Facial Plast Surg 2003; 19(1): 007-018
DOI: 10.1055/s-2003-39137
Copyright © 2002 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662

Body Dysmorphic Disorder in Cosmetic Surgery Patients

David B. Sarwer1 , Canice E. Crerand2 , Elizabeth R. Didie2
  • 1Departments of Psychiatry and Surgery, The University of Pennsylvania School of Medicine, The Edwin and Fannie Gray Hall Center for Human Appearance, Philadelphia, PA
  • 2Department of Psychology, Drexel University, Philadelphia, PA
Further Information

Publication History

Publication Date:
09 May 2003 (online)

ABSTRACT

This article discusses body dysmorphic disorder (BDD) among cosmetic surgery patients. BDD is characterized as a preoccupation with a slight or imagined defect with some aspect of physical appearance that leads to significant disruption in daily functioning. Although the prevalence of BDD within the general population is unknown, recent evidence suggests that the disorder may be overrepresented among persons who seek cosmetic medical treatments. Preliminary evidence suggests that persons with BDD do not benefit from cosmetic treatments and frequently experience a worsening of their BDD symptoms. Thus, identification of BDD symptomotology has become an important part of determining patients' appropriateness for cosmetic procedures.

REFERENCES

  • 1 Grossbart T A, Sarwer D B. Psychosocial issues and their relevance to the cosmetic surgery patient. In: Kaminer M, Dover J, Arndt K, eds. Atlas of Cosmetic Surgery Philadelphia, PA: WB Saunders 2001 0: 60-70
  • 2 Sarwer D B. Psychological considerations in cosmetic surgery. In: Goldwyn RM and Cohen MN, eds. The Unfavorable Result in Plastic Surgery Philadelphia, PA: Lippincott, Williams, & Wilkins 2001 0: 14-23
  • 3 Sarwer D B, Pertschuk M J, Wadden T A, Whitaker L A. Psychological investigations of cosmetic surgery patients: a look back and a look ahead.  Plast Reconstr Surg . 1998;  101 1136-1142
  • 4 Sarwer D B, Wadden T A, Pertschuk M J, Whitaker L A. The psychology of cosmetic surgery: a review and reconceptualization.  Clin Psychol Rev . 1998;  18 1-22
  • 5 Sarwer D B, Crerand C E. Psychological issues in patient outcomes.  Facial Plast Surg . 2002;  18 125-133
  • 6 Meyer E, Jacobson W E, Edgerton M T, Canter A. Motivational patterns in patients seeking elective plastic surgery.  Psychosom Med . 1960;  22 193-202
  • 7 Webb W L, Slaughter R, Meyer E, Edgerton M. Mechanisms of psychosocial adjustment in patients seeking "face-lift" operation.  Psychosom Med . 1965;  27 183-192
  • 8 Marcus P. Psychological aspects of cosmetic rhinoplasty.  Br J Plast Surg . 1984;  37 313-318
  • 9 Goin M K, Burgoyne R W, Goin J M, Staples F R. A prospective psychological study of 50 female face-lift patients.  Plast Reconstr Surg . 1980;  65 436-442
  • 10 Wright M R, Wright W K. A psychological study of patients undergoing cosmetic surgery.  Arch Otolaryngol . 1975;  101 145-151
  • 11 Goin M K, Rees T D. A prospective study of patients' psychological reactions to rhinoplasty.  Ann Plast Surg . 1991;  27 210-215
  • 12 Baker J L, Kolin I S, Bartlett E S. Psychosexual dynamics of patients undergoing mammary augmentation.  Plast Reconstr Surg . 1974;  53 652-659
  • 13 Shipley R H, O'Donnell J M, Bader K F. Personality characteristics of women seeking breast augmentation.  Plast Reconstr Surg . 1977;  60 369-376
  • 14 American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 4th ed. Washington, DC: APA Press; 1994
  • 15 Sarwer D B, Wadden T A, Pertschuk M J, Whitaker L A. Body image dissatisfaction and body dysmorphic disorder in 100 cosmetic surgery patients.  Plast Reconstr Surg . 1998;  101 1644-1649
  • 16 Sarwer D B, Whitaker L A, Wadden T A, Pertschuk M J. Body image dissatisfaction in women seeking rhytidectomy or blepharoplasty.  Aesthet Surg J . 1997;  17 230-234
  • 17 Sarwer D B, Bartlett S P, Whitaker L A, Paige K T, Pertschuk M J, Wadden T A. Bigger is not always better: body image dissatisfaction in breast reduction and breast augmentation patients.  Plast Reconstr Surg . 1999;  101 1956-1961
  • 18 Pertschuk M J, Sarwer D B, Wadden T A, Whitaker L A. Body image dissatisfaction in male cosmetic surgery patients.  Aesthet Plast Surg . 1998;  22 20-24
  • 19 Morselli E. Sulla dismorfofobia e sulla tafefobia.  Boll Accad Sci Med Genova . 1886;  6 100
  • 20 American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 3rd ed. Washington, DC: APA Press; 1980
  • 21 American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 3rd ed, rev. Washington, DC: APA Press; 1987
  • 22 Phillips K A, McElroy S L, Keck J P, Hudson J I, Pope H G. A comparison of delusional and nondelusional body dysmorphic disorder in 100 cases.  Psychopharmacol Bull . 1994;  30(2) 179-186
  • 23 World Health Organization. The ICD-10 Classification of Mental and Behavioural Disorders Geneva: World Health Organization; 1992
  • 24 Cotterill J A. Dermatological non-disease: a common and potentially fatal disturbance of cutaneous body image.  Br J Dermatol . 1981;  104 611-619
  • 25 Edgerton M T, Jacobson W E, Meyer E. Surgical-psychiatric study of patients seeking plastic (cosmetic) surgery: ninety-eight consecutive patients with minimal deformity.  Br J Plast Surg . 1960;  13 136-145
  • 26 Knorr N J, Edgerton M T, Hoopes J E. The "insatiable" cosmetic surgery patient.  Plast Reconstr Surg . 1967;  40(3) 285-289
  • 27 Edgerton M T, Langman M W, Pruzinsky T. Plastic surgery and psychotherapy in the treatment of 100 psychologically disturbed patients.  Plast Reconstr Surg . 1991;  88 594-608
  • 28 Phillips K A, Diaz S F. Gender differences in body dysmorphic disorder.  J Nerv Ment Dis . 1997;  185 570-577
  • 29 Phillips K A, McElroy S L, Keck P E, Pope H G, Hudson J I. Body dysmorphic disorder: 30 cases of imagined ugliness.  Am J Psychiatry . 1993;  150 302-308
  • 30 Phillips K A. The Broken Mirror: Understanding and Treating Body Dysmorphic Disorder. New York: Oxford University Press; 1996
  • 31 Hollander E, Cohen L, Simeon D. Body dysmorphic disorder.  Psychiatric Ann . 1993;  23(7) 359-364
  • 32 Rosen J C, Reiter J, Orosan P. Cognitive-behavioral body image therapy for body dysmorphic disorder.  J Consult Clin Psychol . 1995;  63(2) 263-269
  • 33 Phillips K A, McElroy S L. Insight, overvalued ideation, and delusional thinking in body dysmorphic disorder: theoretical and treatment implications.  J Nerv Ment Dis . 1993;  181(11) 699-702
  • 34 Veale D. Outcome of cosmetic surgery and 'DIY' surgery in patients with body dysmorphic disorder.  Psychiatr Bull . 2000;  24 218-221
  • 35 Phillips K A. Body dysmorphic disorder: the distress of imagined ugliness.  Am J Psychiatry . 1991;  148(9) 1138-1149
  • 36 Veale D, Boocock A, Gournay K. et al . Body dysmorphic disorder: a survey of fifty cases.  Br J Psychiatry . 1996;  169 196-201
  • 37 Phillips K A, Taub S L. Skin picking as a symptom of body dysmorphic disorder.  Psychopharmacol Bull . 1995;  31 279-288
  • 38 Cotterill J A, Cunliffe W J. Suicide in dermatological patients.  Br J Dermatol . 1997;  137 246-250
  • 39 Thompson J K, Smolak L. Body Image, Eating Disorders, and Obesity in Youth: Assessment, Prevention, and Treatment. Washington, DC: APA Press; 2001
  • 40 Sarwer D B, Grossbart T A, Didie E R. Beauty and society. In: Kaminer M, Dover J, Arndt K, eds. Atlas of Cosmetic Surgery Philadelphia, PA: WB Saunders 2001: 48-59
  • 41 Thompson J K, Heinberg L J, Altabe M, Tantleff-Dunn S. Exacting Beauty: Theory, Assessment, and Treatment of Body Image Disturbance. Washington, DC: APA Press; 1999
  • 42 Perugi G, Akiskal H, Giannotti D, Frare F, Di Vaio S, Cassano G B. Gender-related differences in body dysmorphic disorder (dysmorphophobia).  J Nerv Ment Dis . 1997;  185(9) 578-582
  • 43 Pope H G, Phillips K A, Olivardia R. The Adonis Complex: The Secret Crisis of Male Body Obsession. New York: Free Press; 2000
  • 44 Phillips K A, McElroy S L, Hudson J I, Pope H G. Body dysmorphic disorder: an obsessive-compulsive spectrum disorder, a form of affective spectrum disorder, or both?.  J Clin Psychiatry . 1995;  56(Suppl 4) 41-51
  • 45 Wilhelm S, Otto M W, Zucker B G, Pollack M H. Prevalence of body dysmorphic disorder in patients with anxiety disorders.  J Anxiety Disord . 1997;  11(5) 499-502
  • 46 Neziroglu F, McKay D, Todaro J, Yaryura-Tobias J A. Effect of cognitive behavior therapy on persons with body dysmorphic disorder and comorbid axis II diagnoses.  Behav Ther . 1996;  27 67-77
  • 47 Phillips K A, McElroy S L. Personality disorders and traits in patients with body dysmorphic disorder.  Compr Psychiatry . 2000;  41(4) 229-236
  • 48 Rosen J C, Reiter J. Development of the body dysmorphic disorder examination.  Behav Res Ther . 1996;  34(9) 755-766
  • 49 Ishigooka J, Iwao M, Suzuki M, Fukuyama Y, Muraski M, Miura S. Demographic features of patients seeking cosmetic surgery.  Psychiatry Clin Neurosci . 1998;  52 283-287
  • 50 Phillips K A, Dufresne R G. Body dysmorphic disorder: a guide for dermatologists and cosmetic surgeons.  Am J Clin Dermatol . 2000;  4 235-243
  • 51 Phillips K A, Dufresne R G, Wilkel C S, Vittorio C C. Rate of body dysmorphic disorder in dermatology patients.  J Am Acad Dermatol . 2000;  42 436-441
  • 52 Dufresne Jr G R, Phillips K A, Vittorio C C, Wilkel C S. A screening questionnaire for body dysmorphic disorder in a cosmetic dermatologic surgery practice.  Dermatol Surg . 2001;  27 457-462
  • 53 Sarwer D B, Whitaker L A, Pertschuk M J, Wadden T A. Body image concerns of reconstructive surgery patients: an under-recognized problem.  Ann Plast Surg . 1998;  40 404-407
  • 54 Cunningham S J, Bryant C J, Manisali M, Hunt N P, Feinmann C. Dysmorphophobia: recent developments of interest to the maxillofacial surgeon.  Br J Oral Maxillofacial Surg . 1996;  34 368-374
  • 55 Cunningham S J, Feinmann C. Psychological assessment of patients requesting orthognathic surgery and the relevance of body dysmorphic disorder.  Br J Orthod . 1998;  25 293-298
  • 56 Simeon D, Hollander E, Stein D J, Cohen L, Aronowitz B. Body dysmorphic disorder in the DSM-IV field trial for obsessive compulsive disorder.  Am J Psychiatry . 1995;  152(8) 1207-1209
  • 57 Leonardo J. New York's highest court dismisses BDD case.  Plast Surg News . 2001;  July 1-9
  • 58 Goin J M, Goin M K. Changing the Body: Psychological Effects of Plastic Surgery. Baltimore, MD: Williams & Wilkins; 1981
  • 59 Yazel L. The serial-surgery murder.  Glamour . 1999;  May 108-114
  • 60 Cotterill J A. Body dysmorphic disorder.  Dermatol Clin . 1996;  14 457-463
  • 61 Sarwer D B, Didie E R. Body image in cosmetic surgical and dermatological practice. In: Castle D, Phillips KA, eds. Disorders of Body Image Stroud, England: Wrighton Biomedical; in press
  • 62 Sarwer D B, Pertschuk M J. Cosmetic surgery. In: Kornstein SG, Clayton AH, eds. Textbook of Women's Mental Health New York: Guilford; 2002: 417-430
  • 63 Sarwer D B. Plastic surgery in children and adolescents. In: Thompson JK, Smolak L, eds. Body Image, Eating Disorders, and Obesity in Children and Adolescents Washington, DC: APA Press; 2001: 341-366
  • 64 Phillips K A. Body dysmorphic disorder: clinical aspects and treatment strategies.  Bull Menninger Clin . 1998;  62 A33-A48
  • 65 Hollander E, Liebowitz M, Winchel R, Klumker A, Klein D. Treatment of body-dysmorphic disorder with serotonin reuptake blockers.  Am J Psychiatry . 1989;  146(6) 768-770
  • 66 Perugi G, Giannotti D, Di Vaio S, Frare F, Saettoni M, Cassano G B. Fluvoxamine in the treatment of the body dysmorphic disorder (dysmorphophobia).  Int Clin Psychopharmacol . 1996;  11 247-254
  • 67 Phillips K A, Dwight M M, McElroy S L. Efficacy and safety of fluvoxamine in body dysmorphic disorder.  J Clin Psychiatry . 1998;  59(4) 165-171
  • 68 Hollander E, Allen A, Kwon J. et al . Clomipramine vs desipramine crossover trial in body dysmorphic disorder.  Arch Gen Psychiatry . 1999;  56 1033-1039
  • 69 Neziroglu F, Yaryura-Tobias J A. Exposure, response prevention, and cognitive therapy in the treatment of body dysmorphic disorder.  Behav Ther . 1993;  24 431-438
  • 70 Veale D, Gournay K, Dryden W. et al . Body dysmorphic disorder: a cognitive behavioural model and pilot randomised controlled trial.  Behav Res Ther . 1996;  34(9) 717-729
  • 71 Wilhelm S, Otto M W, Lohr B, Deckersbach T. Cognitive behavior group therapy for body dysmorphic disorder: a case series.  Behav Res Ther . 1999;  37 71-75

1 *Sarwer and colleagues have written several detailed reviews of this literature. Those who are interested in reading about this literature in greater detail are referred to the papers and chapters cited here