Psychiatric Assessment and Management of Clients Undergoing Cosmetic Surgery: Overview and Need for an Integrated Approach

Abstract

Background Psychiatric disorders are more common among people undergoing cosmetic procedures than the general population and evaluating mental health can be cumbersome for plastic surgeons. We aim to summarize the available literature in this regard and propose an integrated approach to psychiatric assessment and management of mental health issues among this group. Methods Electronic search of MEDLINE, Google Scholar, and PsycINFO databases was done to identify relevant peer-reviewed English language articles from inception till April 2020. Generated abstracts were screened for their eligibility. Included articles were grouped according to their thematic focus under the following headings; prevalence of psychiatric morbidity among clients posted for cosmetic surgery, assessment tools, and management of psychiatric morbidity in relation to undergoing cosmetic surgery. Results A total of 120 articles were reviewed. The prevalence of psychiatric disorder in patients undergoing cosmetic surgery was 4 to 57% for body dysmorphic disorder (BDD); the corresponding figures for depression, anxiety, and personality disorder were 4.8 to 25.8, 10.8 to 22, and 0 to 53%, respectively. A range of tools have been used to assess these disorders and specific measures are also available to assess clinical outcomes following surgery. Screening for these disorders is essential to prevent unnecessary surgical procedures, as well as to ensure timely management of the psychiatric comorbidity. Conclusion Psychiatric morbidity is a common concomitant in cosmetic surgery. A structured and integrated approach to evaluation and management of psychiatric morbidity will help to optimize postsurgical outcomes.

Evidence‐based review: Screening body dysmorphic disorder in aesthetic clinical settings

“…Validated tool in both psychiatric and aesthetic setting, with 72% sensitivity and 90.7% specificity in the cosmetic surgery setting with cut‐off value ≥14 15,18 . Satisfactory internal consistency.…”

“…Quick and easy to use. In surgical and cosmetic clinics setting demonstrated to have 100% sensitivity and 89%–93% specificity and good validity against diagnostic measure, among different populations, in/outside psychiatric setting, and beyond original English language 6,18 …”

“…Gold standard for BDD diagnosis. Requires a trained clinician or mental health professional able to recognize diverse mental health disorders 5,18 …”

“…In this context, the aim of this evidence‐based review was to identify validated BDD screening tools and appraise available data regarding its implementation and efficacy in daily practice, by preventing post‐treatment complications for both aesthetic patients and practitioners. Previous reviews on this topic have not sought to clearly distinguish the validated screening tools for BDD from non‐validated instruments or other measures for BDD that have been misused for screening purposes in the aesthetic population 2,3,18–20 . Therefore, the present study attempted to address this gap in the available literature, and to assess the impact of current discrepant interpretations of screening measures for BDD on reported validation processes of screening instruments, and aesthetic treatment outcome among positive screening patients.…”

Translation, cross-cultural adaptation and validation of the Mandarin version of the BDDQ-AS for rhinoplasty patients

“…Patients with BDD who undergo aesthetic treatment often take up the surgeon's time with frequent phone calls and requests for additional consultations and procedures. These patients also tend to file malpractice suits and may even become physically violent toward their surgeons [ 8 – 11 ]. These problems underscore the need for accurate identification of patients with BDD presenting for aesthetic procedures.…”