MOC-PS(SM) CME Article: Patient Safety: Body Dysmorphic Disorder and Cosmetic Surgery

Abstract

Learning Objectives: After studying this article, the participant should be able to: 1. Identify the clinical features of body dysmorphic disorder and its prevalence in cosmetic populations. 2. Describe the safety concerns related to treating patients with body dysmorphic disorder. 3. Identify mechanisms of screening for body dysmorphic disorder in cosmetic surgery patients. Background: The psychological characteristics of persons who pursue cosmetic procedures are of interest to both surgeons and mental health professionals. Body image dissatisfaction appears to be common among these patients. However, some individuals may present with extreme levels of body image dissatisfaction suggestive of the psychiatric diagnosis of body dysmorphic disorder. Methods: The authors reviewed the diagnostic criteria, etiology, clinical and demographic characteristics, comorbidity, and treatments for body dysmorphic disorder. The prevalence of body dysmorphic disorder in cosmetic populations is highlighted, as are issues related to patient and provider safety. Results: Body dysmorphic disorder is associated with significant distress and impairment, including suicidality. Studies suggest that 5 to 15 percent of patients presenting for cosmetic treatments have the disorder. Affected persons who receive cosmetic procedures are typically dissatisfied with the outcome of the procedures, and their body dysmorphic disorder symptoms rarely improve. These patients may threaten violence or become violent toward themselves or their treatment providers. Psychiatric and psychological interventions are more effective and appropriate treatments. Conclusions: Because persons with body dysmorphic disorder frequently pursue cosmetic procedures, surgeons may be able to identify and refer these patients for psychiatric or psychological treatment. Direct questioning of potential symptoms as well as screening questionnaires can aid in the assessment of body dysmorphic disorder in cosmetic surgery settings. The Maintenance of Certification module series is designed to help the clinician structure his or her study in specific areas appropriate to his or her clinical practice. This article is prepared to accompany practice-based assessment of preoperative assessment, anesthesia, surgical treatment plan, perioperative management, and outcomes. In this format, the clinician is invited to compare his or her methods of patient assessment and treatment, outcomes, and complications, with authoritative, information-based references. This information base is then used for self-assessment and benchmarking in parts II and IV of the Maintenance of Certification process of the American Board of Plastic Surgery. This article is not intended to be an exhaustive treatise on the subject. Rather, it is designed to serve as a reference point for further in-depth study by review of the reference articles presented. (Plast. Reconstr. Surg. 122: 1, 2008.)

Psychiatric Assessment and Management of Clients Undergoing Cosmetic Surgery: Overview and Need for an Integrated Approach

“…2 Prevalence of psychiatric disorders in this group increases the risk for patient dissatisfaction and poorer outcomes such as patient distress, adjustment problems, social isolation, worsening of preexisting mental health conditions, and risk of self-harm. [3][4][5][6] Hence, identifying the presence of any psychiatric disorder through preoperative screening and conducting a psychological risk assessment (PRA) needs to be an integral aspect during the screening of patients seeking elective appearance-altering procedures.…”

Part of the problem or part of the solution? Plastic surgeons and body image dissatisfaction

“…As the uptake of cosmetic surgery increases, so too does the probability that most psychiatric disorders will be present among prospective patients-particularly those characterised by elevated levels of body image dissatisfaction such as body dysmorphic disorder (BDD) and eating disorders. 43,44 Patient selection is key in ensuring that cosmetic surgery is an appropriate response. Indeed, the imperative of improving methods of patient selection has been highlighted in a number of reports.…”

Body Dysmorphic Disorder et chirurgie esthétique : une revue de la littérature

“…Un patient se focalisant au moins une heure par jour sur son défaut supposé est un patient souffrant de BBD. Dans les cas sévères, il peut être difficile pour les personnes atteintes de ce trouble de penser à autre chose qu'à leur apparence [22]. Un grand nombre des patients souffrant de BDD sont incapables de reconnaître l'excès de leurs préoccupations (insight faible) alors que certains sont critiques quant à leurs pensées anxieuses (bon insight).…”

“…Les patients consultant en chirurgie esthétique sont souvent demandeurs d'une correction pour un léger défaut de leur apparence physique ou pour simplement améliorer une morphologie quasi normale. De par leur formation, les chirurgiens plasticiens sont également entraînés à identifier et réparer des défauts « mineurs » [22] et un certain nombre de nos patients pourraient correspondre au premier critère du DSM-V. Diagnostiquer un patient atteint de BDD est particulièrement important pour le chirurgien plasticien, non seulement pour des raisons médicolégales, mais également pour orienter ces patients vers une prise en charge adaptée.…”