Body dysmorphic disorder and other psychiatric morbidity in aesthetic rhinoplasty candidates

doi:10.1016/j.bjps.2010.09.019

Journal of Plastic, Reconstructive & Aesthetic Surgery

Volume 64, Issue 6, June 2011, Pages 738-741

https://doi.org/10.1016/j.bjps.2010.09.019 Get rights and content

Summary

Background

Body dysmorphic disorder (BDD) is a psychiatric disorder characterised by the patient’s preoccupation with an imagined defect in his or her physical appearance. Subjects with BDD often seek cosmetic surgery; however, the outcome of surgery is usually not satisfactory. The aim of current study was to investigate the prevalence of BDD among the patients seeking cosmetic surgery.

Method

In a cross-sectional study, 306 patients referred to cosmetic surgery clinics were recruited. Two psychiatrists detected BDD by interviewing the patients using Diagnostic and Statistical Manual of Mental Disorders fourth edition Text Revision (DSM IV-TR) criteria. Data analysis was done in Statistical Package for Social Sciences (SPSS) using the t-test and the Mann–Whitney test for numeral variables and the chi-square and Fisher’s exact tests for nominal variables.

Results

Data analysis of demographics showed that 80% of patients were female. Analysis on disease-related variables showed that 126 (41%) of patients had an associated psychiatric disorder. Moreover, 75 patients (24.5%) fulfilled the DSM IV criteria for BDD.

Conclusion

Findings from this study support earlier studies, which found that BDD is a relatively common disorder among individuals seeking aesthetic surgery, in particular in rhinoplasty patients. Preoperative psychiatry assessment recommends avoiding subsequent risk for both patients and surgeons.

Section snippets

Methods

In this cross-sectional study, a population was recruited from consecutive patients presenting to plastic surgery and Ear, Nose and Throat (ENT) clinics for cosmetic rhinoplasty affiliated with Shiraz University of Medical Sciences in Iran. The study was conducted over a period of 6 months from August 2007 to January 2008. Patients were included in this study if they sought cosmetic rhinoplasty surgery for the first time. Those subjects, who presented with correct defects from a medical

Results

Table 1 provides information on the socio-demographic characteristics of BDD and non-BDD subjects. As shown is Table 1, 80% of patients were female. The mean age for BDD subjects and non-BDD subjects was the same (range 23 SD ± 4.9 years). There was no significant difference between BDD and non-BDD subjects as regards their sex and marital status. Initial analyses showed that at least 126 patients (41%) met the criteria for associated psychiatric disorders such as BDD, OCD, AN, social anxiety

Discussion

The nose has a central position in the face and subjective perception of the nose can affect our image of both soma and psych. Cultural, psychological and sexual significance of the nose has been evaluated for more than a century.¹² Last et al. showed that both objective and subjective preciseness of nasal deformity was correlated to various aspects of mental health.¹³ There is some evidence that female patients with nasal deformity experienced more psychological distress than men.¹⁴ From this

Conflict of interest

None.

Funding

None.

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The popularity of cosmetic surgery is on the increase with the face being one of the most common anatomical areas operated on. Pre-existing mental health conditions can be associated with adverse patient outcomes after cosmetic surgery and can result in deterioration of postoperative mental health and lack of patient satisfaction. Therefore, identifying the presence of psychiatric disorders through preoperative screening should be considered during consultation for facial cosmetic surgery. In this study, we reviewed the types of preoperative mental health screening tools used in cosmetic facial surgery and the prevalence of mental health conditions among patients undergoing cosmetic facial surgery. A literature search was conducted on Pubmed, Prospero, Dynamed, DARE, EMBASE, and COCHRANE databases. A total of 12 articles fulfilled the inclusion criteria. A total of 2194 participants were included in this review. Rhinoplasty (n=1154), blepharoplasty (n=138) and rhytidectomy (n=83) were the most performed facial cosmetic procedures, respectively. A total of 758 (34.1%) had a diagnosis of a potential mental health problem following the preoperative screening. With body dysmorphic disorder (BDD) being the most common (20.0%). The BDD questionnaire was the most used screening tool (n=4). Mental health diagnoses were more common in patients in low-income countries (48.4%) compared to patients from non-low-income countries (25.7%). Given our findings, we propose the routine use of mental health screening tools in all patients undergoing facial cosmetic surgery. This will improve satisfaction rates post-facial cosmetic surgery and may reduce the number of unnecessary procedures.
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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.
In this review study, a search was conducted in national and international databases of Cochrane, Embase, ScienceDirect, Scopus, PubMed, and Web of Science (WoS) between 1878 and January 2020. A random-effects model was used to analyze the data, and heterogeneity of studies was examined with the I² index. Data analysis was done using comprehensive meta-analysis (Version 2).
BDD prevalence in individuals requesting cosmetic surgery in 48 articles with a sample size of 14,913 was 19.2% (95% CI: 15.8–23%). Regarding heterogeneity based on meta-regression, a significant difference between the sample size (p<0.001) and BDD prevalence in patients with cosmetic surgery was observed.
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Citation Excerpt :
Even, when the Mini International Neuropsychiatry Interview, which includes diagnoses of eating disorders, was used, results on eating disorders were not mentioned. Also authors11, 12, who applied the Structured Clinical Interview (SCID) for DSM-IV, axis 1 diagnoses13, did not report on eating disorders. Furthermore, some anecdotal reports mention eating disorders in patients requesting aesthetic surgery.14-16
There is a lack of data concerning the prevalence of eating disorders in patients requesting aesthetic surgery in spite of a large body of literature on the psychopathology of these patients. This may mostly be due to insufficient diagnostic assessment instruments. Therefore, the aim of this study was to determine the prevalence of eating disorders and their comorbidities in patients undergoing aesthetic surgery.
The assessment of prevalence of the eating disorders as anorexia nervosa, bulimia nervosa and binge eating disorder as well as other mental disorders was performed with the Structured Clinical Interview for DSM-IV mental disorders (SCID), axis 1.
212 patients (198 females, 14 males), requesting different types of aesthetic surgery, were included in this study. Eating disorders had a current prevalence of 8.0% (17/212) and a lifetime prevalence of 11.3% (24/212). Anorexia nervosa was predominantly found in patients with breast augmentation [current: 7.4% (2/27); lifetime: 11.1% (3/27)] and rhinoplasty [6.3 (1/16); 12.6% (2/16)]. Bulimia nervosa dominated in patients with liposuction [10% (3/30); 13.3% (4/30)] and binge eating disorder in patients with abdominoplasty [current/lifetime: 10.8% (4/37)]. Levels of significance (p ≤ 0.002) were reached for prevalence of the eating disorders in above mentioned types of surgery, when compared to prevalence data of the general population (two proportion Z test for SPSS).
Eating disorders are distributed according to a certain pattern in the different types of aesthetic surgery. Interestingly, the current prevalence of eating disorders (17/212) was comparable to that of body dysmorphic disorder (26/212).
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Comparison of Aesthetic and Functional Rhinoplasty Outcomes Between Patients with Body Dysmorphic Disorder and Normal Individuals
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Body dysmorphic disorder and other psychiatric morbidity in aesthetic rhinoplasty candidates

Summary

Background

Method

Results

Conclusion

Section snippets

Methods

Results

Discussion

Conflict of interest

Funding

J Am Acad Dermatol

Compr Psychiatry

J Anxiety Disord

J Plast Reconstr Aesthet Surg

Arch Psychiatr Nurs

Psychosomatics

Psychiatr Clin North Am

Body dysmorphic disorder: a survey of fifty cases

Br J Psychiatry

Psychological issues in patient outcomes

Facial Plast Surg Clin North Am

Clomipramine vs Desipramine crossover trial in body dysmorphic disorder

Arch general psychiatry