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

      Abstract

      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.
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      References

        • Diagnostic and Statistical Manual of Mental Disorders: DSM-5
        5th ed. American Psychiatric Publishing, Washington, DC2013
        • Marques L
        • Leblanc N
        • Robinaugh D
        • Weingarden H
        • Keshaviah A
        • Wilhelm S.
        Correlates of quality of life and functional disability in individuals with body dysmorphic disorder.
        Psychosomatics. 2011; 52: 245-254
        • Zakhary L
        • Weingarden H
        • Sullivan A
        • Wilhelm S.
        • Pittenger C
        Clinical features, assessment, and treatment of body dysmorphic disorder, Chapter 2.
        Obsessive-compulsive Disorder: Phenomenology, Pathophysiology, and Treatment. Oxford University Press, Cary, NC2017https://doi.org/10.1093/med/9780190228163.003.0002
        • Mufaddel A
        • Osman OT
        • Almugaddam F
        • Jafferany M.
        A review of body dysmorphic disorder and its presentation in different clinical settings.
        Prim Care Companion CNS Disord. 2013; 15 (PCC.12r01464)
        • Möllmann A
        • Dietel FA
        • Hunger A
        • Buhlmann U.
        Prevalence of body dysmorphic disorder and associated features in German adolescents: a self-report survey.
        Psychiatry Res. 2017; 254: 263-267
        • Frías Á
        • Palma C
        • Farriols N
        • González L.
        Comorbidity between obsessive-compulsive disorder and body dysmorphic disorder: prevalence, explanatory theories, and clinical characterization.
        Neuropsychiatr Dis Treat. 2015; 11: 2233-2244
        • Angelakis I
        • Gooding PA
        • Panagioti M.
        Suicidality in body dysmorphic disorder (BDD): a systematic review with meta-analysis.
        Clin Psychol Rev. 2016; 49: 55-66
        • Bjornsson AS.
        Age at onset and clinical course of body dysmorphic disorder, Chapter 10.
        in: Phillips KA Body Dysmorphic Disorder: Advances in Research and Clinical Practice. Oxford University Press, Cary, NC2017
        • Phillips KA
        • Menard W
        • Quinn E
        • Didie ER
        • Stout RL
        A 4-year prospective observational follow-up study of course and predictors of course in body dysmorphic disorder.
        Psychol Med. 2012; 43: 1109-1117
        • Reddy KK
        • Besen J.
        Body dysmorphic disorder: epidemiology and specific cohorts.
        in: Vashi NA Beauty and Body Dysmorphic Disorder. Springer International Publishing, Switzerland2015: 127-137 (https://www.springer.com/gp/book/9783319178660)
        • Hartmann AS
        • Buhlmann U.
        Prevalence and underrecognition of body dysmorphic disorder.
        in: Phillips KA Body Dysmorphic Disorder: Advances in Research and Clinical Practice. Oxford University Press, New York2017: 49
        • Phillips KA
        • Menard W
        • Fay C.
        Gender similarities and differences in 200 individuals with body dysmorphic disorder.
        Compr Psychiatry. 2006; 47: 77-87
        • França K
        • Roccia MG
        • Castillo D
        • et al.
        Body dysmorphic disorder: history and curiosities.
        Wiener Medizinische Wochenschrift. 2017; 167: 5-7
      1. Substance Abuse and Mental Health Services Administration.
        DSM-5 Changes: Implications for Child Serious Emotional Disturbance. 2016; : 52-54
        • Veale D
        • Gledhill LJ
        • Christodoulou P
        • Hodsoll J.
        Body dysmorphic disorder in different settings: a systematic review and estimated weighted prevalence.
        Body Image. 2016; 18: 168-186
        • Ribeiro RVE.
        Prevalence of body dysmorphic disorder in plastic surgery and dermatology patients: a systematic review with meta-analysis.
        Aesthetic Plast Surg. 2017; 41: 964-970
        • Conrado LA
        • Hounie AG
        • Diniz JB.
        • et al.
        Body dysmorphic disorder among dermatologic patients: prevalence and clinical features.
        J Am Acad Dermatol. 2010; 63: 235-243
        • Phillips KA
        • Stein DJ.
        • Tasman A
        • Kay J
        • Lieberman JA
        • First MB
        • Riba MB.
        Obsessive-compulsive and related disorders: body dysmorphic disorder, trichotillomania (hair-pulling disorder), and excoriation (skin-picking) disorder.
        Psychiatry. Wiley, Hoboken, NJ2015: 1129-1141
        • Koblenzer CS.
        Body dysmorphic disorder in the dermatology patient.
        Clin Dermatol. 2017; 35: 298-301
        • Crerand CE
        • Menard W
        • Phillips KA.
        Surgical and minimally invasive cosmetic procedures among persons with body dysmorphic disorder.
        Ann Plast Surg. 2010; 65: 11-16
        • Metcalfe DB
        • Duggal CS
        • Gabriel A
        • Nahabedian MY
        • Carlson GW
        • Losken A.
        Prevalence of body dysmorphic disorder among patients seeking breast reconstruction.
        Aesthet Surg J. 2014; 34: 733-737
        • Sarwer DB
        • Spitzer JC
        • Sobanko JF
        • Beer KR.
        Identification and management of mental health issues by dermatologic surgeons: a survey of American Society for Dermatologic Surgery members.
        Dermatol Surg. 2015; 41: 352-357
        • Sarwer D.
        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: 531-535
        • Felix GA
        • de Brito MJ
        • Nahas FX
        • et al.
        Patients with mild to moderate body dysmorphic disorder may benefit from rhinoplasty.
        J Plast Reconstr Aesthet Surg. 2014; 67: 646-654
        • Veale D
        • Naismith I
        • Eshkevari E
        • et al.
        Psychosexual outcome after labiaplasty: a prospective case-comparison study.
        Int Urogynecol J. 2014; 25: 831-839
        • de Brito MJ
        • de Almeida Arruda
        • Felix G
        • Nahas FX
        • et al.
        Body dysmorphic disorder should not be considered an exclusion criterion for cosmetic surgery.
        Plast Reconstr Aesthet Surg. 2015; 68: 270-272
        • Azevedo de Brito MJ
        • Nahas FX
        • Ferreira LM
        Should plastic surgeons operate on patients diagnosed with body dysmorphic disorder?.
        Plast Reconstr Surg. 2012; 129: 406e-407e
        • Morselli PG
        • Boriani F.
        Should plastic surgeons operate on patients diagnosed with body dysmorphic disorders?.
        Plast Reconstr Surg. 2012; 130: 620e-622e
        • Crerand CE
        • Phillips KA.
        Reply to: ‘Patients with mild to moderate body dysmorphic disorder may benefit from rhinoplasty.
        J Plast Reconstr Aesthet Surg. 2014; 67: 1754-1755
        • Tignol J
        • Biraben-Gotzamanis L
        • Martin-Guehl C
        • Grabot D
        • Aouizerate B.
        Body dysmorphic disorder and cosmetic surgery: evolution of 24 subjects with a minimal defect in appearance 5 years after their request for cosmetic surgery.
        Eur Psychiatry. 2007; 22: 520-524
        • Barone M
        • Cogliandro A
        • Persichetti P.
        Preoperative symptoms of body dysmorphic disorder determine postoperative satisfaction and quality of life in aesthetic rhinoplasty.
        Plast Reconstr Surg. 2013; 132: 1078e-1079e
        • Phillips KA.
        Body dysmorphic disorder in children and adolescents, Chapter 14.
        in: Phillips KA Body Dysmorphic Disorder: Advances in Research and Clinical Practice. Oxford University Press, Cary, NC2017
        • Yang J
        • Fardouly J
        • Wang Y
        • Shi W
        Selfie-viewing and facial dissatisfaction among emerging adults: a moderated mediation model of appearance comparisons and self-objectification.
        Int J Environ Res Public Health. 2020; 17: 672
        • Lonergan AR
        • Bussey K
        • Mond J
        • et al.
        Me, my selfie, and I: the relationship between editing and posting selfies and body dissatisfaction in men and women.
        Body Image. 2019; 28: 39-43
        • Ward B
        • Ward M
        • Fried O
        • Paskhover B.
        Nasal distortion in short-distance photographs: the selfie effect.
        JAMA Facial Plast Surg. 2018; 4: 333-335
        • Özgür E
        • Muluk NB
        • Cingi C.
        Is selfie a new cause of increasing rhinoplasties?.
        Facial Plast Surg. 2017; 33: 423-427
        • Rajanala S
        • Maymone MBC
        • Vashi NA.
        Selfies—living in the era of filtered photographs.
        JAMA Facial Plast Surg. 2018; 20: 443-444
        • Sola CA
        • Fabi SG.
        Perception drift.
        Dermatol Surg. 2019; 45: 1747-1748
        • Rieder EA.
        In response to “Perception drift.
        Dermatol Surg. 2020; 46: 1259-1260
        • Simberlund J
        • Hollander E.
        The relationship of body dysmorphic disorder to obsessive-compulsive disorder and the concept of the obsessive-compulsive spectrum, Chapter 34.
        in: Phillips KA Body Dysmorphic Disorder: Advances in Research and Clinical Practice. Oxford University Press, Cary, NC2017
        • Bowyer L
        • Krebs G
        • Mataix-Cols D
        • Veale D
        • Monzani B.
        A critical review of cosmetic treatment outcomes in body dysmorphic disorder.
        Body Image. 2016; 19: 1-8
        • Wang Q
        • Cao C
        • Guo R
        • et al.
        Avoiding psychological pitfalls in aesthetic medical procedures.
        Aesthetic Plast Surg. 2016; 40: 954-961
        • Rieder E.
        Approaches to the cosmetic patient with potential body dysmorphia.
        J Am Acad Dermatol. 2015; 73: 304-307
      2. Lynn G v Hugo, 96 NY2d 306 (2001).

        • Appelbaum PS
        Clinical practice. Assessment of patient's competence to consent to treatment.
        N Eng J Med. 2007; 357: 1834-1840
        • Cotterill JA.
        Body dysmorphic disorder.
        Dermatol Clin. 1996; 14: 457-464
        • Phillips KA.
        Understanding body dysmorphic disorder: an essential guide.
        Oxford University Press, Cary, NC2009
        • Picavet V
        • Gabriëls L
        • Jorissen M
        • Hellings PW.
        Screening tools for body dysmorphic disorder in a cosmetic surgery setting.
        Laryngoscope. 2011; 121: 2535-2541
        • Dey JK
        • Ishii M
        • Phillis M
        • Byrne PJ
        • Boahene KD
        • Ishii LE.
        Body dysmorphic disorder in a facial plastic and reconstructive surgery clinic.
        JAMA Facial Plast Surg. 2015; 17: 137-143
        • Stangier U
        • Janich C
        • Adam-Schwebe S
        • Berger P
        • Wolter M.
        Screening for body dysmorphic disorder in dermatological outpatients.
        Dermatol Psychosom. 2003; 4: 66-71
        • 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: 457-462
        • Joseph AW
        • Ishii L
        • Joseph SS
        • et al.
        Prevalence of body dysmorphic disorder and surgeon diagnostic accuracy in facial plastic and oculoplastic surgery clinics.
        JAMA Facial Plast Surg. 2017; 19: 269-274
        • Phillips KA
        • Dufresne RG.
        Body dysmorphic disorder.
        Am J Clin Dermatol. 2000; 1: 235-243
        • Wang JV
        • Rieder EA
        • Schoenberg E
        • Zachary CB
        • Saedi N.
        Patient perception of beauty on social media: professional and bioethical obligations in esthetics.
        J Cosmet Dermatol. 2020; 19: 1129-1130