High Prevalence of Body Dysmorphic Disorder and Moderate to Severe Appearance-Related Obsessive–Compulsive Symptoms Among Rhinoplasty Candidates



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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Correspondence to Maria José Azevedo de Brito.

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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

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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

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  • Body dysmorphic disorders
  • Body image
  • Plastic surgery
  • Rhinoplasty