Body Dysmorphic Disorder: A Decade of Mandatory Psychiatric Evaluation in Cosmetic Rhinoplasty Aspirants

Overview

Body dysmorphic disorder is an obsessive-compulsive condition about body image that distorts how a person sees themselves, leaving them dissatisfied even when surgery meets its objectives. The authors describe a two specialist protocol pairing the rhinoplasty surgeon with a psychiatrist to standardize diagnosis using DSM-5 criteria. Patients judged suitable at the surgeon's first consultation were then sent for mandatory psychiatric evaluation.

Sections of note

• Design: practice protocol description with 13 years of accumulated data, 2010 to 2023.
• The psychiatric evaluation used a semi-structured clinical interview incorporating the Cosmetic Procedure Screening Questionnaire and the Appearance Anxiety Inventory.
• 1602 patients attended seeking cosmetic rhinoplasty; 892 were sent to the same psychiatrist for evaluation.
• 22 of 892, 2.5 percent, were identified as having mild body dysmorphic disorder.
• Of those 22, 15 were considered suitable for surgery and had successful rhinoplasty, with follow up from 1 to 10 years, mean 4.33 years.
• Moderate to severe cases were filtered out at the first stage and not offered surgery.
• The authors state the condition is less prevalent among rhinoplasty candidates than previously reported.

What it means for a patient

• Psychological screening is presented as a routine step, not an accusation, and most candidates screened negative.
• Mild or borderline cases were still offered surgery when the person had good insight and support, which departs from treating the diagnosis as an automatic bar.
• Only 892 of 1602 patients were sent for evaluation, so the 2.5 percent figure applies to a filtered group, not to everyone who came through the door.
• The authors acknowledge that mandatory psychiatric evaluation is not practical for every practice.

Why this paper matters

Reported rates of body dysmorphic disorder among rhinoplasty candidates vary widely, largely because screening methods differ. Applying one psychiatrist and one standard over 13 years produces a more consistent figure than questionnaire based estimates. Whether this protocol reduces dissatisfaction compared with no screening is not tested.

Terms

• Body dysmorphic disorder: a condition involving preoccupation with a perceived flaw in appearance.
• DSM-5: the fifth edition of the standard psychiatric diagnostic manual.
• Semi-structured interview: a clinical interview following a framework while allowing follow up questions.
• Appearance Anxiety Inventory: a questionnaire measuring anxiety about physical appearance.
• Contraindication: a reason a treatment should not be given.