Body dysmorphic disorder (BDD) is under recognised and under detected among patients undergoing facial plastic and reconstructive surgery. Patients with BDD require psychiatric care not cosmetic surgery. In order to protect patients and surgeons, sound screening for BDD preoperatively should become the routine, rather than routinely relying on the gut feeling about whether a patient has BDD or is a candidate for surgery. The authors present a prospective prevalence and validation study, which was based on a patient cohort (n=234) that was seeking cosmetic or reconstructive surgery. Prevalence of BDD was determined by the BDD screening instrument (the Body Dysmorphic Disorder Questionnaire, BDDQ). In cases of a positive BDDQ-screening result patients were invited to a clinician-administered, semi structured interview that is considered the criterion-standard (BDD SCID) diagnostic measure for BDD. Dey et al. analysed the prevalence of BDD in an academic facial plastic and reconstructive practice. Furthermore, they validated the established BBDQ in their patient cohort and assessed the feasibility of implementing a standardised process for identification of patients in a busy clinical practice. The prevalence of patients with a BDDQ-positive screen result was much higher in the cosmetic (19.7%) than in the reconstructive (3.6%) group. Of the 19.7% of patients with a positive BDDQ screening result 13.1% were diagnosed with BDD by means of BDD SCID. The authors were able to prove the BBDQ to be a valid and accurate screening tool which can easily be introduced as a screening routine in a busy practice. Dey et al. suggest the implementation of the BDDQ during check-in followed by administration to the BDD SCID for the fraction of patients with a BDDQ-positive screen result. The presented study is the largest of BDD prevalence in a cosmetic surgery population in the United States and the first BDDQ validation study in a facial plastic and reconstructive surgery setting.
Body dysmorphic disorder in a facial plastic and reconstructive surgery clinic
Reviewed by Gregor M Bran
Body dysmorphic disorder in a facial plastic and reconstructive surgery clinic – measuring prevalence, assessing comorbidities, and validating a feasible screening instrument.
