Abstract
Objectives: The aim of the study was to research the characteristics of body dysmorphic symptoms, and any associated psychiatric comorbidity, in outpatient presentations for cosmetic plastic surgery. Patients who presented for plastic procedures as a result of underlying illness or organic pathology were therefore excluded from the study.
Method: Patients attending plastic surgery clinics for cosmetic reasons were screened for dysmorphic symptoms using the Dysmorphic Concern Questionnaire (DCQ), a seven item questionnaire designed to detect the presence and extent of dysmorphic concern.
Patients also completed the General Health Questionnaire (GHQ) and Brief Psychiatric Rating Scale (BPRS). GHQ cases as were defined by a threshold of 4. Patients were divided into high & low scorers on the DCQ and BPRS on the basis of their respective median scores.
Results: 36 subjects were eligible for the study of whom all participated. There was a significant preponderance of females (92%). 64% were referred for mammoplasty (n = 23) followed by rhinoplasty (8%). The other seven cases (28%) were for other procedures including abdominoplasty, bilateral blepharoplasty and facelifts. 42% of the sample were GHQ cases (n = 15). The mean DCQ score was 9.2 with a median of 9.0, while the mean & median BPRS scores were 5.1 and 4.0 respectively. There was a statistically significant positive correlation between the DCQ and BPRS scores (Kendall's tau = 0.5, p < 0.001), as well as between scores of the DCQ and GHQ (Kendall's tau = 0.6, p < 0.001). 68% of patients with high DCQ scores (n = 19) were GHQ cases (n = 13) as opposed to only 2 with low DCQ scores (12%). Patients with high DCQ scores were therefore 16 times as likely to be GHQ cases (95% confidence intervals (95% CI) of 2.8 to 94.0), and 8 times as likely to have high BPRS scores (95% CI = 1.7–37.9). Although the BPRS is sensitive for psychosis, no psychotic symptoms were noted on any of the subscale scores for all 36 patients regardless of DCQ status.
Conclusions: Although this a small pilot study, dysmorphic concern was measured using a standardised instrument. Despite the small numbers, there was a strong positive association between dysmorphic concern symptoms (the central component of BDD) and psychiatric morbidity as rated by the BPRS and GHQ. The lack of psychotic symptoms noted in this sample is consistent with the general trend in the psychiatric literature which places less emphasis on the association between BDD and psychosis. This pilot study will form part of a larger research project to look at different cosmetic procedures (eg rhinoplasties, breast augmentation), and their respective rates of BDD and psychiatric co-morbidity.