The importance of recognizing body dysmorphic disorder in cosmetic surgery patients: do our patients need a preoperative psychiatric evaluation?

Body dysmorphic disorder (BDD) is classified in DSM IV as a somatoform disorder. The main features of this condition are a persistent preoccupation with a supposed physical defect or the presence of a slight imperfection in appearance. If a real defect should exist, the importance given to this in determining self-appreciation causes an important impairment in social, affective, or other functioning areas. This affection causes the patient to ask for multiple esthetic treatments. In most cases such interventions do not produce positive results in improving symptoms and may induce a chronic situation. The aim of this report is to aid in recognition of BDD in patients requesting esthetic improvements and to study psychopathological comorbidities. A counseling service was established, and 56 patients (11 men, 45 women) were seen. There were two specific interviews, one for personality, psychotic, and mood disorders and the other for the diagnosis of BDD (SCID II 2.0 and MINIPLUS 5.0). The findings in this study confirm those reported previously: BDD is more frequent in this selected population than in the general population (53.6%). There is a high prevalence of mood and anxiety disorders. Among personality disorders the most frequent are borderline and obsessive-compulsive types. We emphasize the importance of increasing the collaboration between the esthetic surgeon and the psychiatrist to determine the true motivation for surgical improvement and to avoid esthetic surgery on patients with psychiatrist disorders.