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    Importance of psychological screening for nonsurgical procedures may be underappreciated


    Key iconKey Points

    • Formal psychological screening for patients requesting nonsurgical rejuvenation is not common
    • Recent pilot study evaluated probability of body dysmorphic disorder in patients seeking nonsurgical aesthetic medical procedures

    The results from the BDDQ showed three (8.6 percent) patients had a high probability of BDD, and an additional five (14.2 percent) had scores indicating a moderate probability of BDD. BDDQ testing in other populations shows a high probability of BDD is present in 1 to 2 percent of the general population, 4 to 5 percent of patients seeking medical treatment, and 7 percent of cosmetic surgery patients, Dr. Dzwierzynski says.

    "The finding that our study group had good quality of life overall is not surprising, considering they are likely affluent individuals who in a difficult economy were able to afford the out-of-pocket costs of an elective cosmetic procedure. However, in considering the study results, we think it is more important to look at the individual scores rather than the means, and for all three tests, there is an appreciable proportion of outliers who generate concern," he says. "The proportion of patients with a moderate to high probability of BDD in our population was particularly shocking, considering they are individuals seeking minimally invasive treatments."

    BDD CHALLENGES As plastic surgeons know, patients with BDD have an increased likelihood of being dissatisfied with the outcome after cosmetic surgery, and it is also associated with certain psychiatric comorbidities, including obsessive-compulsive disorder and depression, Dr. Dzwierzynski says.

    "In fact, it's been reported that up to one-third of people with BDD have attempted suicide, and there is also an increased chance that BDD patients who undergo a cosmetic procedure may become violent toward the surgeon or file a lawsuit," he says.

    Having found a concerning prevalence of low quality of life and psychopathology in this patient cohort, the next question that should be explored is what effect having a minimally invasive cosmetic procedure has on the affected individuals, Dr. Dzwierzynski says, adding that he hopes to conduct a follow-up study in which patients will be reassessed at six months after their procedure.

    "Improving quality of life and self-esteem may be part of the motivation of patients seeking these minimally invasive cosmetic procedures. It is important to know whether these goals are achieved in persons with underlying psychopathology or if we should be referring them for professional mental health intervention," he explains.


    Cheryl Guttman Krader
    Cheryl Guttman is a medical writer based in Deerfield, Ill.