Rhinoplasty is one of the most sought-after procedures in plastic surgery by individuals with body dysmorphic disorder (BDD). The identification of BDD symptoms is a challenge for plastic surgeons. The purpose of this study was to use a specific instrument for detection of BDD symptoms as a screening tool in rhinoplasty candidates and estimate the prevalence and severity of BDD symptoms in this population.
Eighty patients of both sexes seeking rhinoplasty were consecutively recruited at a plastic surgery outpatient clinic of a university hospital from February 2014 to March 2015. In a clinical interview, 50 of them showed an excessive preoccupation with physical appearance associated with clinically significant subjective distress and were, therefore, selected to participate in the study. All participants were assessed using the Brazilian-Portuguese versions of the Yale-Brown Obsessive Compulsive Scale modified for BDD (BDD-YBOCS) and the Body Dysmorphic Symptoms Scale (BDSS), which can be applied by plastic surgeons, who are laypersons in psychology/psychiatry.
Twenty-four (48%, 24/50) candidates had BDD symptoms, and 27 (54%, 27/50) showed moderate to severe appearance-related obsessive–compulsive symptoms. A strong correlation was found between the BDSS and BDD-YBOCS scores (r = 0.841, P < 0.001), and a strong agreement was observed between the BDSS cutoff point and body dysmorphic disorder symptom status (kappa = 0.822).
A high prevalence of BDD and moderate to severe appearance-related obsessive–compulsive symptoms was found among aesthetic rhinoplasty candidates. The BDSS may be used as a screening tool for BDD symptoms in plastic surgery patients.
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Felix GA, de Brito MJ, Nahas FX, Tavares H, Cordás TA, Dini GM, Ferreira LM (2014) Patients with mild to moderate body dysmorphic disorder may benefit from rhinoplasty. J Plast Reconstr Aesth Surg 67:646–654
De Brito MJ, Nahas FX, Cordás TA, Tavares H, Ferreira LM (2016) Body dysmorphic disorder in patients seeking abdominoplasty, rhinoplasty and rhytidectomy. Plast Reconstr Surg 137:462–471
Javo IM, Sørlie T (2010) Psychosocial characteristics of young Norwegian women interested in liposuction, breast augmentation, rhinoplasty, and abdominoplasty: a population-based study. Plast Reconstr Surg 125:1536–1543
Andretto Amodeo C (2007) The central role of the nose in the face and the psyche: review of the nose and the psyche. Aesthetic Plast Surg 31:406–410
Kisely S, Morkell D, Allbrook B, Briggs P, Jovanovic J (2002) Factors associated with dysmorphic concern and psychiatric morbidity in plastic surgery outpatients. Aust N Z J Psychiatry 36:121–126
Javanbakht M, Nazari A, Javanbakht A, Moghaddam L (2012) Body dysmorphic factors and mental health problems in people seeking rhinoplastic surgery. Acta Otorhinolaryngol Ital 32:37–40
Alavi M, Kalafi Y, Dehbozorgi GR, Javadpour A (2011) Body dysmorphic disorder and other psychiatric morbidity in aesthetic rhinoplasty candidates. J Plast Reconstr Aesthet Surg 64:738–741
Ambro BT, Wright RJ (2008) Psychological considerations in revision rhinoplasty. Facial Plast Surg 24:288–292
Sarwer DB, Crerand CE (2008) Body dysmorphic disorder and appearance enhancing medical treatments. Body Image 5:50–58
Picavet VA, Prokopakis EP, Gabriëls L, Jorissen M, Hellings PW (2011) High prevalence of body dysmorphic disorder symptoms in patients seeking rhinoplasty. Plast Reconstr Surg 128:509–517
Picavet VA, Gabriëls L, Grietens J, Jorissen M, Prokopakis EP, Hellings PW (2013) Preoperative symptoms of body dysmorphic disorder determine postoperative satisfaction and quality of life in aesthetic rhinoplasty. Plast Reconstr Surg 131:861–868
Phillips KA, Wilhelm S, Koran LM, Didie ER, Fallon BA, Feusner J, Stein DJ (2010) Body dysmorphic disorder: some key issues for DSM-V. Depress Anxiety 27:573–591
Reese HE, McNally RJ, Wilhelm S (2010) Facial asymmetry detection in patients with body dysmorphic disorder. Behav Res Ther 48:936–940
Veale D, Neziroglu F (2010) Body dysmorphic disorder (a treatment manual). Wiley-Blackwell, West Sussex
De Brito MJ, Sabino Neto M, de Oliveira MF, Cordás TA, Duarte LS, Rosella MF, Felix GA, Ferreira LM (2015) Yale-Brown Obsessive Compulsive Scale modified for Body Dysmorphic Disorder (BDD-YBOCS): Brazilian Portuguese translation, cultural adaptation and validation. Rev Bras Psiquiatr 37:310–316
Ramos TD, Brito MJ, Piccolo MS, Rosella MF, Neto Sabino M, Ferreira LM (2016) Body Dysmorphic Symptoms Scale in patients seeking esthetic surgery: cross-cultural validation study. Sao Paulo Med J 134:480–490
Phillips KA, Hollander E, Rasmussen SA, Aronowitz BR, DeCaria C, Goodman WK (1997) A severity rating scale for body dysmorphic disorder: development, reliability, and validity of a modified version of the Yale-Brown Obsessive Compulsive Scale. Psychopharmacol Bull 33:17–22
Perugi G, Akiskal HS, Giannotti D, Frare F, Di Vaio S, Cassano GB (1997) Gender-related differences in body dysmorphic disorder (dysmorphophobia). J Nerv Ment Dis 185:578–582
Mühlbauer W, Holm C, Wood DL (2001) The thersites complex in plastic surgical patients. Plast Reconstr Surg 107:319–326
American Psychiatric Association (2013) Obsessive–compulsive and related disorders. In: Diagnostic and statistical manual of mental disorders. 5th edn. American Psychiatric Association, Arlington
Brito MJ, Nahas FX, Cordás TA, Gama MG, Sucupira ER, Ramos TD, Felix Gde A, Ferreira LM (2016) Prevalence of body dysmorphic disorder symptoms and body weight concerns in patients seeking abdominoplasty. Aesthet Surg J 36:324–332
Vindigni V, Pavan C, Semenzin M, Granà S, Gambaro F, Marini M, Bassetto F, Mazzoleni F (2002) The importance of recognizing body dysmorphic disorder in cosmetic surgery patients: do our patients need a preoperative psychiatric evaluation? Eur J Plast Surg 25:305–308
Brito De, Nahas FX, Ferreira LM (2012) Should plastic surgeons operate on patients diagnosed with body dysmorphic disorder? Plast Reconstr Surg 129:406e–407e
De Brito MJ, de Almeida Arruda Felix G, Nahas FX, Tavares H, Cordás TA, Dini GM, Ferreira LM (2015) Body dysmorphic disorder should not be considered an exclusion criterion for cosmetic surgery. J Plast Reconstr Aesthet Surg 68:270–272
Conflict of interest
The authors declare that they have no conflict of interest.
All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments. The study was approved by the Institutional Research Ethics Committee and performed in accordance with the Brazilian Ethical Review System on research involving human beings
Written informed consent was obtained from all patients and parents or legal representatives after the procedures had been fully explained and prior to their inclusion in the study; anonymity was assured.
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Ramos, T.D., de Brito, M.J.A., Suzuki, V.Y. et al. High Prevalence of Body Dysmorphic Disorder and Moderate to Severe Appearance-Related Obsessive–Compulsive Symptoms Among Rhinoplasty Candidates. Aesth Plast Surg 43, 1000–1005 (2019). https://doi.org/10.1007/s00266-018-1300-1
- Body dysmorphic disorders
- Body image
- Plastic surgery