Body Dysmorphic Disorder in Rhinoplasty Candidates: Prevalence and Functional Correlations

Overview

Body dysmorphic disorder describes a person perceiving a physical defect out of proportion to its actual extent, causing significant distress. Such patients often have high expectations of surgery and are frequently dissatisfied afterward. This study measured how common the disorder is among people seeking rhinoplasty and whether it changes how they rate their own nasal function.

Sections of note

• Cross sectional comparative study; the journal assigns level of evidence III.
• Eighty eight participants: 57 rhinoplasty candidates and 31 people from a random population as controls.
• Self assessment questionnaires used were the BDSS, the Utrecht, the SNOT 22 and the NOSE.
• A BDSS score of 6 or above was counted as positive for body dysmorphic disorder.
• Prevalence was 35.1 percent among rhinoplasty candidates and 3.2 percent among controls.
• Rhinoplasty candidates had significantly higher NOSE and SNOT 22 scores, indicating worse self rated nasal function, than controls.
• Within the candidate group, those screening positive scored worse than those screening negative, P less than 0.05.

What it means for a patient

• About one in three people presenting for rhinoplasty in this sample screened positive for the disorder.
• A positive screen was linked to reporting worse breathing, which raises the question of whether the reported blockage reflects perception rather than airflow.
• These were screening questionnaires, not psychiatric diagnoses made by an examiner.
• The study measured people before surgery only, so it says nothing about their outcomes afterward.

Why this paper matters

Body dysmorphic disorder is the main psychiatric consideration in cosmetic nasal surgery, and identifying it before operating is standard advice. This study adds evidence that it also distorts self reported breathing scores, which surgeons use to justify functional surgery. Whether treating the disorder changes those scores is untested.

Terms

• Body dysmorphic disorder: a condition in which a perceived flaw in appearance causes disproportionate distress.
• BDSS: the Body Dysmorphic Symptom Scale, a screening questionnaire.
• NOSE: the Nasal Obstruction Symptom Evaluation, a questionnaire on blocked breathing.
• SNOT 22: the Sino Nasal Outcome Test, a 22 item questionnaire on nasal and sinus symptoms.
• Cross sectional study: one measuring a group at a single point in time.