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Tijdschrift voor Psychiatrie 56 (2014) 8, 514 - 522

Review article

Body dysmorphic disorder in cosmetic surgery - prevalence, psychiatric comorbidity and outcome

T. Hundscheid, R.R.W.J. van der Hulst, B.P.F. Rutten, C. Leue

background Patients suffering from body dysmorphic disorder (bdd) are preoccupied with a slight or imagined defect in appearance.
aim First of all, to review the literature on the prevalence of bdd in cosmetic surgery and thereafter to review the literature on psychiatric comorbidity and the outcome of surgical interventions.
method We based our search strategy on Embase, Medline and PubMed, using the search terms ‘body dysmorphic disorder’, ’cosmetic surgery’, ‘prevalence’, ‘comorbidity’ and ‘outcome’. Our search covered English and Dutch literature published after the introduction of bdd in dsm-iii-r and before 1 November, 2013. A study of the relevant articles enabled us to access additional articles mentioned in these texts.
results Our initial search strategy turned out to be too narrow. It was therefore broadened to include ‘body dysmorphic disorder’, ‘cosmetic surgery’, and ‘prevalence’. Eventually we included 23 original articles. In 11 of these the prevalence of bdd varied from 3.2 to 53.6%. Twelve articles on psychiatric comorbidity revealed predominantly mood and anxiety disorders on axis I and cluster C personality disorders on axis II. Only two studies reported on the outcome of cosmetic surgery performed on bdd patients; surgical interventions, however, seemed to result in new preoccupations with the prolongation of psychiatric comorbidity.
conclusion bdd is a common psychiatric disorder that can sometimes lead to cosmetic surgery. However, pre-operative screening of bdd patients is vital so that efficient psychiatric treatment can be initiated and patients are not subjected to surgical interventions which may be ineffective or even harmful.

keywords body dysmorphic disorder, comorbidity, cosmetic surgery, prevalence