High Prevalence of Body Dysmorphic Disorder and Moderate to Severe Appearance-Related Obsessive-Compulsive Symptoms Among Rhinoplasty Candidates

Overview

Body dysmorphic disorder involves distressing preoccupation with a perceived flaw others barely notice, and people with it frequently seek rhinoplasty. Surgeons find it difficult to identify. This study tested a short screening instrument that a plastic surgeon without psychiatric training can administer.

Sections of note

• 80 patients seeking rhinoplasty were consecutively recruited at a university hospital plastic surgery clinic from February 2014 to March 2015.
• In a clinical interview, 50 showed excessive preoccupation with physical appearance plus clinically significant distress and were selected for the study.
• Instruments were the Brazilian-Portuguese versions of the Yale-Brown Obsessive Compulsive Scale modified for BDD and the Body Dysmorphic Symptoms Scale.
• 24 of 50 (48 percent) had body dysmorphic disorder symptoms.
• 27 of 50 (54 percent) had moderate to severe appearance-related obsessive-compulsive symptoms.
• A strong correlation was found between the two scales, r 0.841, P below 0.001.
• Strong agreement was observed between the shorter scale's cutoff and disorder status, kappa 0.822. Level of evidence IV.

What it means for a patient

• The 48 percent figure applies to the 50 patients preselected for excessive appearance preoccupation, not to all 80 who sought surgery, and not to rhinoplasty candidates generally.
• A short questionnaire agreed closely with a longer specialist instrument, so surgeons can screen without psychiatric training.
• Body dysmorphic disorder is a psychiatric condition that surgery generally does not resolve, which is why identifying it before operating matters.
• Limits: 50 patients, one hospital, preselected sample, and no follow-up on what happened to those identified.

Why this paper matters

Screening for body dysmorphic disorder before cosmetic surgery is widely recommended but rarely done systematically because the tools are specialist. Validating a short surgeon-administered scale addresses that. The preselected sample means the prevalence figure cannot be read as the rate among all rhinoplasty candidates.

Terms

• Body dysmorphic disorder: A psychiatric condition of distressing preoccupation with a perceived appearance flaw.
• Obsessive-compulsive symptoms: Intrusive thoughts and repetitive behaviors, here focused on appearance.
• Screening tool: A short test used to identify who may need fuller assessment.
• Correlation coefficient r: A number from -1 to 1 showing how strongly two measures move together.
• Kappa: A statistic measuring agreement beyond chance between two classifications.