces varied with short (500 msec) and long (2000 msec) viewing periods. Participants were asked to identify whether the digital morphs represented themselves or the other woman. Self-reports regarding acceptance of cosmetic surgery and dysmorphic concerns were collected. Participants PSE indicated a tendency towards self-bias under short presentation times, shifting towards the other as presentation times lengthened. Interestingly, this effect was associated with greater acceptance of cosmetic surgery and higher body dysmorphic concerns. This study underscores the importance of understanding how perceptions of others’ physical appearances can influence self-recognition and attitudes towards cosmetic surgery, which may have both positive and potentially harmful implications.
... Body dysmorphic disorder refers to a disorder in the perception of one's own body. It describes a subjectively perceived ugliness, which is hardly noticeable to others, that creates a high level of suffering [14]. This review article will explain the genesis of body dysmorphic disorder and what distinguishes it from simple dissatisfaction with one's appearance. ...
This article provides an overview of the development of the body dysmorphic disorder in the context of various prevailing ideals of beauty. The distinction from simple body dissatisfaction is presented, also in view of brain-organic as well as neurochemical differences. Individuals with body dysmorphic disorder have an increased sensitivity to the detection of detail-instead of a holistic view-, making them more likely to notice flaws or blemishes that are unnoticeable to others. This distorted perception can be corrected in the context of cognitive behavioural therapy, provided that the body dysmorphic disorder is recognised as such. The concealment by comorbidities as well as the consequences for affected persons and treatment options are described.
... They can give points ranging from 1 to 6 for each question (except for questions 16a and 16b, which are answered as ‗yes/no'). 19 BDDE-SR has been used as a diagnostic tool in cosmetic surgery patients, 20,21 and to measure negative BI in different populations seeking cosmetic surgery. 22,23 It has acceptable internal consistency and test-retest reliability. ...
Body dysmorphic disorder (BDD) is a psychiatric condition characterized by profound concern about a minor or imagined defect in the appearance of individuals and increased preoccupation with the imagined/perceived defect. Individuals with BDD often undergo cosmetic intervention for the perceived imperfection but rarely experience improvement in their signs and symptoms following such treatment. It is recommended that aesthetic providers evaluate individuals face-to-face and screen for BDD with approved scales preoperatively to determine the candidate's suitability for the procedure. This contribution focuses on diagnostic and screening tools and measures of disease severity and insight that providers working in non-psychiatric settings can utilize. Several screening tools were explicitly developed for BDD, while others were designed to evaluate body image/dysmorphic concern. The BDD Questionnaire (BDDQ)-Dermatology Version (BDDQ-DV), BDDQ-Aesthetic Surgery (BDDQ-AS), Cosmetic Procedure Screening Questionnaire (COPS), and Body Dysmorphic Symptom Scale (BDSS) have been explicitly developed for BDD and validated in cosmetic settings. Limitations of screening tools are discussed. Given the increasing use of social media, future revisions of BDD instruments should consider incorporating questions relevant to patients' behaviors on social media. Current screening tools can adequately test for BDD despite their limitations and a need for updates.
... Im Bereich der Dermatologie liegt die Punktprävalenz zwischen circa 9 und 14 % (Bowe et al., 2007;Phillips et al., 2000b;Uzun et al., 2003). Ähnliche relative Häufigkeiten von 7 bis 16.6 % können bei Patienten der plastischen Chirurgie ausfindig gemacht werden (Bellino et al., 2006;Crerand et al., 2004;Ishigooka et al., 1998;Sarwer et al., 1998). Die berichteten Prävalenzraten sind jedoch mit Vorsicht zu betrachten. ...
Die vorliegende Abschlussarbeit untersucht die Wirkung einer Spiegelexposition auf affektive und physiologische Veränderungen im Vergleich von Personen mit und ohne körperdysmorphe Symptomatik. Ferner sollte erfasst werden, ob hinsichtlich emotionaler Zustände Habituationseffekte zu beobachten sind. Insgesamt wurden 55 Personen zu zwei Terminen im Abstand von einer Woche (± einem Tag) eingeladen. Diese wurden mit Hilfe eines VorabScreening-Fragebogens in zwei Gruppen unterteilt: Personen mit (N = 26) und ohne körperdysmorphe Symptomatik (N = 29). Zur Registrierung physiologischer Veränderungen wurde die Herzrate mittels physiologischer Messinstrumente erfasst. Die affektiven Zustände Angst, Anspannung und Scham wurden per Fragebogen während und nach der Konfrontation mit dem eigenen Spiegelbild erhoben. Im Anschluss an die Körperbildexposition berichteten die Probanden mit körperdysmorpher Symptomatik im Vergleich zur Kontrollgruppe eine höhere Ausprägung von Angst, Anspannung und Scham. Hinsichtlich der Herzrate konnten keine signifikanten Unterschiede zwischen den beiden Subgruppen ausfindig gemacht werden. Die affektiven Zustände Angst, Anspannung und Scham erfuhren innerhalb der Gruppe mit körperdysmorpher Symptomatik eine Reduktion von der ersten zur zweiten Sitzung. Abschließend lässt sich somit eine höhere affektive Reaktivität seitens der Personen mit körperdysmorpher Symptomatik bei Spiegelexpositionen feststellen. Über mehrere Sitzungen hinweg können Habituationseffekte hinsichtlich emotionaler Zustände ausfindig gemacht werden und liefern Implikationen für mögliche Behandlungsmethoden.
This thesis analyzes the effect of mirror exposure on affective and physiological changes, comparing subjects with and without body dysmorphic symptoms. Furthermore, it aimed at verifying if affective states habituate. In total 55 people were invited to two appointments in a temporal distance of one week (± one day). Using a pre-screening-questionnaire they were divided into two groups: subjects with (N = 26) and without body dysmorphic symptoms (N = 29). To detect physiological changes, heart rate was measured by physiological measuring instruments. The affective states fear, aversive tension and shame were identified by a questionnaire during and following a confrontation with their reflection in the mirror. After body image exposure, participants with body dysmorphic symptoms reported a higher level of fear, aversive tension and shame compared to the control group. Regarding heart rate, no significant differences between the two subgroups could be identified. The affective states of fear, aversive tension and shame decreased from the first to the second session in the group with body dysmorphic symptoms. Thus, a higher affective reactivity by the subjects with body dysmorphic symptoms could be observed during mirror exposures. Between sessions, habituation effects regarding affective states have been identified and yield implications for possible treatment methods.
... In particular, prevalence rates of BDD were found to be 13-16% in a sample of psychiatric patients who were hospitalized for another disorder (Conroy et al., 2008;Grant et al., 2001). As well, prevalence rates assessed in plastic surgery and dermatology settings were roughly 8.5-15% and 7-8%, respectively (Crerand et al., 2004;Phillips et al., 2000;Sarwer and Crerand, 2008;Sarwer et al., 1998). ...
Body dysmorphic disorder (BDD) is primarily characterized by an excessive preoccupation with a perceived defect or flaw in appearance that others would be unable to observe, or would consider slight in appearance. BDD is accompanied by repetitive behaviors intended to hide, fix or check on the perceived appearance flaw. This article provides an overview of the current understanding of the factors influencing the onset and maintenance of BDD symptoms, as well as prevalence rates. The assessment and treatment of this common and severe disorder are also discussed.
... A number of studies have examined the rate of BDD among individuals presenting for medical and non-medical cosmetic procedures. In the United States, the rates of BDD range from 7 to 8% in cosmetic surgery populations [26,25] and 8.5 to 15% in dermatology populations [24,14]. ...
Body dysmorphic disorder (BDD) is defined as a preoccupation with an imagined or slight defect in appearance that results in significant distress or impairment in functioning and cannot be accounted for by another psychological condition (e.g., dissatisfaction with weight or shape in anorexia nervosa). If a slight physical anomaly is present the concern must be excessive. Some individuals with BDD are so convinced about the existence of their perceived flaw that they are unable to consider that their appearance concerns might be exaggerated or exist only in their imagination. While insight is often poor in individuals with BDD, approximately 35 to 40% of patients qualify for an additional diagnosis of delusional disorder, somatic subtype. Two-thirds of patients with BDD have delusional ideas of reference, in that they are completely convinced that others are taking special notice of (e.g., laughing about or staring at) their perceived flaw. Of note, insight often varies over the course of the disorder, and individuals with delusional and non-delusional BDD are largely similar in demographics and clinical features. Moreover, both non-delusional and delusional variants respond favorably to treatment with serotonin reuptake inhibitors (SRIs). Thus, given the fluctuations in insight that occur throughout the course of the disorder and the comparable treatment response, it has been suggested that delusional and non-delusional forms of BDD reflect a single disorder with a continuum of insight.
(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.
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.
This is a comprehensive, up-to-date and evidence-based review of women's mental health. It starts by considering the social and cultural contexts of women's lives today before addressing how developmental aspects pertain to mental health, exploring biological, evolutionary and psychosocial parameters. The heart of the book contains a series of chapters with a clinical emphasis. These aim to elucidate causal mechanisms for gender differences in mental disorder considering hormonal and environmental influences. The therapeutic implications of gender are then addressed in some detail, with a focus on inter-partner and other forms of violence, substance misuse, personality disorder and post-traumatic stress disorder. The book concludes with a detailed section considering psychosis and its sequelae in women and their families. The book's scope is intended to be broad, and it is aimed at a clinical audience including psychiatrists and general physicians, as well as mental health nurses, psychologists, social workers and occupational therapists.
With no consensus document or guideline to help us compute the psychological make-up of rhinoplasty candidates and in the light of new perspectives of some key opinion leaders in the field of patient selection, the goals of this article are to offer a glimpse of the current literature together with the knowledge gaps, introduce some new tools for the preoperative consultation, help us identify who among our patients is at greatest risk for a poor outcome, and explain how childhood trauma can be linked to body shame and postoperative dissatisfaction.
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 to 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 forty-eight articles with a sample size of 14913 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.
One of the most difficult challenges in aesthetic surgery is dealing with the unhappy postoperative patient. Unhappy patients are unpleasant in any field of medicine. Surgeons by and large are perfectionists, deeply engaged and heavily invested in their work, and immersed in the responsibility of getting the best possible result for their patient. Therefore, we are disappointed and personally affected by any patient who is unhappy with their result. But I believe that in aesthetic surgery, the stakes are particularly high. The patient doesn’t start out with a life-threatening problem: they typically come in healthy. Their expectations are high. They have paid a lot of money out of pocket and therefore feel entitled to a good result. Therefore, when things go awry in the postoperative course, the stage is set for a very bumpy ride. The surgeon must be most masterful in order to guide the patient through this part of their journey and achieve as good a result as possible both physically and psychologically.
Youth with craniofacial conditions often have appearance and speech differences and are vulnerable to social stigmatization and body image disturbances. Given sociocultural pressures for female attractiveness, adolescent girls with craniofacial conditions may be especially vulnerable to body dissatisfaction and appearance-related social stigmatization, though such sex differences have been infrequently studied in this population. This study aimed to: (1) examine sex differences in body image disturbance, satisfaction with speech and facial appearance, and perceived stigmatization among adolescents with craniofacial conditions; and (2) evaluate whether stigmatization perceptions are predictive of body image disturbance and satisfaction with facial appearance and speech. Using a cross-sectional design, 110 adolescents from two craniofacial centers completed measures of body image disturbance, satisfaction with speech and facial appearance, and perceived stigmatization. Females reported significantly greater levels of body image disturbance and lower satisfaction with facial appearance compared to males. There were no significant sex differences for satisfaction with speech or perceived stigmatization. Perceived stigmatization was a significant predictor of body image disturbance, and satisfaction with facial appearance and speech while controlling for sex, body mass index, and age. Interventions to prevent and/or address body image and stigmatization concerns are clinically indicated for both sexes.
Background:
The main objective of this study was to prospectively analyze which personality traits, clinical psychiatric states, and patient decision-making characteristics predict who will be less satisfied after facial plastic surgery.
Methods:
This prospective study enrolled 60 adult subjects into one of three groups: aesthetic, functional, and reconstructive facial plastic surgery procedures (n = 20 in each group) from November of 2011 to February of 2016. Self-report surveys of personality traits (i.e., NEO Personality Inventory-Revised), psychiatric state (i.e., Patient Health Questionnaire, Generalized Anxiety Disorder, Health Anxiety Inventory-Short Form), and decision-making characteristics (maximizer/satisficer survey) were given during the preoperative clinic visits. In postoperative follow-up, satisfaction questionnaires at 3, 6, and 12 months were administered. Data analysis examined associations between patient satisfaction, decision-making characteristics, and psychiatric variables.
Results:
Bivariate analyses showed that maximizer/satisficer decision-making style was significantly related to patient satisfaction scores in the year following surgery. This difference reached statistical significance at 6 months and remained a strong trend at 12 months. Patients who were less than extremely satisfied at both postoperative time points were more likely to portray the maximizer decision-making style. No other variables were associated with patient satisfaction at any time point. Maximizer/satisficer survey scores were not associated with self-reports of depression, anxiety, or illness anxiety. Mean scores on the maximizer/satisficer survey did not differ among the aesthetic, functional, and reconstructive groups.
Conclusions:
The maximizer/satisficer survey captures an aspect of patient care not traditionally measured by standard clinical psychometric screening tools to help predict satisfaction. A short questionnaire targeting consumer decision-making may be a helpful tool for preoperative counseling.
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.
This is a comprehensive, up-to-date and evidence-based review of women's mental health. It starts by considering the social and cultural contexts of women's lives today before addressing how developmental aspects pertain to mental health, exploring biological, evolutionary and psychosocial parameters. The heart of the book contains a series of chapters with a clinical emphasis. These aim to elucidate causal mechanisms for gender differences in mental disorder considering hormonal and environmental influences. The therapeutic implications of gender are then addressed in some detail, with a focus on inter-partner and other forms of violence, substance misuse, personality disorder and post-traumatic stress disorder. The book concludes with a detailed section considering psychosis and its sequelae in women and their families. The book's scope is intended to be broad, and it is aimed at a clinical audience including psychiatrists and general physicians, as well as mental health nurses, psychologists, social workers and occupational therapists.
This is a comprehensive, up-to-date and evidence-based review of women's mental health. It starts by considering the social and cultural contexts of women's lives today before addressing how developmental aspects pertain to mental health, exploring biological, evolutionary and psychosocial parameters. The heart of the book contains a series of chapters with a clinical emphasis. These aim to elucidate causal mechanisms for gender differences in mental disorder considering hormonal and environmental influences. The therapeutic implications of gender are then addressed in some detail, with a focus on inter-partner and other forms of violence, substance misuse, personality disorder and post-traumatic stress disorder. The book concludes with a detailed section considering psychosis and its sequelae in women and their families. The book's scope is intended to be broad, and it is aimed at a clinical audience including psychiatrists and general physicians, as well as mental health nurses, psychologists, social workers and occupational therapists.
This is a comprehensive, up-to-date and evidence-based review of women's mental health. It starts by considering the social and cultural contexts of women's lives today before addressing how developmental aspects pertain to mental health, exploring biological, evolutionary and psychosocial parameters. The heart of the book contains a series of chapters with a clinical emphasis. These aim to elucidate causal mechanisms for gender differences in mental disorder considering hormonal and environmental influences. The therapeutic implications of gender are then addressed in some detail, with a focus on inter-partner and other forms of violence, substance misuse, personality disorder and post-traumatic stress disorder. The book concludes with a detailed section considering psychosis and its sequelae in women and their families. The book's scope is intended to be broad, and it is aimed at a clinical audience including psychiatrists and general physicians, as well as mental health nurses, psychologists, social workers and occupational therapists.
This is a comprehensive, up-to-date and evidence-based review of women's mental health. It starts by considering the social and cultural contexts of women's lives today before addressing how developmental aspects pertain to mental health, exploring biological, evolutionary and psychosocial parameters. The heart of the book contains a series of chapters with a clinical emphasis. These aim to elucidate causal mechanisms for gender differences in mental disorder considering hormonal and environmental influences. The therapeutic implications of gender are then addressed in some detail, with a focus on inter-partner and other forms of violence, substance misuse, personality disorder and post-traumatic stress disorder. The book concludes with a detailed section considering psychosis and its sequelae in women and their families. The book's scope is intended to be broad, and it is aimed at a clinical audience including psychiatrists and general physicians, as well as mental health nurses, psychologists, social workers and occupational therapists.
This is a comprehensive, up-to-date and evidence-based review of women’s mental health. It starts by considering the social and cultural contexts of women’s lives today before addressing how developmental aspects pertain to mental health, exploring biological, evolutionary and psychosocial parameters. The heart of the book contains a series of chapters with a clinical emphasis. These aim to elucidate causal mechanisms for gender differences in mental disorder considering hormonal and environmental influences. The therapeutic implications of gender are then addressed in some detail, with a focus on inter-partner and other forms of violence, substance misuse, personality disorder and post-traumatic stress disorder. The book concludes with a detailed section considering psychosis and its sequelae in women and their families. The book’s scope is intended to be broad, and it is aimed at a clinical audience including psychiatrists and general physicians, as well as mental health nurses, psychologists, social workers and occupational therapists.
This is a comprehensive, up-to-date and evidence-based review of women's mental health. It starts by considering the social and cultural contexts of women's lives today before addressing how developmental aspects pertain to mental health, exploring biological, evolutionary and psychosocial parameters. The heart of the book contains a series of chapters with a clinical emphasis. These aim to elucidate causal mechanisms for gender differences in mental disorder considering hormonal and environmental influences. The therapeutic implications of gender are then addressed in some detail, with a focus on inter-partner and other forms of violence, substance misuse, personality disorder and post-traumatic stress disorder. The book concludes with a detailed section considering psychosis and its sequelae in women and their families. The book's scope is intended to be broad, and it is aimed at a clinical audience including psychiatrists and general physicians, as well as mental health nurses, psychologists, social workers and occupational therapists.
This is a comprehensive, up-to-date and evidence-based review of women's mental health. It starts by considering the social and cultural contexts of women's lives today before addressing how developmental aspects pertain to mental health, exploring biological, evolutionary and psychosocial parameters. The heart of the book contains a series of chapters with a clinical emphasis. These aim to elucidate causal mechanisms for gender differences in mental disorder considering hormonal and environmental influences. The therapeutic implications of gender are then addressed in some detail, with a focus on inter-partner and other forms of violence, substance misuse, personality disorder and post-traumatic stress disorder. The book concludes with a detailed section considering psychosis and its sequelae in women and their families. The book's scope is intended to be broad, and it is aimed at a clinical audience including psychiatrists and general physicians, as well as mental health nurses, psychologists, social workers and occupational therapists.
This is a comprehensive, up-to-date and evidence-based review of women's mental health. It starts by considering the social and cultural contexts of women's lives today before addressing how developmental aspects pertain to mental health, exploring biological, evolutionary and psychosocial parameters. The heart of the book contains a series of chapters with a clinical emphasis. These aim to elucidate causal mechanisms for gender differences in mental disorder considering hormonal and environmental influences. The therapeutic implications of gender are then addressed in some detail, with a focus on inter-partner and other forms of violence, substance misuse, personality disorder and post-traumatic stress disorder. The book concludes with a detailed section considering psychosis and its sequelae in women and their families. The book's scope is intended to be broad, and it is aimed at a clinical audience including psychiatrists and general physicians, as well as mental health nurses, psychologists, social workers and occupational therapists.
This is a comprehensive, up-to-date and evidence-based review of women's mental health. It starts by considering the social and cultural contexts of women's lives today before addressing how developmental aspects pertain to mental health, exploring biological, evolutionary and psychosocial parameters. The heart of the book contains a series of chapters with a clinical emphasis. These aim to elucidate causal mechanisms for gender differences in mental disorder considering hormonal and environmental influences. The therapeutic implications of gender are then addressed in some detail, with a focus on inter-partner and other forms of violence, substance misuse, personality disorder and post-traumatic stress disorder. The book concludes with a detailed section considering psychosis and its sequelae in women and their families. The book's scope is intended to be broad, and it is aimed at a clinical audience including psychiatrists and general physicians, as well as mental health nurses, psychologists, social workers and occupational therapists.
This is a comprehensive, up-to-date and evidence-based review of women's mental health. It starts by considering the social and cultural contexts of women's lives today before addressing how developmental aspects pertain to mental health, exploring biological, evolutionary and psychosocial parameters. The heart of the book contains a series of chapters with a clinical emphasis. These aim to elucidate causal mechanisms for gender differences in mental disorder considering hormonal and environmental influences. The therapeutic implications of gender are then addressed in some detail, with a focus on inter-partner and other forms of violence, substance misuse, personality disorder and post-traumatic stress disorder. The book concludes with a detailed section considering psychosis and its sequelae in women and their families. The book's scope is intended to be broad, and it is aimed at a clinical audience including psychiatrists and general physicians, as well as mental health nurses, psychologists, social workers and occupational therapists.
This is a comprehensive, up-to-date and evidence-based review of women's mental health. It starts by considering the social and cultural contexts of women's lives today before addressing how developmental aspects pertain to mental health, exploring biological, evolutionary and psychosocial parameters. The heart of the book contains a series of chapters with a clinical emphasis. These aim to elucidate causal mechanisms for gender differences in mental disorder considering hormonal and environmental influences. The therapeutic implications of gender are then addressed in some detail, with a focus on inter-partner and other forms of violence, substance misuse, personality disorder and post-traumatic stress disorder. The book concludes with a detailed section considering psychosis and its sequelae in women and their families. The book's scope is intended to be broad, and it is aimed at a clinical audience including psychiatrists and general physicians, as well as mental health nurses, psychologists, social workers and occupational therapists.
This is a comprehensive, up-to-date and evidence-based review of women's mental health. It starts by considering the social and cultural contexts of women's lives today before addressing how developmental aspects pertain to mental health, exploring biological, evolutionary and psychosocial parameters. The heart of the book contains a series of chapters with a clinical emphasis. These aim to elucidate causal mechanisms for gender differences in mental disorder considering hormonal and environmental influences. The therapeutic implications of gender are then addressed in some detail, with a focus on inter-partner and other forms of violence, substance misuse, personality disorder and post-traumatic stress disorder. The book concludes with a detailed section considering psychosis and its sequelae in women and their families. The book's scope is intended to be broad, and it is aimed at a clinical audience including psychiatrists and general physicians, as well as mental health nurses, psychologists, social workers and occupational therapists.
This is a comprehensive, up-to-date and evidence-based review of women's mental health. It starts by considering the social and cultural contexts of women's lives today before addressing how developmental aspects pertain to mental health, exploring biological, evolutionary and psychosocial parameters. The heart of the book contains a series of chapters with a clinical emphasis. These aim to elucidate causal mechanisms for gender differences in mental disorder considering hormonal and environmental influences. The therapeutic implications of gender are then addressed in some detail, with a focus on inter-partner and other forms of violence, substance misuse, personality disorder and post-traumatic stress disorder. The book concludes with a detailed section considering psychosis and its sequelae in women and their families. The book's scope is intended to be broad, and it is aimed at a clinical audience including psychiatrists and general physicians, as well as mental health nurses, psychologists, social workers and occupational therapists.
This is a comprehensive, up-to-date and evidence-based review of women's mental health. It starts by considering the social and cultural contexts of women's lives today before addressing how developmental aspects pertain to mental health, exploring biological, evolutionary and psychosocial parameters. The heart of the book contains a series of chapters with a clinical emphasis. These aim to elucidate causal mechanisms for gender differences in mental disorder considering hormonal and environmental influences. The therapeutic implications of gender are then addressed in some detail, with a focus on inter-partner and other forms of violence, substance misuse, personality disorder and post-traumatic stress disorder. The book concludes with a detailed section considering psychosis and its sequelae in women and their families. The book's scope is intended to be broad, and it is aimed at a clinical audience including psychiatrists and general physicians, as well as mental health nurses, psychologists, social workers and occupational therapists.
This is a comprehensive, up-to-date and evidence-based review of women's mental health. It starts by considering the social and cultural contexts of women's lives today before addressing how developmental aspects pertain to mental health, exploring biological, evolutionary and psychosocial parameters. The heart of the book contains a series of chapters with a clinical emphasis. These aim to elucidate causal mechanisms for gender differences in mental disorder considering hormonal and environmental influences. The therapeutic implications of gender are then addressed in some detail, with a focus on inter-partner and other forms of violence, substance misuse, personality disorder and post-traumatic stress disorder. The book concludes with a detailed section considering psychosis and its sequelae in women and their families. The book's scope is intended to be broad, and it is aimed at a clinical audience including psychiatrists and general physicians, as well as mental health nurses, psychologists, social workers and occupational therapists.
This is a comprehensive, up-to-date and evidence-based review of women's mental health. It starts by considering the social and cultural contexts of women's lives today before addressing how developmental aspects pertain to mental health, exploring biological, evolutionary and psychosocial parameters. The heart of the book contains a series of chapters with a clinical emphasis. These aim to elucidate causal mechanisms for gender differences in mental disorder considering hormonal and environmental influences. The therapeutic implications of gender are then addressed in some detail, with a focus on inter-partner and other forms of violence, substance misuse, personality disorder and post-traumatic stress disorder. The book concludes with a detailed section considering psychosis and its sequelae in women and their families. The book's scope is intended to be broad, and it is aimed at a clinical audience including psychiatrists and general physicians, as well as mental health nurses, psychologists, social workers and occupational therapists.
This is a comprehensive, up-to-date and evidence-based review of women's mental health. It starts by considering the social and cultural contexts of women's lives today before addressing how developmental aspects pertain to mental health, exploring biological, evolutionary and psychosocial parameters. The heart of the book contains a series of chapters with a clinical emphasis. These aim to elucidate causal mechanisms for gender differences in mental disorder considering hormonal and environmental influences. The therapeutic implications of gender are then addressed in some detail, with a focus on inter-partner and other forms of violence, substance misuse, personality disorder and post-traumatic stress disorder. The book concludes with a detailed section considering psychosis and its sequelae in women and their families. The book's scope is intended to be broad, and it is aimed at a clinical audience including psychiatrists and general physicians, as well as mental health nurses, psychologists, social workers and occupational therapists.
This is a comprehensive, up-to-date and evidence-based review of women's mental health. It starts by considering the social and cultural contexts of women's lives today before addressing how developmental aspects pertain to mental health, exploring biological, evolutionary and psychosocial parameters. The heart of the book contains a series of chapters with a clinical emphasis. These aim to elucidate causal mechanisms for gender differences in mental disorder considering hormonal and environmental influences. The therapeutic implications of gender are then addressed in some detail, with a focus on inter-partner and other forms of violence, substance misuse, personality disorder and post-traumatic stress disorder. The book concludes with a detailed section considering psychosis and its sequelae in women and their families. The book's scope is intended to be broad, and it is aimed at a clinical audience including psychiatrists and general physicians, as well as mental health nurses, psychologists, social workers and occupational therapists.
This is a comprehensive, up-to-date and evidence-based review of women's mental health. It starts by considering the social and cultural contexts of women's lives today before addressing how developmental aspects pertain to mental health, exploring biological, evolutionary and psychosocial parameters. The heart of the book contains a series of chapters with a clinical emphasis. These aim to elucidate causal mechanisms for gender differences in mental disorder considering hormonal and environmental influences. The therapeutic implications of gender are then addressed in some detail, with a focus on inter-partner and other forms of violence, substance misuse, personality disorder and post-traumatic stress disorder. The book concludes with a detailed section considering psychosis and its sequelae in women and their families. The book's scope is intended to be broad, and it is aimed at a clinical audience including psychiatrists and general physicians, as well as mental health nurses, psychologists, social workers and occupational therapists.
This is a comprehensive, up-to-date and evidence-based review of women's mental health. It starts by considering the social and cultural contexts of women's lives today before addressing how developmental aspects pertain to mental health, exploring biological, evolutionary and psychosocial parameters. The heart of the book contains a series of chapters with a clinical emphasis. These aim to elucidate causal mechanisms for gender differences in mental disorder considering hormonal and environmental influences. The therapeutic implications of gender are then addressed in some detail, with a focus on inter-partner and other forms of violence, substance misuse, personality disorder and post-traumatic stress disorder. The book concludes with a detailed section considering psychosis and its sequelae in women and their families. The book's scope is intended to be broad, and it is aimed at a clinical audience including psychiatrists and general physicians, as well as mental health nurses, psychologists, social workers and occupational therapists.
Body dysmorphic disorder (BDD) is a debilitating clinical condition in which individuals experience severe distress and preoccupation regarding one or more aspects of physical appearance. Body dysmorphic disorder is a complex syndrome that, while classified as a member of the obsessive-compulsive and related disorders (OCRD) category, has a number of distinct features beyond simply an excessive concern with specific body areas. By moving BDD from Somatoform Disorders into the new OCRD section, the recently published fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) lent official credence to the conceptualization of BDD that currently dominates the psychological literature - that is, placing BDD along a spectrum of disorders characterized by compulsive and repetitive behaviors. Cognitive-behavior therapy (CBT) is currently the first line treatment for BDD. Cognitive-behavior therapy for BDD typically includes psychoeducation, exposure and response prevention, and cognitive restructuring.
Individuals with body dysmorphic disorder (BDD) suffer from preoccupations of perceived physical defects. As a result, these patients are more likely to present to a dermatologist or cosmetic surgeon for consultation for their services than they are to a psychiatrist. BDD is not an uncommon condition, with global prevalence estimated at 2 %. Individuals with BDD also have a high prevalence of comorbid psychiatric disorders, including depression, anxiety, social phobia, and obsessive–compulsive disorder (OCD). While patients with BDD frequently request treatments or procedures for physical imperfections, they are unlikely to be satisfied with the results. Therefore, it is critical for clinicians to better understand the epidemiology and comorbidities associated with this disease to avoid unnecessary procedures and to involve psychiatric professionals in their care.
Surgeons who perform orthognathic procedures need to be familiar with a common and usually severe body image disorder known as body dysmorphic disorder (BDD). Surgeons should directly ask about the patient's history of psychiatric and psychological treatment, including psychiatric hospitalization. Cosmetic surgical procedures and dermatologic treatments are most often sought and received by persons with BDD. A screening interview during the initial consultation can be an effective way of identifying patients with BDD. This interview can help safeguard providers against patients who could become litigious or violent; it also provides an opportunity to direct patients with BDD to more effective and appropriate psychiatric treatment. This interview should include an assessment of appearance concerns and BDD symptoms; patient motivations and expectations for the desired procedure; psychiatric status and history; and observations of the patient's behaviour in the office.
This is a comprehensive, up-to-date and evidence-based review of women's mental health. It starts by considering the social and cultural contexts of women's lives today before addressing how developmental aspects pertain to mental health, exploring biological, evolutionary and psychosocial parameters. The heart of the book contains a series of chapters with a clinical emphasis. These aim to elucidate causal mechanisms for gender differences in mental disorder considering hormonal and environmental influences. The therapeutic implications of gender are then addressed in some detail, with a focus on inter-partner and other forms of violence, substance misuse, personality disorder and post-traumatic stress disorder. The book concludes with a detailed section considering psychosis and its sequelae in women and their families. The book's scope is intended to be broad, and it is aimed at a clinical audience including psychiatrists and general physicians, as well as mental health nurses, psychologists, social workers and occupational therapists.
This is a comprehensive, up-to-date and evidence-based review of women's mental health. It starts by considering the social and cultural contexts of women's lives today before addressing how developmental aspects pertain to mental health, exploring biological, evolutionary and psychosocial parameters. The heart of the book contains a series of chapters with a clinical emphasis. These aim to elucidate causal mechanisms for gender differences in mental disorder considering hormonal and environmental influences. The therapeutic implications of gender are then addressed in some detail, with a focus on inter-partner and other forms of violence, substance misuse, personality disorder and post-traumatic stress disorder. The book concludes with a detailed section considering psychosis and its sequelae in women and their families. The book's scope is intended to be broad, and it is aimed at a clinical audience including psychiatrists and general physicians, as well as mental health nurses, psychologists, social workers and occupational therapists.
This is a comprehensive, up-to-date and evidence-based review of women's mental health. It starts by considering the social and cultural contexts of women's lives today before addressing how developmental aspects pertain to mental health, exploring biological, evolutionary and psychosocial parameters. The heart of the book contains a series of chapters with a clinical emphasis. These aim to elucidate causal mechanisms for gender differences in mental disorder considering hormonal and environmental influences. The therapeutic implications of gender are then addressed in some detail, with a focus on inter-partner and other forms of violence, substance misuse, personality disorder and post-traumatic stress disorder. The book concludes with a detailed section considering psychosis and its sequelae in women and their families. The book's scope is intended to be broad, and it is aimed at a clinical audience including psychiatrists and general physicians, as well as mental health nurses, psychologists, social workers and occupational therapists.
As the popularity of cosmetic breast augmentation has surged in the past decade, so has interest in the psychological aspects of the procedures. A growing literature has investigated the preoperative characteristics of women who seek cosmetic breast augmentation. The preoperative psychological assessment of breast augmentation patients should focus on three areas: motivations for and expectations about surgery, physical appearance and body image, and psychiatric history and status. The surgeon should assess the patient as a routine part of the initial consultation. In addition to assessing for body dysmorphic disorder, mood disorders and eating disorders may be overrepresented among women who seek breast augmentation. There has been an association between cosmetic breast implants and subsequent suicides. Breast augmentation candidates who present with a history of psychopathology, or those who are suspected of having some form of psychopathology, should undergo a mental health consultation prior to surgery.
Objectives. To explore the relationship of self-rated own physical attractiveness and personality traits to: (1) motives underlying the decision to undergo cosmetic breast surgery, and (2) expected consequences of the surgery. Method. Participants in the study conducted in the years 2006-2008 were 113 women who anonymously and individually responded to a questionnaire developed for the research purposes. Results. The decision to improve their appearance is usually made by single women aged about 30, who assess their looks as rather attractive or average, and their personality traits as positive or very positive. Their self-rating of own physical attractiveness is consistent with that of their personality traits, and both these variables are related to inner-directedness of their decision-making concerning the surgery. However, neither of these variables is related to the participants' generally positive expectations of the cosmetic breast surgery consequences. Conclusions. A combination of the patient's external motivation with overly positive expectations about post-surgery changes in her appearance and interpersonal relationships (especially these with her partner) involves the greatest risk to her mental health. Therefore, special attention and care are required from the medical team.
The goals of this research were: 1) to establish the importance of making a decision about breast cosmetic surgery as a significant life event, 2) quality of life valuation before surgery, 3) to establish the expectations concerning surgery and its consequences. The research was conducted in the group of 113 women who decided to undergo breast plastic surgery. Additionally, a few important guidelines for the medical team qualifying for the surgery were determined.
Body dysmorphic disorder (BDD) is a somatoform disorder characterised by a distressing obsession with an imagined or slight appearance defect, which can significantly impair normal day-to-day functioning. Patients with BDD often first present, and are hence diagnosed, in cosmetic surgery settings. Several studies have investigated the prevalence rate of BDD in the general population or have done so for patients referring to cosmetic medical centers. To date, however, no review has been undertaken to compare the prevalence in the general community versus in a cosmetic surgery setting. Despite the lack of such a review it is a commonly held belief that BDD is more common in patients seeking cosmetic surgery. The current study aims to review the available literature in order to investigate whether BDD is indeed more prevalent in patients requesting cosmetic surgery, and if that is the case, to provide possible reasons for the difference in prevalence. In addition this review provides evidence on the effectiveness of cosmetic surgery as a treatment of BDD.
Thirteen cases of Body Dysmorphic Disorder (BDD) were described. There were eight males (61.5%) and five females (38.5%) with ages ranging from 16 to 37 (mean=24.7). All patients were also diagnosed as obsessive compulsive disorder (OCD), according to DSM-III-R, with the exception of one. Patients were administered the Yale Brown Obsessive Compulsive Scale, Beck Depression Inventory, Wechsler Intelligence Scale, Over-valued Ideation Scale and MMPI. The Phenomenology of BDD, its relationship to OCD, and the patients' responses to the above tests were reported. Due to the bizarreness of the symptoms and the secretiveness of the patients, it was suggested that clinicians be thoroughly aware of the disorder and inquire as to its presence during the initial consultation. Otherwise, these patients go unnoticed and they resort to treatment from dermatologists and plastic surgeons.
Body dysmorphic disorder (BDD) consists of a preoccupation with an 'imagined' defect in appearance which causes significant distress or impairment in functioning. There has been little previous research into BDD. This study replicates a survey from the USA in a UK population and evaluates specific measures of BDD.
Cross-sectional interview survey of 50 patients who satisfied DSM-IV criteria for BDD as their primary disorder.
The average age at onset was late adolescence and a large proportion of patients were either single or divorced. Three-quarters of the sample were female. There was a high degree of comorbidity with the most common additional Axis l diagnosis being either a mood disorder (26%), social phobia (16%) or obsessive-compulsive disorder (6%). Twenty-four per cent had made a suicide attempt in the past. Personality disorders were present in 72% of patients, the most common being paranoid, avoidant and obsessive-compulsive.
BDD patients had a high associated comorbidity and previous suicide attempts. BDD is a chronic handicapping disorder and patients are not being adequately identified or treated by health professionals.
Body dysmorphic disorder (BDD) consists of a preoccupation with an imagined or slight defect in appearance, which causes significant distress or impairment in functioning. There has been little previous research about the prevalence and clinical features of BDD in different cultures. This study aimed to find the rate and the clinical features of BDD among 420 female college students in Turkey. A self-report questionnaire was used to determine the subjects' body dissatisfactions and compulsive behaviors. BDD was diagnosed using DSM-IV criteria. In this study, 43.8% of the subjects were dissatisfied with their appearance and 4.8% of all subjects were diagnosed with BDD. Head/face area and hips were the most common areas of concern. The results of this study suggested that body dissatisfaction and BDD among Turkish college students are not rare.
Body image issues are at the core of major eating disorders. They are also important phenomena in and of themselves. Kevin Thompson and his colleagues provide an overview of a wide variety of body image issues, ranging from reconstructive surgery to eating disorders. The book will be a valuable resource for even the most established researchers in the field, as it is filled with data, information about assessment tools, and a thorough treatment of virtually all major theoretical perspectives on the development of body image and their implications for treatment and prevention. At the same time, the authors' decision to include numerous experiential anecdotes makes the book easily accessible to those just entering the field who are trying to understand the nature of these phenomena. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
A critical issue for aesthetic surgeons may be whether some patients have psychiatric conditions that contraindicate cosmetic procedures.
This study reports on the results of an e-mail survey of American Society for Aesthetic Plastic Surgery (ASAPS) members about their awareness of and experiences with body dysmorphic disorder (BDD).
In August 2001, all active ASAPS members with e-mail addresses listed in the ASAPS membership registry were e-mailed the "2001 Body Image Survey." Participants were given until August 31 to complete the 8-question survey. The responses were compiled by an independent research firm.
Two hundred sixty-five ASAPS members responded to the survey. Respondents indicated that they believed 2% of patients seen for an initial cosmetic surgery consultation suffer from BDD. Eighty-four percent indicated that they have refused to operate on persons with BDD. Eighty-four percent indicated that they had operated on a patient whom they believed was appropriate for surgery, only to realize after operation that the patient had BDD. Eighty-two percent of these surgeons believed that these patients had a poor postoperative outcome. However, only 30% of respondents indicated that they believed BDD was always a contraindication to cosmetic surgery.
The estimated rate of BDD reported by participants in the survey is consistent with the rate of occurrence in the general population but lower than the rate reported for cosmetic surgery patients in other studies. This suggests that although most surgeons are aware that BDD exists among their patients, they may underestimate the rate at which it occurs. (Aesthetic Surg J 2002;22:531-535.).
This article presents an analysis of the factor structure of the Body-Self Relations Questionnaire (BSRQ), an attitudinal body-image instrument. Random stratified samples, drawn from a national survey, included 1,064 females and 988 males. In order to evaluate the replicability of the BSRQ factor structure, separate split-sample factor analyses (principal components with varimax rotation) were conducted for each sex. Largely consistent with the conceptual basis of the BSRQ, the resultant factors derived from each analysis were: Appearance Evaluation, Appearance Orientation, Fitness Evaluation, Fitness Orientation, Health Evaluation, Health Orientation, and Illness Orientation. Subsequent concordance analyses revealed marked stability of the factor structure both within and between sexes. Females demonstrated somewhat greater differentiation of body-image attitudes than did males. The utility of the BSRQ is discussed relative to extant body-image measures.
Body dysmorphic disorder, preoccupation with an imagined defect in appearance, is included in DSM-III-R but has received little empirical study. The authors investigated the demographics, phenomenology, course, associated psychopathology, family history, and response to treatment in a series of 30 patients with the disorder.
The patients (including 12 whose preoccupation was of probable delusional intensity) were assessed with a semistructured interview and the Structural Clinical Interview for DSM-III-R, and their family histories were obtained.
The 17 men and 13 women reported a lifetime average of four bodily preoccupations, most commonly "defects" of the hair, nose, and skin. The average age at onset of body dysmorphic disorder was 15 years, and the average duration was 18 years. Seventy-three percent of the patients reported associated ideas or delusions of reference; 73%, excessive mirror checking; and 63%, attempts to camouflage their "deformities." As a result of their symptoms, 97% avoided usual social and occupational activities, 30% had been housebound, and 17% had made suicide attempts. Ninety-three percent of the patients had an associated lifetime diagnosis of a major mood disorder; 33%, a psychotic disorder; and 73%, an anxiety disorder. The patients generally responded poorly to surgical, dermatologic, and dental treatments and to adequate trials of most psychotropic medications, with the exception of fluoxetine and clomipramine (to which more than half had a complete or partial response).
This often secret, chronic disorder can cause considerable distress and impairment, may be related to obsessive-compulsive disorder or mood disorder, and may respond to serotonin reuptake-blocking antidepressants.
The Body Dysmorphic Disorder Examination (BDDE) is a semi-structured clinical interview designed to diagnose body dysmorphic disorder and to measure symptoms of severely negative body image. It tape into preoccupation with and negative evaluation of appearance, self-consciousness and embarrassment, excessive importance given to appearance in self-evaluation, avoidance of activities, body camouflaging, and body checking. The BDDE had adequate internal consistency and test-retest and interrater reliability. It correlated with measures of body image, negative self-esteem, and psychological symptoms, and was sensitive to change following treatment of body dysmorphic disorder. The BDDE distinguished body dysmorphic disorder patients from clinical and non-clinical control subjects and agreed with other clinicians' diagnosis of body dysmorphic disorder. The BDDE provided unique information in predicting clinical status when controlling for psychological adjustment and other measures of body image.
Since the exclusion of somatic causes is necessary for somatoform disorders (SMD) to be diagnosed, there is little information on the prevalence of such disorders in the community. As the method we have previously developed [general practitioners (GPs) with psychiatric training who interview samples representative of the general population] seemed to be appropriate to deal with the problem, we carried out a community survey focused on somatoform disorders. The prevalence rates of DSM-III-R somatoform disorders were studied in two wards of the city of Florence. In order to be representative of the general population, 673 subjects randomly selected were interviewed by their own GP. Four GPs, all with specific training in psychiatry, participated in the interviewing process. The 1-year prevalence figures were as follows: 0.7% body dysmorphic disorder; 4.5% hypochondriasis; 0.6% somatoform pain disorder; 0.3% conversion disorder; 0.7% somatization disorder; 13.8% undifferentiated somatoform disorder. No specific comorbidity was found between somatoform disorders and mood or anxiety disorders. Although the sample investigated was small, this study may be seen as one of the first in an area where knowledge is still scant. The prevalence rates of somatoform disorders were generally found to be slightly lower than expected.
Gender differences in body dysmorphic disorder (BDD) have received little investigation. This study assessed gender differences in 188 subjects with BDD who were evaluated with instruments to assess demographic characteristics, clinical features of BDD, treatment history, and comorbid Axis I disorders. Ninety-three (49%) subjects were women, and 95 (51%) were men. Men and women did not significantly differ in terms of most variables examined, including rates of major depression, although women were more likely to be preoccupied with their hips and their weight, pick their skin and camouflage with makeup, and have comorbid bulimia nervosa. Men were more likely to be preoccupied with body build, genitals, and hair thinning, use a hat for camouflage, be unmarried, and have alcohol abuse or dependence. Although men were as likely as women to seek nonpsychiatric medical and surgical treatment, women were more likely to receive such care. Men, however, were as likely as women to have cosmetic surgery. Although the clinical features of BDD appear remarkably similar in women and men, there are some differences, some of which reflect those found in the general population, suggesting that cultural norms and values may influence the content of BDD symptoms.
This article discusses the psychology of cosmetic surgery. A review of the research on the psychological characteristics of individuals who seek cosmetic surgery yielded contradictory findings. Interview-based investigations revealed high levels of psychopathology in cosmetic surgery patients, whereas studies that used standardized measurements reported far less disturbance. It is difficult to fully resolve the discrepancy between these two sets of findings. We believe that investigating the construct of body image in cosmetic surgery patients will yield more useful findings. Thus, we propose a model of the relationship between body image dissatisfaction and cosmetic surgery and outline a research agenda based upon the model. Such research will generate information that is useful to the medical and mental health communities and, ultimately, the patients themselves.
This study assessed the body image concerns of reconstructive plastic surgery patients. Forty-three reconstructive surgery patients completed two measures of body image. Responses were compared with a group of patients seeking cosmetic procedures. The two groups did not differ in the degree of dissatisfaction with their overall appearance or dissatisfaction with the specific feature for which they were seeking surgery. Reconstructive patients did consider themselves less healthy and less invested in their appearance than did cosmetic patients. Seven of the reconstructive surgery patients (all scar revision patients) reported a level of dissatisfaction and preoccupation consistent with the psychiatric diagnostic of body dysmorphic disorder. These results underscore the importance of screening for body image dissatisfaction in persons with an objective deformity. Plastic surgeons are in an optimal position to identify body image concerns in these patients and provide appropriate referrals for psychotherapy.
This study was the first empirical investigation of body image dissatisfaction and body dysmorphic disorder in cosmetic surgery patients. Of 132 women, 100 women (response rate, 76 percent) completed two body image measures prior to surgery, the Multidimensional Body-Self Relations Questionnaire and the Body Dysmorphic Disorder Examination Self-Report. Cosmetic surgery patients did not demonstrate greater dissatisfaction with their overall appearance compared with the reported normal values of the measures. However, when asked about the specific bodily feature they were considering for cosmetic surgery, they reported significantly greater dissatisfaction than a normative sample. In addition, 7 percent of the sample met diagnostic criteria for body dysmorphic disorder, a potential psychiatric contraindication to cosmetic surgery. Implications of these findings are discussed with respect to the nature of body image dissatisfaction and the prevalence of body dysmorphic disorder in cosmetic surgery populations.
The demographic features of 415 patients seeking cosmetic surgery were investigated from a psychiatric point of view. Of the 415 patients, 198 (47.7%) were found to have mental disorders according to ICD-10 including: 17 with schizophrenia, 20 with other persistent delusional disorders, 33 with depressive episode, 47 with neurotic disorders, 42 with hypochondriacal disorder, five with paranoid personality disorder and 14 with histrionic personality disorder. The rate of subjects with poor social adjustment was 56.0%. It was noteworthy that such a considerable number of patients with mental disorders or with poor social adjustment had sought cosmetic surgery. Distinct gender differences were found: male subjects were characterized to have a greater number of mental disorders, especially dysmorphophobia (other persistent delusional disorders plus hypochondriacal disorder) and showed the narrow age range between teenage and young adult age when they were preoccupied with their 'deformity', and poor social function. A history of frequent operations was not considered to be an indicator for mental abnormality. The diagnostic issue in dysmorphophobia is briefly described.
The treatment of Body Dysmorphic Disorder (BDD) has received little empirical attention despite evidence that BDD is a debilitating mental health problem. This open case series provides data on a new cognitive-behavioral treatment for BDD. Participants diagnosed with BDD were treated in small groups that met for 12 weekly 90-minute sessions. Patients improved significantly over the course of treatment, with reductions in both BDD and depression symptoms. This finding adds to a nascent literature documenting the potential efficacy of short-term cognitive-behavior therapy for patients suffering from BDD.
Dermatologists appear to be the physicians most often seen by patients with the psychiatric condition body dysmorphic disorder (BDD), a distressing or impairing preoccupation with a nonexistent or slight defect in appearance. The frequency of BDD among patients seeking dermatologic treatment is unknown, however.
This study determined the percentage of patients seeking dermatologic treatment who screened positive for BDD.
A validated self-report questionnaire and a reliable defect severity scale were used to determine the rate of BDD in 268 patients seeking dermatologic treatment.
A total of 11.9% (95% confidence interval [CI], 8.0%-15.8%) of patients screened positive for BDD. Rates were similar in a community general dermatology setting (14.4% [95% CI, 8.5%-20.3%]) and a university cosmetic surgery setting (10. 0% [95% CI, 6.1%-13.9%]).
BDD appears relatively common among patients seeking dermatologic treatment. Further research is needed to confirm these findings and to assist dermatologists in identifying these potentially high-risk patients.
Dermatologic surgeons frequently see patients with body dysmorphic disorder, a distressing or impairing preoccupation with a nonexistent or slight defect in appearance. Recognition of this disorder is essential to avoid unnecessary and generally unsatisfying surgical outcomes, but no screening tools are available for use in a dermatology setting.
To develop and validate a brief self-report questionnaire to screen for body dysmorphic disorder in dermatology settings.
A questionnaire was developed and its sensitivity and specificity determined in 46 subjects, using a reliable clinician-administered diagnostic interview for body dysmorphic disorder. The interrater reliability of a defect severity scale was also determined (n = 50).
The self-report questionnaire had a sensitivity of 100% and a specificity of 93%. The interrater reliability (ICC) of the defect rating scale was.88.
This brief questionnaire was a highly effective screening tool for body dysmorphic disorder in a cosmetic dermatology setting. Use of this questionnaire may help identify patients with this syndrome.
In a large population-based study, the authors examined the prevalence and correlates of body dysmorphic disorder, a debilitating and chronic condition characterized by an imagined defect in appearance.
Rates and diagnostic correlates of body dysmorphic disorder were examined by using data from the Harvard Study of Moods and Cycles. This study used in-person structured clinical interviews to characterize the diagnostic status of a population-based, cross-sectional sample of 318 depressed and 658 nondepressed women between the ages of 36 and 44 who were selected from seven Boston metropolitan area communities.
The presence of body dysmorphic disorder was significantly associated with the presence of major depression and anxiety disorders. The authors estimated the overall point prevalence of body dysmorphic disorder as 0.7% in women in this age range in the community.
The authors found that the presence of body dysmorphic disorder was linked to the presence of major depression and anxiety disorders, which is similar to findings in clinical studies. Their estimate of the point prevalence of body dysmorphic disorder is consistent with data from a community-based sample of Italian women and suggests a prevalence similar to that of other serious psychiatric disorders in women (e.g., schizophrenia and drug abuse and dependence). These prevalence data encourage the further development of treatment options for this debilitating condition.
It appears that many individuals with body dysmorphic disorder (BDD) receive nonpsychiatric medical treatment and surgery; however, this topic has had little systematic investigation. This study assessed the nonpsychiatric treatment sought and received by 289 individuals (250 adults and 39 children/adolescents) with DSM-IV BDD. Such treatment was sought by 76.4% and received by 66.0% of adults. Dermatologic treatment was most often received (by 45.2% of adults), followed by surgery (by 23.2%). These treatments rarely improved BDD symptoms. Results were similar in children/adolescents. These findings indicate that a majority of patients with BDD receive nonpsychiatric treatment but tend to respond poorly.
The prevalence of body dysmorphic disorder (BDD) was investigated in a non-clinical sample. German college students (n=133; 73.7% female) completed self-report questionnaires assessing BDD, self-esteem, symptoms of depression, obsessive-compulsive disorder and skin picking. Based on our data, seven participants (5.3%) satisfied DSM-IV BDD criteria. Significant differences were found between students with and without BDD in the number of endorsed obsessive-compulsive disorder symptoms. Poor body image was associated with poor self-esteem, symptoms of depression and obsessive-compulsive disorder. One student with BDD also reported severe skin picking. In conclusion, BDD is a common psychiatric disorder in college students.
The authors investigated the prevalence of body image concerns, body dysmorphic disorder, and related psychiatric symptoms in a group of 101 American students. Results were compared with data from a group of 133 German students. Survey data were collected on body image concerns, self-esteem, depression, anxiety, obsessive-compulsive symptoms, and skin picking. A total of 74.3% of the American students endorsed body image concerns, and 28.7% were preoccupied by them; 4.0% appeared to meet DSM-IV criteria for body dysmorphic disorder. Body esteem was significantly correlated with self-esteem and depressive, anxiety, and obsessive-compulsive symptoms. Body image concerns and preoccupation were significantly greater in American than in German students, although the prevalence of probable body dysmorphic disorder was not.
This article discusses body dysmorphic disorder (BDD) among cosmetic surgery patients. BDD is characterized as a preoccupation with a slight or imagined defect with some aspect of physical appearance that leads to significant disruption in daily functioning. Although the prevalence of BDD within the general population is unknown, recent evidence suggests that the disorder may be overrepresented among persons who seek cosmetic medical treatments. Preliminary evidence suggests that persons with BDD do not benefit from cosmetic treatments and frequently experience a worsening of their BDD symptoms. Thus, identification of BDD symptomotology has become an important part of determining patients' appropriateness for cosmetic procedures.
There is growing evidence that the prevalence of body dysmorphic disorder (BDD) is significantly higher in specially selected populations as compared to the general population. The goal of the current study was to evaluate prevalence of BDD in Turkish patients with mild acne presenting to a dermatologist for treatment. This study was the first empirical investigation of BDD in acne patients in Turkey. One hundred fifty-nine outpatients diagnosed with acne who consulted to the dermatology clinic were included in the study. The diagnosis of BDD was based on DSM-IV criteria and the Structured Clinical Interview for DSM-IV (SCID-I). A study-specific questionnaire was administered to document and investigate the demographic and clinical characteristics of the cases. Fourteen (8.8%) patients were diagnosed with BDD. Three (21.4%) patients with acne and BDD also had concomitant psychiatric diagnoses. All of the patients were psychiatric management-naive, never received any psychological or physical treatments. BDD was a common psychiatric condition in acne cases. We suggest that dermatologists should routinely explore symptoms and screen such patients for BDD.
Body dysmorphic disorder (B.D.D.) consists of a preoccupation with an imagined or slight physical defect. This study is the first European report on prevalence and several clinical and functional characteristics of patients with B.D.D. in a cosmetic surgery setting. Comparisons with defect- and severity-matched subjects without B.D.D. were also performed.
This large, multisite study investigated female college students' experiences with and attitudes about cosmetic surgery. The study also assessed the relationship between several aspects of body image, including appearance satisfaction and investment and symptoms of body dysmorphic disorder, and interest in cosmetic surgery. Thirty (5 percent) of the 559 women surveyed reported that they had undergone cosmetic surgery. Two thirds of respondents reported knowing someone who had received cosmetic surgery, and approximately one third indicated that a family member had undergone surgery. Overall, participants held relatively favorable attitudes about surgery. Regression analysis suggested that a greater psychological investment in physical appearance and greater internalization of mass media images of beauty predicted more favorable attitudes toward cosmetic surgery. Fourteen women (2.5 percent) screened positive for body dysmorphic disorder based on the nature and severity of their self-reported body-image concerns. Results of this study provide new information on young women's experiences and attitudes about cosmetic surgery and how these attitudes relate to body image.
Cosmetic medical treatments have become increasingly popular over the past decade. The explosion in popularity can be attributed to several factors-the evolution of safer, minimally invasive procedures, increased mass media attention, and the greater willingness of individuals to undergo cosmetic procedures as a means to enhance physical appearance. Medical and mental health professionals have long been interested in understanding both the motivations for seeking a change in physical appearance as well as the psychological outcomes of these treatments. Body image has been thought to play a key role in the decision to seek cosmetic procedures, however, only recently have studies investigated the pre- and postoperative body image concerns of patients. While body image dissatisfaction may motivate the pursuit of cosmetic medical treatments, psychiatric disorders characterized by body image disturbances, such as body dysmorphic disorder and eating disorders, may be relatively common among these patients. Subsequent research on persons who alter their physical appearance through cosmetic medical treatments are likely provide important information on the nature of body image.
The great American shape-up: body image survey report
- T F Cash
- Wmstead
- L H Janda
Diagnostic instruments for body dysmorphic disorder
- K A Phillips
- Atala
- H G Pope
Textbook of Women's Mental Health
- Sarwer
- M J Pertschuk
Body dysmorphic disorder and aesthetic surgery
- D B Sarwer
- Crerand
- L M Gibbons
Body image in cosmetic surgical and dermatological practice
- E R Sarwer Db Didie