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DOI: 10.1055/s-0038-1632400
Patients Screening Positive for Body Dysmorphic Disorder Show No Significant Health-Related Quality of Life Gain after Functional Septorhinoplasty at a Tertiary Referral Center
Publikationsverlauf
Publikationsdatum:
27. April 2018 (online)
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Abstract
Body dysmorphic disorder (BDD) is a psychiatric disorder defined by an excessive concern about one's physical appearance, especially regarding slight or imagined abnormities of the body. This study was conducted to compare postoperative quality of life (QOL) changes after primary septorhinoplasty among patients screening positive and those screening negative for BDD. Two common instruments for the screening of BDD were used namely the Dysmorphic Concern Questionnaire (DCQ) and the BDD Concern Questionnaire (BDDQ). For the determination of QOL changes, three validated screening instruments were used. The Functional Rhinoplasty Outcome Inventory (FROI-17) and the Rhinoplasty Outcomes Evaluation (ROE) were used as disease-specific instruments and the Short Form 36 Health Survey (SF-36) was used as a general instrument. All patients completed the FROI-17, the ROE, and the SF-36 preoperatively and 60 months postoperatively. The BDD questionnaires were singularly obtained 60 months after surgery. The authors identified 9.8% of our patients with a possible BDD diagnosis. The patients screening positive for BDD showed significantly lower ROE scores postoperatively, compared with those screening negative for BDD. QOL gains detected by the disease-specific instruments (ROE and FROI-17) were only significant in the non-BDD group. No significant QOL gains were detectable with the FROI-17, the ROE, and the SF-36 in the BDD group. In patients screening negative for BDD, QOL, as measured with the SF-36, improved significantly in five categories: physical functioning, role-functioning physical, bodily pain, general health, and social functioning. Patients screening positive for BDD did not improve in any categories of the general SF-36 questionnaire. Instead, their score in the “mental health” category was significantly lower 5 years after their surgery compared with preoperatively. Patients retrospectively screening positive for BDD in our cohort did not improve in QOL postoperatively. Alternative nonsurgical treatments such as cognitive behavioral treatment and/or selective serotonin reuptake inhibitors have been reported to be effective and should be considered as the treatment of choice. Some studies suggest that a smaller subgroup of BDD patients may benefit from functional rhinoplasty. Further research and larger long-term prospective outcome studies are needed to understand the influence of BDD symptoms on postoperative satisfaction and QOL changes after septorhinoplasty.
Ethical Approval
All procedures performed in studies 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 or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.
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References
- 1 Veale D, De Haro L, Lambrou C. Cosmetic rhinoplasty in body dysmorphic disorder. Br J Plast Surg 2003; 56 (06) 546-551
- 2 Baykal B, Erdim I, Ozbay I. , et al. Evaluation of relationship between body dysmorphic disorder and self-esteem in rhinoplasty candidates. J Craniofac Surg 2015; 26 (08) 2339-2341
- 3 Phillips KA. The Broken Mirror: Understanding and Treating Body Dysmorphic Disorder. New York, NY: Oxford University Press; 2005
- 4 Phillips KA, Hollander E. Treating body dysmorphic disorder with medication: evidence, misconceptions, and a suggested approach. Body Image 2008; 5 (01) 13-27
- 5 Phillips KA, McElroy SL. Insight, overvalued ideation, and delusional thinking in body dysmorphic disorder: theoretical and treatment implications. J Nerv Ment Dis 1993; 181 (11) 699-702
- 6 Conroy M, Menard W, Fleming-Ives K, Modha P, Cerullo H, Phillips KA. Prevalence and clinical characteristics of body dysmorphic disorder in an adult inpatient setting. Gen Hosp Psychiatry 2008; 30 (01) 67-72
- 7 Harrison A, Fernández de la Cruz L, Enander J, Radua J, Mataix-Cols D. Cognitive-behavioral therapy for body dysmorphic disorder: a systematic review and meta-analysis of randomized controlled trials. Clin Psychol Rev 2016; 48: 43-51
- 8 Ipser JC, Sander C, Stein DJ. Pharmacotherapy and psychotherapy for body dysmorphic disorder. Cochrane Database Syst Rev 2009; 200921 (01) CD005332
- 9 Ziglinas P, Menger DJ, Georgalas C. The body dysmorphic disorder patient: to perform rhinoplasty or not?. Eur Arch Otorhinolaryngol 2014; 271 (09) 2355-2358
- 10 Crerand CE, Franklin ME, Sarwer DB. Body dysmorphic disorder and cosmetic surgery. Plast Reconstr Surg 2006; 118 (07) 167e-180e
- 11 Picavet VA, Prokopakis EP, Gabriëls L, Jorissen M, Hellings PW. High prevalence of body dysmorphic disorder symptoms in patients seeking rhinoplasty. Plast Reconstr Surg 2011; 128 (02) 509-517
- 12 Babuccu O, Latifoğlu O, Atabay K, Oral N, Coşan B. Sociological aspects of rhinoplasty. Aesthetic Plast Surg 2003; 27 (01) 44-49
- 13 Veale D, Boocock A, Gournay K. , et al. Body dysmorphic disorder. A survey of fifty cases. Br J Psychiatry 1996; 169 (02) 196-201
- 14 Phillips KA. Body dysmorphic disorder: the distress of imagined ugliness. Am J Psychiatry 1991; 148 (09) 1138-1149
- 15 Veale D. Outcome of cosmetic surgery and ‘DIY'surgery in patients with body dysmorphic disorder. Psychiatrist 2000; 24 (06) 218-220
- 16 Felix GAA, de Brito MJA, Nahas FX. , et al. Patients with mild to moderate body dysmorphic disorder may benefit from rhinoplasty. J Plast Reconstr Aesthet Surg 2014; 67 (05) 646-654
- 17 Oosthuizen P, Lambert T, Castle DJ. Dysmorphic concern: prevalence and associations with clinical variables. Aust N Z J Psychiatry 1998; 32 (01) 129-132
- 18 Dufresne RG, Phillips KA, Vittorio CC, Wilkel CS. A screening questionnaire for body dysmorphic disorder in a cosmetic dermatologic surgery practice. Dermatol Surg 2001; 27 (05) 457-462
- 19 Bulut OC, Wallner F, Hohenberger R, Plinkert PK, Baumann I. Quality of life after primary septorhinoplasty in deviated- and non-deviated nose measured with ROE, FROI-17 and SF-36. Rhinology 2017; 55 (01) 75-80
- 20 Bulut OC, Wallner F, Plinkert PK, Prochnow S, Kuhnt C, Baumann I. Quality of life after septorhinoplasty measured with the Functional Rhinoplasty Outcome Inventory 17 (FROI-17). Rhinology 2015; 53 (01) 54-58
- 21 Alsarraf R. Outcomes research in facial plastic surgery: a review and new directions. Aesthetic Plast Surg 2000; 24 (03) 192-197
- 22 Meningaud JP, Lantieri L, Bertrand JC. Rhinoplasty: an outcome research. Plast Reconstr Surg 2008; 121 (01) 251-257
- 23 Saleh AM, Younes A, Friedman O. Cosmetics and function: quality-of-life changes after rhinoplasty surgery. Laryngoscope 2012; 122 (02) 254-259
- 24 Picavet VA, Gabriëls L, Grietens J, Jorissen M, Prokopakis EP, Hellings PW. Preoperative symptoms of body dysmorphic disorder determine postoperative satisfaction and quality of life in aesthetic rhinoplasty. Plast Reconstr Surg 2013; 131 (04) 861-868
- 25 Picavet V, Gabriëls L, Jorissen M, Hellings PW. Screening tools for body dysmorphic disorder in a cosmetic surgery setting. Laryngoscope 2011; 121 (12) 2535-2541
- 26 Stangier U, Janich C, Adam-Schwebe S, Berger P, Wolter M. Screening for body dysmorphic disorder in dermatological outpatients. Dermatol Psychosom 2003; 4 (02) 66-71
- 27 Bullinger M, Kirchberger I. Fragebogen zum Gesundheitszustand: SF-36; Handanweisung . Hogrefe, Verlag für Psychologie; 1998
- 28 Malick F, Howard J, Koo J. Understanding the psychology of the cosmetic patients. Dermatol Ther (Heidelb) 2008; 21 (01) 47-53
- 29 Sarwer DB, Cash TF, Magee L. , et al. Female college students and cosmetic surgery: an investigation of experiences, attitudes, and body image. Plast Reconstr Surg 2005; 115 (03) 931-938
- 30 Sarwer DB. Awareness and identification of body dysmorphic disorder by aesthetic surgeons: results of a survey of american society for aesthetic plastic surgery members. Aesthet Surg J 2002; 22 (06) 531-535
- 31 Buhlmann U, Glaesmer H, Mewes R. , et al. Updates on the prevalence of body dysmorphic disorder: a population-based survey. Focus 2015; 13 (02) 252-257
- 32 Phillips KA, Grant J, Siniscalchi J, Albertini RS. Surgical and nonpsychiatric medical treatment of patients with body dysmorphic disorder. Psychosomatics 2001; 42 (06) 504-510
- 33 Sarwer DB, Crerand CE, Didie ER. Body dysmorphic disorder in cosmetic surgery patients. Facial Plast Surg 2003; 19 (01) 7-18
- 34 Lekakis G, Picavet VA, Gabriëls L, Grietens J, Hellings PW. Body dysmorphic disorder in aesthetic rhinoplasty: validating a new screening tool. Laryngoscope 2016; 126 (08) 1739-1745
- 35 Hinderer UT. Dr. Vazquez Añón's last lesson. Aesthetic Plast Surg 1978; 2 (01) 375-382