Patients Screening Positive for Body Dysmorphic Disorder Show No Significant Health-Related Quality of Life Gain after Functional Septorhinoplasty at a Tertiary Referral Center

Abstract

Body dysmorphic disorder (BDD) is a psychiatric disorder defined by an excessive concern about one's physical appearance, especially regarding slight or imagined abnormities of the body. This study was conducted to compare postoperative quality of life (QOL) changes after primary septorhinoplasty among patients screening positive and those screening negative for BDD. Two common instruments for the screening of BDD were used namely the Dysmorphic Concern Questionnaire (DCQ) and the BDD Concern Questionnaire (BDDQ). For the determination of QOL changes, three validated screening instruments were used. The Functional Rhinoplasty Outcome Inventory (FROI-17) and the Rhinoplasty Outcomes Evaluation (ROE) were used as disease-specific instruments and the Short Form 36 Health Survey (SF-36) was used as a general instrument. All patients completed the FROI-17, the ROE, and the SF-36 preoperatively and 60 months postoperatively. The BDD questionnaires were singularly obtained 60 months after surgery. The authors identified 9.8% of our patients with a possible BDD diagnosis. The patients screening positive for BDD showed significantly lower ROE scores postoperatively, compared with those screening negative for BDD. QOL gains detected by the disease-specific instruments (ROE and FROI-17) were only significant in the non-BDD group. No significant QOL gains were detectable with the FROI-17, the ROE, and the SF-36 in the BDD group. In patients screening negative for BDD, QOL, as measured with the SF-36, improved significantly in five categories: physical functioning, role-functioning physical, bodily pain, general health, and social functioning. Patients screening positive for BDD did not improve in any categories of the general SF-36 questionnaire. Instead, their score in the "mental health" category was significantly lower 5 years after their surgery compared with preoperatively. Patients retrospectively screening positive for BDD in our cohort did not improve in QOL postoperatively. Alternative nonsurgical treatments such as cognitive behavioral treatment and/or selective serotonin reuptake inhibitors have been reported to be effective and should be considered as the treatment of choice. Some studies suggest that a smaller subgroup of BDD patients may benefit from functional rhinoplasty. Further research and larger long-term prospective outcome studies are needed to understand the influence of BDD symptoms on postoperative satisfaction and QOL changes after septorhinoplasty.

Prevalence of Body Dysmorphic Disorder in an Otolaryngology-Head and Neck Surgery Clinic

“…Poor outcomes without improvement in quality of life have been observed in patients with BDD undergoing functional intervention. 14 Though BDD specifically has not been investigated in oncologic patients, it has been shown that a majority of these patients have concern, preoccupation, or avoidance of reconstructive surgery related to body image, representing an opportunity for further study. 29 Screening instruments such as the BDDQ, which was utilized in our study, are not definitive diagnostic tools for BDD, but rather suggest that BDD may be present.…”

“…13 Furthermore, BDD appears to influence clinical outcomes in this population, as Bulut et al described that patients screening positive for BDD have a significantly lessened improvement in quality of life following functional septorhinoplasty. 14 In a prospective study, the BDDQ has been used to identify patients who may be unsuitable for surgical intervention, suggesting a role for preoperative evaluation of BDD. 15 It should be noted that the BDDQ does not reflect an actual diagnosis of BDD but may indicate patients that warrant further psychiatric evaluation.…”

Quality of Life and Screening on Body Dysmorphic Disorder, Depression, Anxiety in Septorhinoplasty

“…8 In an earlier study by Bulut et al, the comparison of BDD-positive screened patients was also found to be lower than the negative screened patients but in a smaller cohort. 17 Patients with BDD have reportedly a high rate of psychiatric comorbidities, especially depression and anxiety, and seek aesthetic surgery more frequently. 23,24 In patients seeking aesthetic treatment including rhinoplasty, a higher rate of psychiatric diseases has also been reported by multiple authors.…”

“…[8][9][10] Despite the high prevalence of BDD and its association with higher levels of depression and anxiety, the prevalence of these psychiatric conditions in rhinoplasty patients is understudied 11,12 and their effect on rhinoplasty outcomes and QoL remains unclear. 6,[13][14][15][16][17] It was hypothesized that patients screening positive for BDD, anxiety, and depression do not show elevated postoperative QoL after SRPL. Investigation design was the prospective assessment of the most common psychiatric disorders (BDD, depression, anxiety disorder) in a large cohort of rhinoplasty patients and their effect on pre-and postoperative QoL.…”

Impact of Psychiatric Symptoms on Nasal Perception in Septorhinoplasty Patients

“…Body dysmorphic disorder (BDD) in individuals seeking SRPL is recognized as a contraindication for surgery due to these considerations. [7][8][9] Characterized by excessive concern about one's physical appearance and daily distress related to perceived slight or imagined defects, the nose often becomes a focal point of concern in BDD. 10 for this purpose.…”