Abstract
Objective
To assess the prevalence of body dysmorphic disorder (BDD) in an aesthetic surgery setting in the region of Southwest China, and to ascertain the differences in terms of body images between patients in the aesthetic setting and general Chinese population. This study tracked patient satisfaction with their body image changes while undergoing aesthetic medical procedures to identify whether the condition of patients who were presenting with BDD symptoms or their psychological symptoms could be improved by enhancing their appearance. Additionally, this study explored whether there was improvement in quality of life (QoL) and self-esteem after aesthetic medical procedures.
Methods
A total of 106 female patients who were undergoing aesthetic medical procedures for the first time (plastic surgery, n = 26; minimally invasive aesthetic treatment, n = 42; and aesthetic dermatological treatment, n = 38) were classified as having body dysmorphic disorder symptoms or not having body dysmorphic disorder symptoms, based on the body dysmorphic disorder examination (BDDE), which was administered preoperatively. These patients were followed up for 1 month after the aesthetic procedures. The multidimensional body self-relations questionnaire-appearance scales (MBSRQ-AS) and rosenberg self-esteem scale (RSE-S) were used to assess patients’ preoccupation with appearance and self-esteem pre-procedure and 1 month post-procedure. Additionally, 100 female healthy control participants were recruited as a comparative group into this study and they were also assessed using BDDE, MBSRQ-AS, and RSE-S.
Results
A total of 14.2 % of 106 aesthetic patients and 1 % of 100 healthy controls were diagnosed with BDD to varying extents. BDDE scores were 72.83 (SD ± 30.7) and 68.18 (SD ± 31.82), respectively, before and after the procedure for the aesthetic patient group and 43.44 (SD ± 15.65) for the healthy control group (F = 34.28; p < 0.001). There was a significant difference between the groups in subscales of MBSRQ-AS, i.e. appearance evaluation (F = 31.31; p < 0.001), appearance orientation (F = 31.65; p < 0.001), body areas satisfaction (F = 27.40; p < 0.001), and RSE-S scores (F = 20.81; p < 0.001). There was no significant difference, however, in subscales of MBSRQ-AS, i.e. overweight preoccupation (F = 1.685; p = 0.187), self-classified weight (F = 0.908; p = 0.404) between groups. All the subscales of MBSRQ-AS showed significant differences between the aesthetic patients (pre-procedure) and female adult norms from Dr. Cash’s result given in Table 4 (p < 0.001). The study also showed that there were no significant differences in the scores of BDDE, MBSRQ-AS, and RSE-S of those fifteen aesthetic patients diagnosed with BDD after aesthetic procedures lasting one month.
Conclusion
There was a high prevalence rate (14.2 %) of body dysmorphic disorder in aesthetic procedure seekers, and it seemed that those patients suffering from BDD were more likely to be dissatisfied with the results of the aesthetic medical procedures. However, general aesthetic patients showed improvement in most assessments which indicated that aesthetic medical procedures could not only enhance patient appearance, but also patient low self-esteem and QoL. Self-satisfaction could also be promoted. A screening procedure for BDD including suitable screening questionnaires might be considered for routine use in aesthetic clinical settings to minimize dissatisfaction and complaints.
Level of Evidence IV
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References
ASAPS (2003) Cosmetic surgery national data bank—2002 statistics[Z]. New York
ASAPS (2016) Cosmetic surgery national data bank—2015 statistics[Z]. New York
ISAPS (2010) ISAPS Biennial Global Survey[Z]. Hanover
Cash TF, Henry PE (1995) Women’s body images: the results of a national survey in the USA. Sex Roles 33:19–28
Rief W, Buhlmann U, Wilhelm S et al (2006) The prevalence of body dysmorphic disorder: a population-based survey[J]. Psychol Med 36(6):877–885
Rabe-Jablonska J, Bienkiewicz W (1994) Anxiety disorders in the fourth edition of the classification of mental disorders prepared by the American Psychiatric Association: diagnostic and statistical manual of mental disorders (DMS-IV—options book][J]. Psychiatr Pol 28(2): 255–268
Phillips KA, Albertini RS, Siniscalchi JM et al (2001) Effectiveness of pharmacotherapy for body dysmorphic disorder: a chart-review study[J]. J Clin Psychiatry 62(9):721–727
Anderson RC (2003) Body dysmorphic disorder: recognition and treatment[J]. Plast Surg Nurs 23(3):125–128, 129
Phillips KA, Wilhelm S, Koran LM et al (2010) Body dysmorphic disorder: some key issues for DSM-V[J]. Depress Anxiety 27(6):573–591
Phillips KA, Menard W (2006) Suicidality in body dysmorphic disorder: a prospective study[J]. Am J Psychiatry 163(7):1280–1282
Reese HE, McNally RJ, Wilhelm S (2011) Reality monitoring in patients with body dysmorphic disorder[J]. Behav Ther 42(3):387–398
Pichot P (1986) DSM-III: the 3d edition of the diagnostic and statistical manual of mental disorders from the American Psychiatric Association[J]. Rev Neurol (Paris) 142(5):489–499
Edgerton MT, Jacobson WE, MEYE RE (1960) Surgical-psychiatric study of patients seeking plastic (cosmetic) surgery: ninety-eight consecutive patients with minimal deformity[J]. Br J Plast Surg 13:136–145
Knorr NJ, Edgerton MT, Hoopes JE (1967) The, “insatiable” cosmetic surgery patient[J]. Plast Reconstr Surg 40(3):285–289
de Brito MJ, Nahas FX, Ortega NR et al (2013) Support system for decision making in the identification of risk for body dysmorphic disorder: a fuzzy model[J]. Int J Med Inform 82(9):844–853
Sarwer DB, Cash TF, Magee L et al (2005) Female college students and cosmetic surgery: an investigation of experiences, attitudes, and body image[J]. Plast Reconstr Surg 115(3):931–938
Ishigooka J, Iwao M, Suzuki M et al (1998) Demographic features of patients seeking cosmetic surgery[J]. Psychiatry Clin Neurosci 52(3):283–287
Veale D, De Haro L, Lambrou C (2003) Cosmetic rhinoplasty in body dysmorphic disorder[J]. Br J Plast Surg 56(6):546–551
Vargel S, Ulusahin A (2001) Psychopathology and body image in cosmetic surgery patients[J]. Aesthetic Plast Surg 25(6):474–478
Altamura C, Paluello MM, Mundo E et al (2001) Clinical and subclinical body dysmorphic disorder[J]. Eur Arch Psychiatry Clin Neurosci 251(3):105–108
Aouizerate B, Pujol H, Grabot D et al (2003) Body dysmorphic disorder in a sample of cosmetic surgery applicants[J]. Eur Psychiatry 18(7):365–368
Bowe WP, Leyden JJ, Crerand CE et al (2007) Body dysmorphic disorder symptoms among patients with acne vulgaris[J]. J Am Acad Dermatol 57(2):222–230
Uzun O, Basoglu C, Akar A et al (2003) Body dysmorphic disorder in patients with acne[J]. Compr Psychiatry 44(5):415–419
Wilson JB, Arpey CJ (2004) Body dysmorphic disorder: suggestions for detection and treatment in a surgical dermatology practice[J]. Dermatol Surg 30(11):1391–1399
de Brito MJ, Nahas FX, Cordas TA et al (2016) Body dysmorphic disorder in patients seeking abdominoplasty, rhinoplasty, and rhytidectomy[J]. Plast Reconstr Surg 137(2):462–471
Ching S, Thoma A, McCabe RE, et al. (2003) Measuring outcomes in aesthetic surgery: a comprehensive review of the literature[J]. Plast Reconstr Surg 111(1): 469–480, 481–482
Kaymak Y, Taner E, Simsek I (2009) Body dysmorphic disorder in university students with skin diseases compared with healthy controls[J]. Acta Derm Venereol 89(3):281–284
Assoc AP (2013) Diagnostic and statistical manual of mental disorders[Z]. Washington, DC: Am. Psychiatr. Assoc. 5th ed
Rosen JC, Reiter J (1996) Development of the body dysmorphic disorder examination[J]. Behav Res Ther 34(9):755–766
Jorge RT, Sabino NM, Natour J et al (2008) Brazilian version of the body dysmorphic disorder examination[J]. Sao Paulo Med J 126(2):87–95
Cash TF (2000) MBSRQ Users’ Manual. 3rd rev[Z]. Available at. www.body-image.com
Untas A, Koleck M, Rascle N et al (2009) Psychometric properties of the French adaptation of the multidimensional body self relations questionnaire-appearance scales[J]. Psychol Rep 105(2):461–471
Vossbeck-Elsebusch AN, Waldorf M, Legenbauer T et al (2014) German version of the Multidimensional Body-Self Relations Questionnaire—Appearance Scales (MBSRQ-AS): confirmatory factor analysis and validation[J]. Body Image 11(3):191–200
Rosenberg M (1965) Self-Image[Z]. Princeton University Press, Princeton
Heaven PC, Ciarrochi J (2007) Personality and religious values among adolescents: a three-wave longitudinal analysis[J]. Br J Psychol 98(Pt 4):681–694
Cash TF, Winstead BW, Janda LH (1985) Your body, yourself: a Psychology Today reader survey[J]. Psychol Today 19(7):22–26
Cash TF, Winstead BW, Janda LH (1986) The great American shape-up: body image survey report[J]. Psychol Today 20(4):30–37
Otto MW, Wilhelm S, Cohen LS et al (2001) Prevalence of body dysmorphic disorder in a community sample of women[J]. Am J Psychiatry 158(12):2061–2063
Bellino S, Zizza M, Paradiso E et al (2006) Dysmorphic concern symptoms and personality disorders: a clinical investigation in patients seeking cosmetic surgery[J]. Psychiatry Res 144(1):73–78
Nevill AM, Lane AM, Duncan MJ (2015) Are the multidimensional body self-relations questionnaire scales stable or transient?[J]. J Sports Sci 33(18):1881–1889
Roberts A, Cash TF, Feingold A et al (2006) Are black-white differences in females’ body dissatisfaction decreasing? A meta-analytic review[J]. J Consult Clin Psychol 74(6):1121–1131
Sarwer DB (2002) Awareness and identification of body dysmorphic disorder by aesthetic surgeons: results of a survey of american society for aesthetic plastic surgery members[J]. Aesthet Surg J 22(6):531–535
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Wang, Q., Cao, C., Guo, R. et al. Avoiding Psychological Pitfalls in Aesthetic Medical Procedures. Aesth Plast Surg 40, 954–961 (2016). https://doi.org/10.1007/s00266-016-0715-9
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DOI: https://doi.org/10.1007/s00266-016-0715-9