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Facial Plast Surg 2024; 40(05): 551-559
DOI: 10.1055/s-0044-1779045
Original Article

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

Munish Shandilya
1   Department of Otolaryngology, UPMC Whitfield Clinic, Waterford, Ireland
2   Department of Otolaryngology, Bon Secours Hospital, Dublin, Ireland
3   Department of Otolaryngology, Blackrock Clinic, Co. Dublin, Ireland
,
Stephanie Bourke
4   Department of Adult Psychiatry, Blackrock Clinic, Co. Dublin, Ireland
,
Avi Shandilya
5   School of Psychology, Trinity College Dublin, Dublin, Ireland
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Abstract

The aim of rhinoplasty is to make the patient happier with their nose. The patient's perception plays a substantial role in their outcome satisfaction. Body dysmorphic disorder (BDD) is an obsessive-compulsive disorder concerning body image, which negatively distorts the patient's perception, rendering them dissatisfied with the outcome even if the results are close to the defined objectives. In this paper, we present a protocol with a two-specialist approach (rhinoplasty surgeon and a psychiatrist) to standardize BDD diagnosis using the DSM-5 criteria. The patients deemed suitable for cosmetic rhinoplasty by the rhinoplasty surgeon's first consultation were sent for Mandatory Psychiatric Evaluation (MPE) for further consultation and second opinion. MPE was employed with a semi-structured clinical interview by a psychiatrist incorporating the Cosmetic Procedure Screening Questionnaire and Appearance Anxiety Inventory. From 2010 to 2023, 1,602 patients attended our practice seeking cosmetic rhinoplasty, out of which, 892 were sent for MPE to the same psychiatrist. The MPE identified 2.5% (22/892) patients as having mild BDD; out of which, 15 were considered suitable for surgical intervention and underwent successful rhinoplasty (follow up: 1–10 years, M = 4.33 years). Although BDD is considered a contraindication in rhinoplasty, our experience shows that borderline and mild BDD can be offered surgery with good insight and support system. Moderate to severe BDD in our practice was filtered out at the first stage and was not offered surgical intervention. BDD among rhinoplasty aspirants is not as prevalent as previously reported. Standardized diagnostic protocols and studying the severity of BDD when present has clarified management of BDD in rhinoplasty aspirants in our practice. MPE is not easy to incorporate in every rhinoplasty practice, but we aim to present guidelines arising from our ongoing experience to help management of BDD in rhinoplasty.

Keywords

body dysmorphic disorder - rhinoplasty - cosmetic surgery - psychiatric disorders - social anxiety - depression - preoperative assessment


Publication History

Article published online:
08 February 2024

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  • References

  • 1 American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (DSM-5®). American Psychiatric Publishing; 2013
    Google Scholar
  • 2 Veale D, Boocock A, Gournay K. et al. Body dysmorphic disorder. A survey of fifty cases. Br J Psychiatry 1996; 169 (02) 196-201
    Google Scholar
  • 3 Phillips KA, McElroy SL, Keck PE, Pope HG, Hudson JI. Body dysmorphic disorder: 30 cases of imagined ugliness. In: The Science of Mental Health. Routledge; 1993: 86-92
    Google Scholar
  • 4 Crerand CE, Phillips KA, Menard W, Fay C. Nonpsychiatric medical treatment of body dysmorphic disorder. Psychosomatics 2005; 46 (06) 549-555
    Google Scholar
  • 5 Phillips KA, Grant J, Siniscalchi J, Albertini RS. Surgical and nonpsychiatric medical treatment of patients with body dysmorphic disorder. Psychosomatics 2001; 42 (06) 504-510
    Google Scholar
  • 6 Tignol J, Biraben-Gotzamanis L, Martin-Guehl C, Grabot D, Aouizerate B. Body dysmorphic disorder and cosmetic surgery: evolution of 24 subjects with a minimal defect in appearance 5 years after their request for cosmetic surgery. Eur Psychiatry 2007; 22 (08) 520-524
    Google Scholar
  • 7 Veale D. Outcome of cosmetic surgery and ‘DIY’ surgery in patients with body dysmorphic disorder. Psychiatr Bull 2000; 24 (06) 218-221
    Google Scholar
  • 8 Crerand CE, Franklin ME, Sarwer DB. Body dysmorphic disorder and cosmetic surgery. Plast Reconstr Surg 2006; 118 (07) 167e-180e
    Google Scholar
  • 9 Honigman RJ, Phillips KA, Castle DJ. A review of psychosocial outcomes for patients seeking cosmetic surgery. Plast Reconstr Surg 2004; 113 (04) 1229-1237
    Google Scholar
  • 10 Brohede S, Wingren G, Wijma B, Wijma K. Prevalence of body dysmorphic disorder among Swedish women: a population-based study. Compr Psychiatry 2015; 58: 108-115
    Google Scholar
  • 11 Buhlmann U, Glaesmer H, Mewes R. et al. Updates on the prevalence of body dysmorphic disorder: a population-based survey. Psychiatry Res 2010; 178 (01) 171-175
    Google Scholar
  • 12 Cerea S, Bottesi G, Grisham JR, Ghisi M. Body dysmorphic disorder and its associated psychological and psychopathological features in an Italian community sample. Int J Psychiatry Clin Pract 2018; 22 (03) 206-214
    Google Scholar
  • 13 Gieler T, Schmutzer G, Braehler E, Schut C, Peters E, Kupfer J. Shadows of beauty–prevalence of body dysmorphic concerns in Germany is increasing: data from two representative samples from 2002 and 2013. Acta Derm Venereol 2016; 96 (217) 83-90
    Google Scholar
  • 14 Schieber K, Kollei I, de Zwaan M, Martin A. Classification of body dysmorphic disorder - what is the advantage of the new DSM-5 criteria?. J Psychosom Res 2015; 78 (03) 223-227
    Google Scholar
  • 15 Alavi M, Kalafi Y, Dehbozorgi GR, Javadpour A. Body dysmorphic disorder and other psychiatric morbidity in aesthetic rhinoplasty candidates. J Plast Reconstr Aesthet Surg 2011; 64 (06) 738-741
    Google Scholar
  • 16 de Brito MJA, Nahas FX, Cordás TA, Tavares H, Ferreira LM. Body dysmorphic disorder in patients seeking abdominoplasty, rhinoplasty, and rhytidectomy. Plast Reconstr Surg 2016; 137 (02) 462-471
    Google Scholar
  • 17 Fathololoomi MR, Goljanian Tabrizi A, Fattahi Bafghi A, Noohi SA, Makhdoom A. Body dysmorphic disorder in aesthetic rhinoplasty candidates. Pak J Med Sci 2013; 29 (01) 197-200
    Google Scholar
  • 18 Picavet VA, Prokopakis EP, Gabriëls L, Jorissen M, Hellings PW. High prevalence of body dysmorphic disorder symptoms in patients seeking rhinoplasty. Plast Reconstr Surg 2011; 128 (02) 509-517
    Google Scholar
  • 19 Veale D, De Haro L, Lambrou C. Cosmetic rhinoplasty in body dysmorphic disorder. Br J Plast Surg 2003; 56 (06) 546-551
    Google Scholar
  • 20 Constantian MB. Commentary on: using nasal self-esteem to predict revision in cosmetic rhinoplasty. Aesthet Surg J 2021; 41 (06) 657-660
    Google Scholar
  • 21 de Brito MJA, de Almeida Arruda Felix G, Nahas FX. et al. Body dysmorphic disorder should not be considered an exclusion criterion for cosmetic surgery. J Plast Reconstr Aesthet Surg 2015; 68 (02) 270-272
    Google Scholar
  • 22 Constantian MB. Childhood Abuse, Body Shame, and Addictive Plastic Surgery: The Face of Trauma. Taylor & Francis;; 2019
    Google Scholar
  • 23 Phillips KA. The Broken Mirror: Understanding and Treating Body Dysmorphic Disorder. Oxford University Press;; 2005
    Google Scholar
  • 24 Sarwer DB. Awareness and identification of body dysmorphic disorder by aesthetic surgeons: results of a survey of American Society for Aesthetic Plastic Surgery members. Aesthet Surg J 2002; 22 (06) 531-535
    Google Scholar
  • 25 Bowyer L, Krebs G, Mataix-Cols D, Veale D, Monzani B. A critical review of cosmetic treatment outcomes in body dysmorphic disorder. Body Image 2016; 19: 1-8
    Google Scholar
  • 26 First MB, Gibbon M, Spitzer R, Williams J. User's Guide for the Structured Clinical Interview for DSM-IV-TR Axis I Disorders-Research Version-(SCID-I for DSM-IV-TR, November 2002 revision). N Y State Psychiatric Institute;; 2002
    Google Scholar
  • 27 Joseph AW, Ishii L, Joseph SS. et al. Prevalence of body dysmorphic disorder and surgeon diagnostic accuracy in facial plastic and oculoplastic surgery clinics. JAMA Facial Plast Surg 2017; 19 (04) 269-274
    Google Scholar
  • 28 Sarwer DB, Spitzer JC. Body image dysmorphic disorder in persons who undergo aesthetic medical treatments. Aesthet Surg J 2012; 32 (08) 999-1009
    Google Scholar
  • 29 Joseph J, Randhawa P, Hannan SA. et al. Body dysmorphic disorder in patients undergoing septorhinoplasty surgery: should we be performing routine screening?. Clin Otolaryngol 2017; 42 (03) 508-513
    Google Scholar
  • 30 Constantian MB. The new criteria for body dysmorphic disorder: who makes the diagnosis?. Plast Reconstr Surg 2013; 132 (06) 1759-1762
    Google Scholar
  • 31 Gibbon M, Spitzer RL, Williams JB. et al User's Guide for the Structured Clinical Interview for DSM-IV Axis II Personality Disorders: SCID-II. American Psychiatric Press; 1997
    Google Scholar
  • 32 Felix GAA, de Brito MJA, Nahas FX. et al. Patients with mild to moderate body dysmorphic disorder may benefit from rhinoplasty. J Plast Reconstr Aesthet Surg 2014; 67 (05) 646-654
    Google Scholar
  • 33 Rabaioli L, Oppermann PO, Pilati NP. et al. Evaluation of postoperative satisfaction with rhinoseptoplasty in patients with symptoms of body dysmorphic disorder. Rev Bras Otorrinolaringol (Engl Ed) 2022; 88 (04) 539-545
    Google Scholar