Caring for Patients With Body Dysmorphic Disorder Seeking to Undergo Plastic Surgery and/or Aesthetic Interventions.

In the field of medical aesthetics and plastic surgery, it is not uncommon to interact with clients who never seem to be satisfied, regardless of the success of an intervention. Medical professionals may attribute this to the patient having an overly critical nature; however, this continual dissatisfaction could also be the result of a mental health disorder known as body dysmorphic disorder (BDD) that is significantly underdiagnosed and prevalent within the plastic surgery and aesthetic patient population. According to the Diagnostic and Statistical Manual of Mental Health Disorders (DSM-5; American Psychiatric Association, 2013), BDD is defined as, "a preoccupation with one or more perceived defects or flaws in physical appearance that are not observable or appear slight to others" (Substance Abuse and Mental Health Services Administration, 2016, Table 23). Having the ability to identify the signs of BDD, utilize appropriate communication skills with individuals who may have BDD, and understand the implications of providing additional aesthetic treatments for patients who present with BDD allows aesthetic practitioners to prioritize and promote patient safety, well-being, and satisfaction.

Psychological evaluation of Asian female patients with rhinoplasty.

BACKGROUND: Patients requiring plastic surgery exhibit more abnormal psychological trends (e.g., body dysmorphic disorder [BDD], depression, and anxiety) than those requiring other surgeries. However, there are only a few domestic studies on the psychological aspects of the population requiring plastic surgery. Therefore, we analyzed the psychological characteristics and psychological impact of rhinoplasty in female patients. METHODS: In this study, patients were classified into 2 groups: 151 males and 60 females. The self-rating scale of body image (SSBI), self-rating anxiety scale, self-rating depression scale, and postoperative satisfaction questionnaire were used to examine the patients before and after surgery. The results were analyzed using t-test, analysis of variance, chi-square test, paired rank sum test, and Pearson correlation analysis. RESULTS: The total prevalence of BDD in female patients who underwent rhinoplasty was 7.3%. The prevalence of anxiety disorders was 31.8% and that of depression was 45.0%. Female patients with BDD were more likely to exhibit depression (55.5%) and anxiety (36.4%). The SSBI score was related to marital status (p = 0.001) and history of rhinoplasty (p = 0.000). Moreover, there was a significant negative correlation between preoperative BDD score and postoperative satisfaction (r = -0.392, p = 0.002) as well as between the previous history of rhinoplasty and postoperative satisfaction (r = -0.603, p = 0.000). CONCLUSION: Pathological psychologies such as anxiety, depression, and BDD are common in patients scheduled to undergo rhinoplasty, and BDD is more likely to be associated with depression. Rhinoplasty has little psychological impact on patients, i.e., it neither causes improvement nor deterioration. Female patients who have undergone rhinoplasty should be considered to a have high risk of BDD. Although the outcomes of surgery are generally quite positive, patients diagnosed with BDD are more likely to be dissatisfied.

Going deeper into eating and body image pathology in males: Prevalence of muscle dysmorphia and eating disorders in a university representative sample.

Disorders associated with body dissatisfaction such eating disorders (ED) and muscle dysmorphia (MD) in males are understudied and surrounded by controversy regarding their nosological aspects. The current study examined the prevalence rates of clinical cases of ED and MD through a two-phase study with gold standard clinical interview in a representative sample of 850 Spanish undergraduate men, of whom 141 were interviewed. Levels of body dissatisfaction, compulsive exercise, anxious-depressive symptoms and the amount of physical activity were also explored. A prevalence rate for ED of 1.4% and 1.3% for MD was found. No differences were observed between the clinical groups on scales related to body image, supporting the current perspective that MD as well as ED and Body Dysmorphic Disorder could be clustered in a new spectrum of body image disorders, where the behaviours performed to achieve body change could range from restriction or muscularity-oriented eating alterations to pathological exercise or cosmetic surgery. The usefulness of the cut-off points of the screening questionnaires in MD and ED in males are discussed.

Quality of Life and Screening on Body Dysmorphic Disorder, Depression, Anxiety in Septorhinoplasty.

OBJECTIVES: Septorhinoplasty (SRPL) can improve quality of life (QoL) in functional and aesthetical aspects of the nose. A key factor compromising postoperative satisfaction is symptoms of body dysmorphic disorder (BDD), defined by excessive concerns and distress over slight or imagined physical defects. Although a high prevalence of BDD in SRPL patients is evident, the effect of positive screening on BDD and other psychiatric disorders is understudied. It was hypothesized that patients screening positive for BDD, depression or anxiety do not show increased postoperative QoL. METHODS: A multicenter, prospective study including 259 patients. For psychiatric evaluation, the BDD concern questionnaire-aesthetic version and the Hospital Anxiety and Depression Scale were used; for disease-specific QoL the Rhinoplasty Outcomes Evaluation (ROE) and the Functional Rhinoplasty Outcome Inventory (FROI-17). RESULTS: In preoperative evaluation, 32.5% had a positive screening for BDD, 42.2% for increased anxiety, and 32.9% for depression. Mean QoL improved in the whole cohort (FROI total score: 54.4 ± 21.8 to 32.8 ± 23.7 and ROE: 32.3 ± 15.6 to 69.8 ± 23.1, both p < 0.001). Patients screening positive for BDD, depression or anxiety did show an increased postoperative QoL, but to a significantly lower degree and with lower pre- and postoperative QoL levels. CONCLUSIONS: SRPL patients show a high prevalence of BDD symptoms, elevated anxiety, and depression. These subgroups show lower QoL levels and an impaired QoL increase after surgery. Rhinoplasty surgeons must be aware of the disorders and their symptoms, discuss potential concerns with the patients, and potentially refer them to a specialist. LEVEL OF EVIDENCE: 3 Laryngoscope, 134:2187-2193, 2024.

PREVALENCE OF BODY DYSMORPHIC DISORDER AMONG ATTENDANCES SEEKING FACIAL COSMETIC PROCEDURES IN BAGHDAD.

OBJECTIVE: Aim: To find out the prevalence of body dysmorphic disorder among patients seeking facial cosmetic procedures, find out association of social demographic (age, gender, occupation, marital status, friends relationship, and dating status) ampatientsient with body dysmorphic disorder. PATIENTS AND METHODS: Materials and Methods: A cross-sectional study was done on a sample of 100 patients from Al-waste Hospital and Ghazy Al-Hariri Hospital for surgical specialties in Baghdad by using a body dysmorphic disorder questionnaire to diagnose a probable case and then a semi-structured questionnaire based on DSM5 criteria to diagnose body dysmorphic disorder during the period extended from beginning of January 2019 to the end of April 2019. RESULTS: Results: The chi-square test proved the association between female gender and body dysmorphic disorder is significant P=0.026. Significant associations were also noticed between single patients and body dysmorphic disorder 76.8% in comparison with married 37.8, and divorced or widowed 42.9% (P=0.001). It was found that 68.6% of unemployed patients think that they need to correct their body dysmorphic disorder so they attended the hospital while only 40% of employed persons did so P=0.008. The mean age of patients exposed to a second operation was significantly higher than the mean age of other patients P=0.022. CONCLUSION: Conclusions: High prevalence of body dysmorphic disorder among patients seeking plastic surgery which is about 60%. Body dysmorphic disorder is more common among single and unemployment and among young adults and gender female. There is no significant association between the mean age of male and female patients of body dysmorphic disorder group.

The heart of it all: Body dysmorphic disorder in cosmetic surgery.

BACKGROUND: Body Dysmorphic Disorder (BDD) represents a prevalent mental health condition characterized by distress arising from self-perceived physical imperfections. BDD serves as a contraindication to aesthetic surgery. Recognizing BDD holds paramount importance for plastic surgeons, as it is instrumental in averting the exacerbation of this condition while ensuring appropriate referrals. OBJECTIVE: This study aimed to investigate the prevalence of BDD in cosmetic surgery patients and to pinpoint key characteristics associated with BDD. This information provides plastic surgeons with specific factors to consider during preoperative evaluations. METHODS: We employed TriNetX database to identify patients with BDD who underwent cosmetic surgery identified by Current Procedural Terminology codes. Demographics and patient characteristics were identified using the International Classification of Diseases 10 codes. We calculated odds ratios (OR) by using chi-squared tests to assess risk factors among patients with BDD. RESULTS: Of 226,374 patients who underwent plastic surgery between August 2002 and August 2022, fewer than 0.1% were diagnosed with BDD. Of the BDD patients, 52.1% were diagnosed after cosmetic surgery. Compared with the control group, BDD patients were more likely to undergo rhinoplasty (OR=1.784, p = 0.004) and nonlocalized lipectomy (OR=1.448, p = 0.021) and less likely to undergo blepharoplasty (OR=0.451, p = 0.002). Findings indicated a strong association between BDD patients undergoing cosmetic procedures and comorbid psychiatric conditions such as depression (OR=4.279, p < 0.05), anxiety (OR=5.490, p < 0.05), and Attention-Deficit Hyperactivity Disorder (OR=3.993, p < 0.05). CONCLUSIONS: These findings underscore the ongoing significance of BDD in the context of cosmetic surgery, potentially indicating a lower surgery rate among BDD patients compared with previous estimates. Nevertheless, avenues for further improvement persist. Our data affirm the noteworthy occurrence of postsurgery BDD development, thereby highlighting the ongoing necessity for psychiatric evaluation in surgical patients.

Prevalence of Body Dysmorphic Disorder in Orbital Plastic Surgery and Its Relationship with the Use of Social Media.

BACKGROUND: The prevalence of body dysmorphic disorder (BDD) in the general population ranges from 0.7 to 2.4%; however, higher rates are seen among aesthetic patients. Given the recent rise in popularity of cosmetic surgery, particularly in the post-COVID pandemic setting, the authors hypothesize the prevalence has increased. The purpose of the study is to examine the prevalence of BDD in patients presenting to an oculoplastic surgery clinic at an academic center and determine correlation with social media use. METHODS: This is a survey of patients presenting to the oculoplastic surgery clinic. Participants completed the Dysmorphic Concern Questionnaire (DCQ), in addition to survey questions about social media use. Main outcomes included a positive screen and social media use. RESULTS: A total of 175 patients that presented to the oculoplastic and reconstructive surgery clinic were surveyed. All patients, including cosmetic, functional, and non-surgical, were offered participation in the survey. 9.13% of all patients screened positive for BDD. Patients that screened positive were more commonly female (71.43%). The distribution of patients with BDD was even between Hispanics (52.38%) and non-Hispanics, and 85.71% of patients with BDD were Caucasian. Of patients that screened positive, 71.43% use social media. CONCLUSIONS: The prevalence of BDD may have increased in the past seven years and is seen most in females and Caucasians. There is a positive correlation with social media, which has increased in popularity since the COVID-19 pandemic. It is important to maintain a high clinical suspicion for BDD and consider screening if there is concern. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Body dysmorphic disorder: A critical appraisal of diagnostic, screening, and assessment tools.

Body dysmorphic disorder (BDD) is a psychiatric condition characterized by profound concern about a minor or imagined defect in the appearance of individuals and increased preoccupation with the imagined/perceived defect. Individuals with BDD often undergo cosmetic intervention for the perceived imperfection but rarely experience improvement in their signs and symptoms after such treatment. It is recommended that aesthetic providers evaluate individuals face-to-face and screen for BDD with approved scales preoperatively to determine the candidate's suitability for the procedure. This contribution focuses on diagnostic and screening tools and measures of disease severity and insight that providers working in nonpsychiatric settings can use. Several screening tools were explicitly developed for BDD; others were designed to evaluate body image/dysmorphic concern. The BDD Questionnaire (BDDQ)-Dermatology Version (BDDQ-DV), BDDQ-Aesthetic Surgery (BDDQ-AS), Cosmetic Procedure Screening Questionnaire (COPS), and Body Dysmorphic Symptom Scale (BDSS) have been developed explicitly for BDD and validated in cosmetic settings. The limitations of screening tools are discussed. Given the increasing use of social media, future revisions of BDD instruments should consider incorporating questions relevant to patients' behaviors on social media. Current screening tools can adequately test for BDD despite their limitations and a need for updates.

Evidence-based review: Screening body dysmorphic disorder in aesthetic clinical settings.

BACKGROUND: Body dysmorphic disorder (BDD) is a psychiatric disturbance with high incidence in aesthetic clinical settings. Early recognition may avoid unnecessary elective procedures with ethical and medicolegal consequences. AIMS: To identify validated BDD screening tools and critically appraise current literature regarding its implementation and efficacy in aesthetic medicine and surgery scenarios, with the purpose of transposing the findings to the broad clinical settings in the field. METHODS: Data was collected using advanced search from PubMed (MEDLINE). Having satisfied the search parameters, 12 studies referring BDD definition according to Diagnostic and Statistical Manual of Mental Disorder (DSM-5) criteria and including a BDD screening tool in clinical aesthetic settings were selected. RESULTS: While BDD screening enables the recognition of at-risk individuals, further work is required to uncover the best screening tool for general aesthetic clinical practice. Level III evidence favored BDD Questionnaire (BDDQ)/BDDQ-Dermatology Version (DV), and The Dysmorphic Concern Questionnaire (DCQ) among the limited available validated screening instruments to be used outside the psychiatric environment. Based on level II self-classification, one study selected BDDQ-Aesthetic Surgery (AS) version for rhinoplasty patients. The validation process of both BDDQ-AS and Cosmetic Procedure Screening Questionnaire (COPS) had limitations. For BDD screening potential in avoiding postoperative complications, the limited studies found evaluating the outcomes following aesthetic treatments using validated BDD screening measures showed a trend toward less satisfaction with aesthetic treatment outcome among positive screening population against non-BDD counterparts. CONCLUSION: Further research is necessary to establish more effective methods to identify BDD and evaluate the impact of positive findings on aesthetic intervention outcomes. Future studies may elucidate which BDD characteristics best predict a favorable outcome and provide high-quality evidence for standardized protocols in research and clinical practice.

Prevalence of Body Dysmorphic Disorder in an Otolaryngology-Head and Neck Surgery Clinic.

OBJECTIVE: To analyze the prevalence of body dysmorphic disorder (BDD) in a general otolaryngology population presenting to an outpatient clinic. STUDY DESIGN: Prospective prevalence study. SETTING: Single tertiary academic otolaryngology clinic. SUBJECT AND METHODS: New patients over 18 years of age who presented to an academic otolaryngology clinic between August 2018 and May 2021 completed a questionnaire including demographic questions and the validated Body Dysmorphic Disorder Questionnaire (BDDQ). Data collected from the questionnaires were analyzed to assess demographics and prevalence of BDD in an otolaryngology clinic. RESULTS: Of the 242 patients queried, 15 patients screened positive for BDD. The screened prevalence of BDD was determined to be 6.2%. None of the patients had previously been diagnosed with BDD. The prevalence of prior mental health diagnoses was 34.3%. These patients had initially presented for a variety of otolaryngologic concerns and had pre-existing diagnoses of anxiety, depression, obsessive-compulsive, bipolar and eating disorders. CONCLUSION: The prevalence of BDD in our population of new patients presenting to an academic otolaryngology practice (6.2%) is higher than that of the general population (1.9%).

Collecting psychological signs in the diagnosis of skeletal dysmorphoses / Recueillir les signes psychologiques dans le diagnostic des dysmorphoses squelettiques

INTRODUCTION: If we must, in all cases, collect the psychological elements of the profile of our patients, in the case of skeletal dysmorphoses, the time of this information gathering is one of the most essential steps for therapeutic success. We must assess whether we are putting the patient at psychological risk, in the case of surgical correction of the bone bases, but these issues also exist in adult orthodontic treatments. MATERIAL AND METHOD: We will see how to organize the verbal exchange during the appointments and how to guide the patient in a human way, if a psychological risk appears to us. We will complete the study with "told" examples of psychotherapeutic management of major problems of recognition and acceptance after maxillofacial surgery. CONCLUSION: Gathering psychological signs from patients seeking orthodontic care is the first step in the consultation. It is a prerequisite for the clinical examination and complementary tests and is equally essential for the success of the treatment.

INTRODUCTION: Si nous devons dans tous les cas recueillir des éléments sur le profil psychologique de nos patients, dans le cas des dysmorphoses squelettiques, le temps de ce recueil est un des temps essentiels au succès thérapeutique. Nous devons évaluer si nous faisons prendre un risque psychologique au patient dans le cas de correction chirurgicale des bases osseuses, mais ces enjeux existent aussi dans les traitements orthodontiques de l'adulte. MATÉRIEL ET MÉTHODE: Nous verrons comment organiser l'échange de parole lors des rendez-vous et comment orienter humainement le patient si un risque psychologique nous apparaît. Nous compléterons l'étude par des exemples « parlants ¼ de prise en charge psychothérapeutique de problèmes majeurs de reconnaissance et d'acceptation après une chirurgie maxillo-faciale. CONCLUSION: Recueillir les signes psychologiques chez des patients en demande de soins d'orthodontie est le premier temps de la consultation. Il est préalable à l'examen clinique, aux examens complémentaires et est tout aussi essentiel au succès thérapeutique.

Motivations and Psychological Characteristics of Men Seeking Penile Girth Augmentation.

BACKGROUND: The popularity of penile augmentation procedures is increasing, but little is known about the motivations and psychological characteristics of men who seek these procedures. OBJECTIVES: Employing valid psychological measures, the authors sought to investigate the motivations and psychological characteristics of men seeking penile girth augmentation. METHODS: Men seeking to undergo a penile girth augmentation (n = 37) completed an online questionnaire containing standardized measures assessing their motivations to undergo augmentation, penile size self-discrepancy, psychological distress, self-esteem, body image-related quality of life, body dysmorphic disorder (BDD), and cosmetic procedure screening scale-penile focused dysmorphic disorder. RESULTS: Men's motivations for seeking penile girth augmentation were characterized as "improve self-confidence," "change penile size/appearance," "sexual function/pleasure," "feelings of insecurity," and "medical issues," with self-confidence being the most commonly reported motivation. The men perceived their actual penis size (girth, flaccid length, erect length) as significantly smaller than ideal size, the size they believed their penis should be, and their expected size postaugmentation. Compared with non-clinical norms, the men seeking penile augmentation had higher penile dysmorphic disorder symptoms, lower self-esteem and lower body image-related quality of life, but comparable psychological distress. In addition, 4 of the men met diagnostic criteria for BDD according to self-reported questionnaire (11%, n = 4/37) and clinical interview (14%, n = 4/29). CONCLUSIONS: Men seek penile girth augmentation for a variety of reasons and perceive all their penile dimensions to be smaller than ideal sizes. They differ from non-clinical samples in some psychological characteristics, and a small but sizeable portion experience BDD.

Reliability and Validity of the Self-Report Chinese Version of the Yale-Brown Obsessive-Compulsive Scale Modified for Body Dysmorphic Disorder (BDD-YBOCS) in Patients Undergoing Plastic Surgery.

BACKGROUND: To develop a self-report Chinese version of the Yale-Brown Obsessive-Compulsive Scale Modified for Body Dysmorphic Disorder (BDD-YBOCS) and determine its validity and reliability in patients seeking a consultation with a plastic surgeon or undergoing plastic surgery in China. METHODS: Forward and backward translation and cultural adaptation of the BDD-YBOCS were performed according to recommended guidelines. The self-report Chinese version of the BDD-YBOCS was psychometrically tested using data collected from a cross-sectional validation study, which included 240 patients seeking a consultation with a plastic surgeon or undergoing plastic surgery at the Department of Plastic Surgery, Jiangsu Province Hospital of Chinese Medicine, Nanjing, China, between May and September 2020. Item analysis used the independent sample t test and bivariate Pearson test. Content validity was established through expert interviews. Construct validity was measured with exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). Convergent validity and discriminant validity were analyzed using Pearson's correlation to evaluate the association between the self-report Chinese version of the BDD-YBOCS and the Body Dysmorphic Disorder Questionnaire (BDDQ). Internal reliability was assessed using Cronbach's α. RESULTS: No items were removed from the original English version of the BDD-YBOCS based on expert interviews and factor analysis. A total of 220 patients completed the study survey (91.7%). EFA extracted 3 factors, which accounted for 64.50% of the variance. CFA supported a 3-factor structure (χ2/df = 1.322, RMSEA = 0.054, GFI = 0.904, NFI = 0.902, CFI = 0.974 and TLI = 0.966). The scale had good convergent and discriminant validity. Cronbach's α for the scale was 0.871 (P < 0.001) and ranged from 0.852 to 0.873 when individual items were removed. CONCLUSION: The self-report Chinese version of the BDD-YBOCS shows good validity and reliability for use in patients seeking a consultation with a plastic surgeon or undergoing plastic surgery in China. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Psychosocial issues and body dysmorphic disorder in aesthetics: Review and debate.

Body dysmorphic disorder (BDD) is a serious and debilitating psychiatric condition that disproportionately presents in dermatologic and cosmetic surgery patients. BDD is currently underrecognized in cosmetic medical settings and is thought to be underdiagnosed by behavioral health professionals. The significant comorbidities associated with this disorder, as well as potential harm done to both patient and physician, raise ethical and medicolegal concerns regarding its treatment. Although cosmetic interventions have historically been discouraged in BDD, recent studies have provided controversial evidence of benefit in certain cohorts. The rise of "snapchat dysmorphia" and the proposed explanatory phenomenon of perception drift have generated further debate around the de novo development or unmasking of BDD. We critically review and summarize existing debates around the treatment of BDD in cosmetic medicine. We provide guidance for screening, clinical interviewing, and the provision of psychoeducation in cases of suspected BDD.

Evaluation of postoperative satisfaction with rhinoseptoplasty in patients with symptoms of body dysmorphic disorder.

INTRODUCTION: The prevalence of body dysmorphic disorder among candidates for plastic surgery may vary from 6% to 54%. Some studies report discrete benefits with the surgical results, while others show symptomatic exacerbation. Some authors even affirm that body dysmorphic disorder would be a surgical contraindication, against others who suggest satisfactory results. OBJECTIVE: To describe the prevalence of body dysmorphic disorder in rhinoseptoplasty candidates and to compare outcomes among patients with and without body dysmorphic disorder symptoms. METHODS: Cohort study. Individuals ≥ 16 years, candidates for aesthetic and/or functional rhinoseptoplasty were recruited at a university hospital in Brazil. The prevalence of body dysmorphic disorder was assessed through the Body Dysmorphic Disorder Examination (BDDE) and the patients divided into groups: no symptoms of body dysmorphic disorder, mild-moderate and severe symptoms. The specific quality of life outcomes, Nasal Obstruction Symptom Evaluation (NOSE) and Rhinoplasty Outcome Evaluation (ROE) were evaluated before and after 90 and 180 days of the procedure. RESULTS: 131 individuals were included, 59.5% female. The prevalence of preoperative symptoms of body dysmorphic disorder was 38%. There was a reduction in the symptoms of body dysmorphic disorder in the preoperative body dysmorphic disorder examination versus 3 and 6 months in all groups (78.94 ±â€¯2.46 vs. 33.63 ±â€¯6.41 and 35.51 ±â€¯5.92, respectively, p < 0.002). Among patients with severe body dysmorphic disorder symptoms, rhinoplasty outcome evaluation ranged from 21.24 ±â€¯3.88 to 58.59 ±â€¯5.83 at 3 months and 52.02 ±â€¯5.41 at 6 months postoperatively (p < 0.001); while NOSE from 71 ±â€¯8.47 to 36.11 ±â€¯12.10 at 6 months postoperatively (p < 0.01). CONCLUSION: The prevalence of body dysmorphic disorder symptoms in our sample was high. Rhinoseptoplasty was associated with an improvement in quality of life outcomes related to nasal function and aesthetic outcome in all groups, irrespective of the presence and intensity of body dysmorphic disorder symptoms. Rhinoseptoplasty in body dysmorphic disorder symptomatic patients was also associated with a reduction in postoperative body dysmorphic disorder symptoms, even in severe cases.

The relationship between body dysmorphic disorder symptoms and 'not just right' experiences in a sample of individuals seeking cosmetic surgery and aesthetic medicine procedures.

BACKGROUND: Body dysmorphic disorder (BDD) is characterized by concerns for perceived defects in physical appearance that appear to others as mild or unobservable. Individuals with BDD frequently refer concerns with their physical appearance being 'not right' (not just right experiences; NJREs), and BDD-related behaviours may be performed until their appearance is perceived as 'right'. The aim of the study was to explore the relationship between BDD and NJREs in cosmetic surgery and aesthetic medicine settings. METHODS: Individuals requesting cosmetic procedures with BDD symptoms (BDD-symptoms group; n = 24), without BDD symptoms (cosmetic intervention [CI] group; n = 45), and individuals that have never required these procedures (no cosmetic intervention [NCI] group; n = 53) entered the study. RESULTS: Results showed a greater number of past-month NJREs, higher NJREs severity, higher drive for thinness, and greater general distress in the BDD-symptoms group. Pertaining to features associated with NJREs (perfectionism and obsessive-compulsive disorder symptoms) and ED core features, the BDD-symptoms group scored higher only with respect to NCI. Regression analyses showed that BDD symptoms were predicted by age, NJREs severity, and drive for thinness above and beyond general distress, perfectionism, obsessive-compulsive disorder symptoms, bulimia, and body dissatisfaction related to weight and shape in the BDD-Symptoms group (in comparison with the CI and NCI groups). CONCLUSIONS: NJREs may represent a potential vulnerability factor for BDD symptoms in cosmetic settings.

Body dysmorphic disorder (BDD) in the orthodontic and orthognathic setting: A systematic review.

General prevalence of Body Dysmorphic Disorder (BDD), a psychiatric disorder in which patients focus on an imagined body defect not visible to others, varies between 0.7 and 2.5%. Up to 86% present with complaints in the area of teeth or face. Patients with BDD pursue an aesthetic rather than functional recovery, making BDD a possible contraindication to treatment. The aim of this systematic review was to review prevalence of BDD within the orthodontic and/or orthognathic population, to describe diagnostic tools for early detection of patients with BDD and to assess the outcome after treatment. A systematic search was conducted up to November 2020 using PubMed, Embase, Web of Science Core Collection and Cochrane Library. Following the screening of 1423 articles, 5 prospective studies were included. Prevalence of BDD within the orthodontic and orthognathic population varied from 5.2% to 13% (average of 6.2%). Literature showed a trend of higher BDD prevalence within younger, female and single patient population, although results are not conclusive. Questionnaires can be useful for preliminary detection of BDD. General anamnesis with questioning medical or psychiatric history, medication and personal expectations remains very important. Red flags could be previous consultations for the same problem or presence of psychiatric comorbidities. Prospective studies are necessary to map satisfaction of these patients and need for re-interventions after treatment.