Outcome of cosmetic surgery and ‘DIY’ surgery in patients with body dysmorphic disorder

Abstract

Aims and MethodLittle is known about the outcome of cosmetic surgery in patients with body dysmorphic disorder (BDD). Self-reported outcome was collected on 25 patients with BDD who at the time of psychiatric assessment had reported that they had had cosmetic surgery in the past.ResultsTwenty-five patients with BDD had a total of 46 procedures. The worst outcome was found in those who had had rhinoplasty and those with repeated operations. Mammoplasty and pinnaplasty was associated with higher degrees of satisfaction. Nine patients with BDD, either in desperation at being turned down for cosmetic surgery or because they could not afford it, had performed their own ‘DIY’ surgery in which they attempted by their own hand to alter their appearance dramatically.Clinical ImplicationsCosmetic surgery cannot at present be recommended for patients with BDD. However, patients turned down for surgery or who cannot afford it, may try to alter their appearance by themselves. The study contains a selection bias of patients in favour of treatment failures in cosmetic surgery and prospective studies are required on BDD patients who obtain cosmetic surgery or dermatological treatment.

Prevalence of Body Dysmorphic Disorder and Impact on Subjective Outcome amongst Singaporean Rhinoplasty Patients

“…Our results reveal that patients with BDD have significantly lower preoperative and postoperative satisfaction of their noses as measured by the ROE instrument as compared to those without BDD. This is in accordance with the small number of studies that also investigated the role of BDD on outcome [5][6][7]. Picavet et al also used the ROE instrument in their study and demonstrated that patients with moderate to severe body dysmorphic disorder symptoms scored their postoperative satisfaction significantly lower compared with patients with no or mild symptoms [6].…”

“…Studies from psychiatric literature reveal that the majority of BDD patients experienced no improvement or even worsening of BDD symptoms after surgery [5]. Although some studies have attempted to investigate the impact of BDD on level of satisfaction after nose surgery [5][6][7], most of them did not use proper validated instruments specific for rhinoplasty to measure outcome.…”

“…Studies from psychiatric literature reveal that the majority of BDD patients experienced no improvement or even worsening of BDD symptoms after surgery [5]. Although some studies have attempted to investigate the impact of BDD on level of satisfaction after nose surgery [5][6][7], most of them did not use proper validated instruments specific for rhinoplasty to measure outcome. Therefore, the two main aims of this study are to determine the prevalence of BDD in patients who received cosmetic rhinoplasty in an Asian population and to determine the impact of BDD on subjective outcome after surgery using the validated Rhinoplasty Outcome Evaluation (ROE) instrument.…”

What is the place for placebo in the management of psychogenic disease?

“…Ethicists have coined the term, 'knowledge framing', to describe desirable treatment effects arising from proper presentation of information to patients during the clinical encounter, distinct from the placebo (unwanted) effect in clinical trials. 10 Whilst debate rages about whether it is permissible to harness the placebo effect to treat psychogenic disease, few would condone placebo use to treat organic diseases for which appropriate therapy is available. Purists maintain that any practice involving deceit of patients is inappropriate, and that they must be informed of the inert nature of the placebo when it is administered.…”

Classification approach

“…There is frequent comorbidity in BDD with depression, a significant risk of suicide 4,5 and dissatisfaction with cosmetic surgery. 6,7 The authors make a number of recommendations for treatment with pimozide (an anti-psychotic drug) which is not evidence based. There have been two randomised controlled trials of serotonin reuptake inhibitor with BDD.…”