Patients with mild to moderate body dysmorphic disorder may benefit from rhinoplasty

Felix, Gabriel A.; Brito, Maria José Azevedo de; Nahas, Fábio Xerfan; Tavares, Hermano; Córdas, Taki Athanássios; Dini, Gal Moreira; Ferreira, Lydia Masako

doi:10.1016/j.bjps.2014.01.002

Cited by 70 publications

(75 citation statements)

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“…3,4 The participants' mean age was 33 years at the time of the interview, which was not associated with the onset of body dysmorphic symptoms and thus was consistent with the literature. [1][2][3][4][5]13,23 The time that elapsed from the onset of body dissatisfaction to the patient's decision to seek cosmetic treatment (about 15 years) was very similar to that of patients seeking mental health treatment, thus showing the different behaviors and profiles of this population. 36 In other words, patients with body dysmorphic disorder may take different paths; those who seek cosmetic surgery will not necessarily seek psychiatric treatment later.…”

Section: Yale-brown Obsessive Compulsive Scale For Body Dysmorphicsupporting

confidence: 74%

“…4,6 Rhinoplasty is one of the most sought-after esthetic surgical procedures. Typical candidates include people with ethnically characteristic noses, teenagers and individuals with body dysmorphic disorder, [3][4][5][7][8][9][10][11] which thus shows the social aspect of rhinoplasty. Rhinoplasty improves appearance through enhancing facial harmony.…”

Section: Introductionmentioning

confidence: 99%

“…3,4 Rhinoplasty is also one of the cosmetic surgical procedures most frequently involved in lawsuits. 5,7,9,10,[12][13][14] Despite indications of improvement in psychosocial wellbeing following rhinoplasty, the prevalence of body dysmorphic disorder in patients seeking this surgical procedure ranges from 12% to 33% 10,13,[15][16][17][18] and 52%.…”

Section: Introductionmentioning

confidence: 99%

“…1 Rhinoplasty is often sought by young people between 13 and 34 years of age. [1][2][3][4][5] Patients between 13 and 19 years account for 5% of all surgical cosmetic procedures performed. 1,2 This shows the high level of social acceptance of esthetic surgery in general and of rhinoplasty in particular, as a means of physical enhancement in a culture in which physical attractiveness is highly valued, thus leading to greater concern regarding appearance based on an ideal standard body.…”

Section: Introductionmentioning

confidence: 99%

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Body Dysmorphic Symptoms Scale for patients seeking esthetic surgery: cross-cultural validation study

et al. 2016

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CONTEXT AND OBJECTIVE: Rhinoplasty is one of the most sought-after esthetic operations among individuals with body dysmorphic disorder. The aim of this study was to cross-culturally adapt and validate the Body Dysmorphic Symptoms Scale. DESIGN AND SETTING: Cross-cultural validation study conducted in a plastic surgery outpatient clinic of a public university hospital. METHODS: Between February 2014 and March 2015, 80 consecutive patients of both sexes seeking rhinoplasty were selected. Thirty of them participated in the phase of cultural adaptation of the instrument. Reproducibility was tested on 20 patients and construct validity was assessed on 50 patients, with correlation against the Yale-Brown Obsessive Compulsive Scale for Body Dysmorphic Disorder. RESULTS:The Brazilian version of the instrument showed Cronbach's alpha of 0.805 and excellent interrater reproducibility (intraclass correlation coefficient, ICC = 0.873; P < 0.001) and intra-rater reproducibility (ICC = 0.939; P < 0.001). Significant differences in total scores were found between patients with and without symptoms (P < 0.001). A strong correlation (r = 0.841; P < 0.001) was observed between the YaleBrown Obsessive Compulsive Scale for Body Dysmorphic Disorder and the Body Dysmorphic Symptoms Scale. The area under the receiver operating characteristic curve was 0.981, thus showing good accuracy for discriminating between presence and absence of symptoms of body dysmorphic disorder. Forty-six percent of the patients had body dysmorphic symptoms and 54% had moderate to severe appearancerelated obsessive-compulsive symptoms. CONCLUSIONS: The Brazilian version of the Body Dysmorphic Symptoms Scale is a reproducible instrument that presents face, content and construct validity.RESUMO CONTEXTO E OBJETIVO: Rinoplastia é uma das operações mais procuradas por indivíduos com o transtorno dismórfico corporal. O objetivo deste estudo foi adaptar culturalmente e validar a Body Dysmorphic Symptoms Scale. DESENHO E LOCAL: Estudo de validação cultural desenvolvido no ambulatório de cirurgia plástica de um hospital universitário público. MÉTODOS: Oitenta pacientes consecutivos de ambos os gêneros que desejavam submeter-se à rinoplastia foram selecionados entre fevereiro de 2014 e março de 2015. Trinta pacientes participaram da fase de adaptação cultural do instrumento. A reprodutibilidade foi testada em 20 pacientes e a validade de construto em 50 pacientes, correlacionando-se a escala com a Yale-Brown Obsessive Compulsive Scale para transtorno dismórfico corporal. RESULTADOS: A versão brasileira do instrumento mostrou alfa de Cronbach de 0,805 e excelente reprodutibilidade interobservador (coeficiente de correlação intraclasse, CCI = 0,873; P < 0,001) e intraobservador (CCI = 0,939; P < 0,001). Houve diferença significante entre os escores totais de pacientes com e sem sintomas (P < 0,001). Observou-se forte correlação (r = 0,841; P < 0,001) entre a Yale-Brown Obsessive Compulsive Scale para transtorno dismórfico corporal e a Body Dysmorphic Symptoms S...

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Section: Yale-brown Obsessive Compulsive Scale For Body Dysmorphicsupporting

confidence: 74%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Body Dysmorphic Symptoms Scale for patients seeking esthetic surgery: cross-cultural validation study

et al. 2016

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“…Sa druge strane, jednogodišnje praće-nje Felix i sar. [38] 31-e žene sa blagim do umerenim telesnim dismorfičkim poremećajem koje su se podvrgle rinoplastici ukazalo je da je 81% pacijenatkinja ušlo u kompletnu remisiju, a 90% je i dalje bilo zadovoljno rezultatima. Medjutim, ostaje problem premeštanja opsesije na drugi deo tela i ishod nakon dužeg praće-nja.…”

Section: Estetske Hirurške Intervencije Kod Pacijenara Sa Telesnim DIunclassified

Aestetic surgery in the treatment of body dysmorphic disorder: Paradox of bioetics

Batinić¹,

Duišin²,

Barišić³

2014

Engrami

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1 Klinika za psihijatriju, Klinički centar Srbije, Beograd 2 Filozofski fakultet, Univerzitet u Beogradu, Odeljenje za psihologiju Napomena: Rad je saopšten na simpozijum Klinike za psihijatriju Kliničkog Centra Srbije "Bioetika i psihijatrija" održanom u Beogradu od 9-10 oktobra, 2014. Kratak sadržajTelesni dismorfički poremećaj pripada opsesivno-kompulzivnom spektru poremećaja i karakteriše se opsesivnom preokupacijom minornim ili nepostojećim manama u fizič-kom izgledu koje nisu vidljive ili su beznačajne za druge ljude, uz repetitivna ponaša-nja kao što su konstantno ogledanje, preterano doterivanje, kamuflaža, traženje razuveravanja, itd. Koža, kosa i nos su najčešća područja opsesivnih preokupacija. Uzrokuje značajnu patnju i oštećenje funkcionisanja. Stope suicidalne ideacije iznose i do 80%, a pokušaji sucida u toku života od 24%-48%. Istraživanja ukazuju da 27%-39% ovih pacijenata nema uvid u poremećaj. Pogadja 0.7%-2.4% opšte populaćije, a učestalost u ordinacijama plastične hirurgije iznosi 6.3%-9%. Želja za estetskom hirurgijom u ovom slučaju je deo problema: pogrešnog verovanja da je "greška" u telu. Estetska hirurgija u nekim slučajevima može da donese privremeno olakšanje, kao svojevrsan kompulzivni akt, ali dugotrajna praćenja ukazuju da održava ili pogoršava telesni dismorfički poremećaj, jer se u setingu "nelimitiranog narcizma" najčešće egzarcerbira preokupacija telesnim nedostacima. Zbog toga što se radi o poremećaju slike tela i opsesiji zamišljenim a ne realnim defektom, povećavaju se zahtevi za ponovljenim intervencijama da bi se postiglo "idealno rešenje", čime mnogi od ovih pacijenata postaju "adikti plastične hirurgije" i u krajnjem ishodu žrtve "viška operativnih intervencija". Tako su hiruške intervencije kod osoba sa telesnim dismorfičkom poremećajem kristalizacija paradoksa vezanih za estetsku hirurgiju kao način lečenja "kompleksa inferiornosti" i "uravnoteženja psihe".Uz prikaz slučaja iz naše kliničke prakse, diskutovani su etički paradoksi hiruških intervencija kod osoba sa telesnim dismorfičkim poremećajem vezani za hirurgiju "po želji", poštovanje prava autonomije, principi dobrobiti pacijenta i nenanošenja štete, informisani pristanak, itd. Ukazano je na načine i neophodnost identifikacije osoba sa telesnim dismorfičkim poremećajem u ordinacijama estetskih hirurga i njihovo upućivanje na psihijatrijski tretman. Sa velikom moći izmene telesnog izgleda u modernom društvu, treba da raste i odgovornost plastičnih hirurga i etičko preispitivanje profesionalnog ponašanja.Ključne reči: telesni dismorfički poremećaj, estetska hirurgija, paradoks, bioetika

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Association of Mental Health Status With Perception of Nasal Function

Strazdins

Nie

Ramli

et al. 2017

JAMA Facial Plast Surg

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IMPORTANCE Mental health issues are thought to be overrepresented among patients undergoing rhinoplasty and may be associated with patient presentation prior to surgery.OBJECTIVE To assess the association of poor mental health with perception of nasal function. DESIGN, SETTING, AND PARTICIPANTSA cross-sectional study of patients presenting for airway assessment was performed from December 1, 2011, to October 31, 2015, at 2 tertiary rhinoplasty centers in Sydney, Australia. Mental health was independently defined preoperatively by the Mental Component Summary of the 36-item Short Form Health Survey version 2 (a score of <40 indicated poor mental well-being), the Rosenberg Self-Esteem Scale (a score of <15 indicated low self-esteem), and the Dysmorphic Concerns Questionnaire (a score of >11 indicated above-average dysmorphic concerns). MAIN OUTCOMES AND MEASURESNasal function was assessed with patient-reported outcome measures, including the Nasal Obstruction Symptom Evaluation Scale, the 22-item Sinonasal Outcome Test, a visual analog scale to rate ease of breathing on the left and right sides, and Likert scales to assess overall function and nasal obstruction. Nasal airflow was assessed by nasal peak inspiratory flow, nasal airway resistance, and minimum cross-sectional area.RESULTS Among 495 patients in the study (302 women and 193 men; mean [SD] age, 36.5 [13.6] years), compared with patients with good mental health, those with poor mental health had poorer scores in all patient-reported outcome measures, including the visual analog scale for the left side (mean [SD], 51 [25] vs 42 [25]; P = .001), visual analog scale for the right side (mean [SD], 54 [24] vs 45 [26]; P < .001), Nasal Obstruction Symptom Evaluation Scale (mean [SD], 2.64 [0.95] vs 1.96 [1.04]; P < .001), 22-item Sinonasal Outcome Test (mean [SD], 2.14 [0.84] vs 1.33 [0.83]; P < .001), nasal obstruction (58 of 145 [40.2%] vs 83 of 350 [23.7%] with severe or worse obstruction; P < .001), and nasal function (72 of 145 [49.7%] vs 111 of 350 [31.8%] with poor or worse function; P < .001). Subclinical differences in nasal peak inspiratory flow could be demonstrated, but all other nasal airflow measures were similar. Low self-esteem produced a similar pattern, but dysmorphia did not. CONCLUSIONS AND RELEVANCEPoor mental health status is associated with a poorer self-perception of nasal function compared with those who are mentally healthy with clinically similar nasal airflow. Clinicians should be aware that patients with poor mental health reporting obstructed airflow may in part be representing an extension of their negative emotions rather than true obstruction and may require further assessment prior to surgery.LEVEL OF EVIDENCE NA.

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Patients with mild to moderate body dysmorphic disorder may benefit from rhinoplasty

Cited by 70 publications

References 36 publications

Body Dysmorphic Symptoms Scale for patients seeking esthetic surgery: cross-cultural validation study

Body Dysmorphic Symptoms Scale for patients seeking esthetic surgery: cross-cultural validation study

Aestetic surgery in the treatment of body dysmorphic disorder: Paradox of bioetics

Association of Mental Health Status With Perception of Nasal Function

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