Prevalence of body dysmorphic disorder in patients who are candidates and/or are submitted to aesthetic procedures in the specialty of plastic surgery: a systematic review with meta-analysis

RIBEIRO, RAFAEL VILELA EIRAS; SILVA, GISELE BOTEGA; AUGUSTO, FREDERICO VIEIRA

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Brasil

Revista Brasileira de Cirurgia Plástica

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Brasil

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Review Artcle • Rev. Bras. Cir. Plást. 32 (3) • 2017 • https://doi.org/10.5935/2177-1235.2017RBCP0070 copy

Prevalence of body dysmorphic disorder in patients who are candidates and/or are submitted to aesthetic procedures in the specialty of plastic surgery: a systematic review with meta-analysis

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

This study aimed at showing the prevalence of body dysmorphic disorder (BDD) in patients who are candidates and/or are submitted to aesthetic procedures in the specialty of plastic surgery via a systematic review of the literature and a meta-analysis. To comply with the proposed objective, we analyzed the most relevant studies originally published in any language that were available in the National Library of Medicine (MEDLINE), Cochrane, and SciELO databases. Searches were performed using keywords associated with the theme and inclusion and exclusion criteria. Thus, the final sample of this study was composed of 15 publications, which were submitted to a meta-analysis. It can be confirmed that 12.5% of the patients who were candidates/submitted to aesthetic procedures in the specialty of plastic surgery had BDD. Of these, the majority were women (75.7%) with a mean age of 30 (± 10.5) years. Given the high number of patients with BDD attended to in the specialty, it is important that plastic surgeons focus on providing patients with adequate care to identify individuals who potentially have BDD and consequently conduct an interdisciplinary follow-up with the participation of psychologists and psychiatrists.

Keywords:
Plastic surgery; Body dysmorphic disorder; Aesthetics; Prevalence

STUDY	SAMPLE'	BDD		Sex				MEAN AGE
	SAMPLE'	BDD		Male		Female
	n	%	n	%	n	%	n
Ishigooka et al.⁶6 Ishigooka J, Iwao M, Suzuki M, Fukuyama Y, Murasaki M, Miura S. Demographic features of patients seeking cosmetic surgery. Psychiatry Clin Neurosci. 1998;52(3):283-7. PMID: 9681579 DOI: http://dx.doi.org/10.1046/j.1440-1819.1998.00388.x http://dx.doi.org/10.1046/j.1440-1819.19...	415	14.94%	62	69%	43	31%	19	35 ± 13.7
Sarwer et al.¹⁹19 Sarwer DB, Wadden TA, Pertschuk MJ, Whitaker LA. Body image dissatisfaction and body dysmorphic disorder in 100 cosmetic surgery patients. Plast Reconstr Surg. 1998;101(6):1644-9. PMID: 9583501 DOI: http://dx.doi.org/10.1097/00006534-199805000-00035 http://dx.doi.org/10.1097/00006534-19980...	100	7.00%	7	0%	0	100%	7	44.06 ± 14.56
Altamura et al.²⁰20 Altamura C, Paluello MM, Mundo E, Medda S, Mannu P. Clinical and subclinical body dysmorphic disorder. Eur Arch Psychiatry Clin Neurosci. 2001;251(3):105-8. PMID: 11697569 DOI: http://dx.doi.org/10.1007/s004060170042 http://dx.doi.org/10.1007/s004060170042...	478	6.28%	30	13%	4	87%	26	25.8 ± 9.0
Vargel & Ulusahin⁷7 Vargel S, Uluşahin A. Psychopathology and body image in cosmetic surgery patients. Aesthetic Plast Surg. 2001;25(6):474-8. DOI: http://dx.doi.org/10.1007/s00266-001-0009-7 http://dx.doi.org/10.1007/s00266-001-000...	40	10.00%	4	50%	2	50%	2	19, 25, 26, and 34
Vindigni et al.²¹21 Vindigni V, Pavan C, Semenzin M, Granà S, Gambaro FM, Marini M, et al. The importance of recognizing body dysmorphic disorder in cosmetic surgery patients: do our patients need a preoperative psychiatric evaluation? Eur J Plast Surg. 2002;25(6):305-8.	56	53.57%	30	17%	5	83%	25	36 ± 13
Aouizerate et al.²²22 Aouizerate B, Pujol H, Grabot D, Faytout M, Suire K, Braud C, et al. Body dysmorphic disorder in a sample of cosmetic surgery applicants. Eur Psychiatry. 2003;18(7):365-8. DOI: http://dx.doi.org/10.1016/j.eurpsy.2003.02.001 http://dx.doi.org/10.1016/j.eurpsy.2003....	132	9.09%	12	17%	2	83%	10	35 ± 10.8
Crerand²³23 Crerand CE. Rate of body dysmorphic disorder among patients seeking facial cosmetic procedures [Thesis]. Philadelphia: Drexel University; 2003.	91	7.69%	7	29%	2	71%	5	34.6 ± 15.99
Bellino et al.⁴4 Bellino S, Zizza M, Paradiso E, Rivarossa A, Fulcheri M, Bogetto F. Dysmorphic concern symptoms and personality disorders: a clinical investigation in patients seeking cosmetic surgery. Psychiatry Res. 2006;144(1):73-8. PMID: 16914206 DOI: http://dx.doi.org/10.1016/j.psychres.2005.06.010 http://dx.doi.org/10.1016/j.psychres.200...	66	16.67%	11	27%	3	73%	8	23.45 ± 14.03
Vulink et al.²⁴24 Vulink NC, Sigurdsson V, Kon M, Bruijnzeel-Koomen CA, Westenberg HG, Denys D. Stoornis in de lichaamsbeleving bij 3-8% van de patiënten op de poliklinieken Dermatologie en Plastische Chirurgie. Ned Tijdschr Geneeskd. 2006;150(2):97-100.	475	3.16%	15	13%	2	87%	13	34 ± 14.7
Hayashi et al.⁵5 Hayashi K, Miyachi H, Nakakita N, Akimoto M, Aoyagi K, Miyaoka H, et al. Importance of a psychiatric approach in cosmetic surgery. Aesthet Surg J. 2007;27(4):396-401. DOI: http://dx.doi.org/10.1016/j.asj.2007.05.010 http://dx.doi.org/10.1016/j.asj.2007.05....	140	7.86%	11	27%	3	73%	8	38.4^* * * Data removed from the meta-analysis. BDD: Body dysmorphic disorder.
Lai et al.²⁵25 Lai CS, Lee SS, Yeh YC, Chen CS. Body dysmorphic disorder in patients with cosmetic surgery. Kaohsiung J Med Sci. 2010;26(9):478-82. DOI: http://dx.doi.org/10.1016/S1607-551X(10)70075-9 http://dx.doi.org/10.1016/S1607-551X(10)...	817	7.71%	63	13%	8	87%	55	47^* * * Data removed from the meta-analysis. BDD: Body dysmorphic disorder.
Alavi et al.²⁶26 Alavi M, Kalafi Y, Dehbozorgi GR, Javadpour A. Body dysmorphic disorder and other psychiatric morbidity in aesthetic rhinoplasty candidates. J Plast Reconstr Aesthet Surg. 2011;64(6):738-41. PMID: 21269896 DOI: http://dx.doi.org/10.1016/j.bjps.2010.09.019 http://dx.doi.org/10.1016/j.bjps.2010.09...	306	24.51%	75	19%	14	81%	61	23 ± 4.9
Picavet et al.²⁷27 Picavet VA, Prokopakis E P, Gabriëls L, Jorissen M, Hellings P W. High prevalence of body dysmorphic disorder symptoms in patients seeking rhinoplasty. Plast Reconstr Surg. 2011;128(2):509-17. PMID: 21788842 DOI: http://dx.doi.org/10.1097/PRS.0b013e31821b631f http://dx.doi.org/10.1097/PRS.0b013e3182...	226	2.21%	5	40%	2	60%	3	33 ± 16
Fathololoomi et al.²⁸28 Fathololoomi MR, Tabrizi AG, Bafghi A F, Noohi SA, Makhdoom A. Body dysmorphic disorder in aesthetic rhinoplasty candidates. Pak J Med Sci. 2013;29(1):197-200.	130	31.54%	41	20%	8	80%	33	25.9 ± 6.05
Felix et al.¹⁰10 Felix GA, Brito MJ, Nahas FX, Tavares H, Cordas TA, Dini GM, et al. Patients with mild to moderate body dysmorphic disorder may benefit from rhinoplasty. J Plast Reconstr Aesthet Surg. 2014;67(5):646-54. PMID: 24508222 DOI: http://dx.doi.org/10.1016/j.bjps.2014.01.002 http://dx.doi.org/10.1016/j.bjps.2014.01...	151	52.98%	80	15%	12	85%	68	32 ± 10

Sociedade Brasileira de Cirurgia Plástica Rua Funchal, 129 - 2º Andar / cep: 04551-060, São Paulo - SP / Brasil, Tel: +55 (11) 3044-0000 - São Paulo - SP - Brazil
E-mail: rbcp@cirurgiaplastica.org.br

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[1] *Corresponding author: Rafael Vilela Eiras Ribeiro Avenida Itamar Franco, 4001 - Dom Bosco - Juiz de Fora, S P, Brazil Zip Code 36033-318 E-mail: vilelaeiras@hotmail.com

Inclusion Criteria
Study Design	• RCT • Meta-analysis
Patients	• Candidates of/submitted to aesthetic procedures exclusively • With/without BDD
Intervention	• Aesthetic procedures • BDD diagnostic
Language	• Not defined
Exclusion Criteria
Study Design	• Poorly explained/incomprehensible methodology • Diagnosis performed in a non-standardized/recommended way
Patients	• Candidates of/submitted to functional surgery • Not related to the specialization of plastic surgery
Type of Publication	• Only abstract
Main results
	• Prevalence of BDD in patients from the specialty of plastic surgery

Author	Year	Title	Language	Objective
Ishigooka et al.⁶6 Ishigooka J, Iwao M, Suzuki M, Fukuyama Y, Murasaki M, Miura S. Demographic features of patients seeking cosmetic surgery. Psychiatry Clin Neurosci. 1998;52(3):283-7. PMID: 9681579 DOI: http://dx.doi.org/10.1046/j.1440-1819.1998.00388.x http://dx.doi.org/10.1046/j.1440-1819.19...	1998	Demographic features of patients seeking cosmetic surgery	English	To describe the demographic characteristics of a large population of patients who seek cosmetic surgery from a psychiatric point of view.
Sarwer et al.¹⁹19 Sarwer DB, Wadden TA, Pertschuk MJ, Whitaker LA. Body image dissatisfaction and body dysmorphic disorder in 100 cosmetic surgery patients. Plast Reconstr Surg. 1998;101(6):1644-9. PMID: 9583501 DOI: http://dx.doi.org/10.1097/00006534-199805000-00035 http://dx.doi.org/10.1097/00006534-19980...	1998	Body image dissatisfaction and body dysmorphic disorder in 100 cosmetic surgery patients	English	To investigate dissatisfaction with body image and BDD in potential plastic surgery patients.
Altamura et al.²⁰20 Altamura C, Paluello MM, Mundo E, Medda S, Mannu P. Clinical and subclinical body dysmorphic disorder. Eur Arch Psychiatry Clin Neurosci. 2001;251(3):105-8. PMID: 11697569 DOI: http://dx.doi.org/10.1007/s004060170042 http://dx.doi.org/10.1007/s004060170042...	2001	Clinical and subclinical body dysmor-phic disorder	English	To define the main demographic and clinical characteristics of BDD in individuals who sought aesthetic plastic surgery services.
Vargel & Ulusahin⁷7 Vargel S, Uluşahin A. Psychopathology and body image in cosmetic surgery patients. Aesthetic Plast Surg. 2001;25(6):474-8. DOI: http://dx.doi.org/10.1007/s00266-001-0009-7 http://dx.doi.org/10.1007/s00266-001-000...	2001	Psychopathology and body image in cosmetic surgery patients	English	To investigate the presence of psychiatric symptoms and to evaluate perceptual, cognitive, and behavioral aspects related to body image in plastic surgery patients.
Vindigni et al.²¹21 Vindigni V, Pavan C, Semenzin M, Granà S, Gambaro FM, Marini M, et al. The importance of recognizing body dysmorphic disorder in cosmetic surgery patients: do our patients need a preoperative psychiatric evaluation? Eur J Plast Surg. 2002;25(6):305-8.	2002	The importance of recognizing body dysmorphic disorder in cosmetic surgery patients: do our patients need a preoperative psychiatric evaluation?	English	To assist in the recognition of BDD in patients who are candidates for aesthetic procedures, besides analyzing the psychopathological comorbidities of these patients.
Aouizerate et al.²²22 Aouizerate B, Pujol H, Grabot D, Faytout M, Suire K, Braud C, et al. Body dysmorphic disorder in a sample of cosmetic surgery applicants. Eur Psychiatry. 2003;18(7):365-8. DOI: http://dx.doi.org/10.1016/j.eurpsy.2003.02.001 http://dx.doi.org/10.1016/j.eurpsy.2003....	2003	Body dysmorphic disorder in a sample of cosmetic surgery applicants	English	To prepare the first European report on the prevalence and clinical and functional characteristics of patients with BDD in the field of plastic surgery.
Crerand²³23 Crerand CE. Rate of body dysmorphic disorder among patients seeking facial cosmetic procedures [Thesis]. Philadelphia: Drexel University; 2003.	2003	Rate of body dysmorphic disorder among patients seeking facial cosmetic procedures	English	To stipulate the prevalence of BDD among patients seeking cosmetic procedures.
Bellino et al.⁴4 Bellino S, Zizza M, Paradiso E, Rivarossa A, Fulcheri M, Bogetto F. Dysmorphic concern symptoms and personality disorders: a clinical investigation in patients seeking cosmetic surgery. Psychiatry Res. 2006;144(1):73-8. PMID: 16914206 DOI: http://dx.doi.org/10.1016/j.psychres.2005.06.010 http://dx.doi.org/10.1016/j.psychres.200...	2006	Dysmorphic concern symptoms and personality disorders: A clinical investigation in patients seeking cosmetic surgery	English	To investigate the relationship between personality disorders and dysmorphic symptoms in patients who are candidates for plastic surgery.
Vulink et al.²⁴24 Vulink NC, Sigurdsson V, Kon M, Bruijnzeel-Koomen CA, Westenberg HG, Denys D. Stoornis in de lichaamsbeleving bij 3-8% van de patiënten op de poliklinieken Dermatologie en Plastische Chirurgie. Ned Tijdschr Geneeskd. 2006;150(2):97-100.	2006	Stoornis in de lichaamsbeleving bij 3-8% van de patiënten op de polikli-nieken Dermatologie en Plastische Chirurgie	Dutch	To determine, comparatively, the prevalence of BDD in a university medical left in the specialties of dermatology and plastic surgery.
Hayashi et al.⁵5 Hayashi K, Miyachi H, Nakakita N, Akimoto M, Aoyagi K, Miyaoka H, et al. Importance of a psychiatric approach in cosmetic surgery. Aesthet Surg J. 2007;27(4):396-401. DOI: http://dx.doi.org/10.1016/j.asj.2007.05.010 http://dx.doi.org/10.1016/j.asj.2007.05....	2007	Importance of a psychiatric approach in Cosmetic Surgery	English	To evaluate the importance of a psychiatric approach in plastic surgery patients.
Lai et al.²⁵25 Lai CS, Lee SS, Yeh YC, Chen CS. Body dysmorphic disorder in patients with cosmetic surgery. Kaohsiung J Med Sci. 2010;26(9):478-82. DOI: http://dx.doi.org/10.1016/S1607-551X(10)70075-9 http://dx.doi.org/10.1016/S1607-551X(10)...	2010	Body dysmorphic disorder in patients with cosmetic surgery	English	To calculate the number of patients with BDD among plastic surgery patients pre-and postoperatively.
Alavi et al.²⁶26 Alavi M, Kalafi Y, Dehbozorgi GR, Javadpour A. Body dysmorphic disorder and other psychiatric morbidity in aesthetic rhinoplasty candidates. J Plast Reconstr Aesthet Surg. 2011;64(6):738-41. PMID: 21269896 DOI: http://dx.doi.org/10.1016/j.bjps.2010.09.019 http://dx.doi.org/10.1016/j.bjps.2010.09...	2011	Body dysmorphic disorder and other psychiatric morbidity in aesthetic rhinoplasty candidates	English	To investigate the prevalence of BDD among patients seeking cosmetic surgery.
Picavet et al.²⁷27 Picavet VA, Prokopakis E P, Gabriëls L, Jorissen M, Hellings P W. High prevalence of body dysmorphic disorder symptoms in patients seeking rhinoplasty. Plast Reconstr Surg. 2011;128(2):509-17. PMID: 21788842 DOI: http://dx.doi.org/10.1097/PRS.0b013e31821b631f http://dx.doi.org/10.1097/PRS.0b013e3182...	2011	High prevalence of body dysmorphic disorder symptoms in patients seeking rhinoplasty	English	To determine the prevalence of BDD and its symptoms in patients seeking rhinoplasty, in addition to assessing the clinical profile of these patients
Fathololoomi et al.²⁸28 Fathololoomi MR, Tabrizi AG, Bafghi A F, Noohi SA, Makhdoom A. Body dysmorphic disorder in aesthetic rhinoplasty candidates. Pak J Med Sci. 2013;29(1):197-200.	2013	Body dysmorphic disorder in aesthetic rhinoplasty candidates	English	To determine the prevalence of BDD among patients seeking rhinoplasty procedures
Felix et al.¹⁰10 Felix GA, Brito MJ, Nahas FX, Tavares H, Cordas TA, Dini GM, et al. Patients with mild to moderate body dysmorphic disorder may benefit from rhinoplasty. J Plast Reconstr Aesthet Surg. 2014;67(5):646-54. PMID: 24508222 DOI: http://dx.doi.org/10.1016/j.bjps.2014.01.002 http://dx.doi.org/10.1016/j.bjps.2014.01...	2014	Patients with mild to moderate body dysmorphic disorder may benefit from rhinoplasty	English	To investigate prospectively whether patients with mild and moderate BDD are suitable for rhinoplasty and to assess the severity of BDD and patient satisfaction with surgical outcome 1 year after the intervention