High prevalence of body dysmorphic disorder symptoms in patients seeking rhinoplasty

Picavet VA, Prokopakis EP, Gabriëls L, Jorissen M, Hellings PW.

What this paper says

Of 226 patients seeking rhinoplasty, 33% showed at least moderate symptoms of body dysmorphic disorder, and their distress bore no relation to how abnormal independent observers judged the nose to be.

Overview

Body dysmorphic disorder (BDD) is a preoccupation with a slight or imagined flaw in appearance. The authors measured how common its symptoms are in a rhinoplasty clinic in Belgium, which patients are most affected, and how the symptoms relate to objective nasal shape, quality of life and daily functioning.

Sections of note

226 patients completed questionnaires: demographics, visual analogue scales for nasal shape, the Yale-Brown Obsessive Compulsive Scale modified for BDD, a generic quality-of-life measure, and the Derriford Appearance Scale 59.
Independent observers scored nasal shape.
33% had at least moderate BDD symptoms.
More severe symptoms were linked to aesthetic goals (p < 0.001), revision rhinoplasty (p = 0.003) and psychiatric history (p = 0.031).
Objective and subjective nasal scores did not correlate; BDD scores correlated inversely with the patient's own rating of the nose (n = 210, p < 0.001) but not with the observed deformity.
BDD symptoms reduced generic quality of life (n = 160, p < 0.001) and disrupted everyday living (n = 161, p < 0.001).
Level of evidence: risk, III.

What it means for a patient

One third of people asking for rhinoplasty in this clinic had meaningful BDD symptoms, far above the general population.
Patients seeking a revision or with a psychiatric history were most at risk.
How bad a patient feels the nose looks did not track how bad it looked to others.
Questionnaire study at one center; it does not report whether these patients had surgery or how they fared.

Why this paper matters

It is one of the largest surveys of BDD symptoms in rhinoplasty candidates and supports routine psychological screening. Whether surgery helps or harms patients with moderate symptoms is not answered here.

Terms

Body dysmorphic disorder (BDD): a psychiatric condition of preoccupation with a slight or imagined appearance defect.
Yale-Brown Obsessive Compulsive Scale modified for BDD: a clinician-rated scale of BDD symptom severity.
Derriford Appearance Scale 59: a questionnaire on how appearance concerns disrupt daily life.
Visual analogue scale: a line on which a patient marks a rating, here for nasal shape.
Revision rhinoplasty: a repeat operation on a nose that has already had surgery.
Level III evidence: an observational study, here a cross-sectional survey.

Summary written by rhinoplasty.cc from the abstract, 2026-09-08; not medical advice. The authors' own abstract follows.

From the abstract

“Nasal aesthetic deformities may be associated with significant body image dissatisfaction. The only diagnostic category in the current list of psychiatric disorders that directly addresses these concerns is body dysmorphic disorder. This large-scale study determined the prevalence of body dysmorphic disorder and its…”

Excerpt; the full abstract is on PubMed.