The Prevalence of Body Dysmorphic Disorder Among Patients Presenting for Orthognathic Surgery. J Duininck, AG Becking.

Date: September 2019.
Source: Journal of Oral and Maxillofacial Surgery, Volume 77, Issue 9, Supplement, Pages e11–e12.
Objective: Patients suffering from Body Dysmorphic Disorder (BDD) experience severe psychological distress resulting from an illusory physical deformation. Over the past decades, research has shown that patients suffering from BDD often seek medical help at departments other than psychiatry, where treatment should take place. Earlier research has shown that surgical procedures aimed at correcting the illusory deformation often lead to disappointing results. The purpose of this study was therefore to determine the prevalence of BDD amongst patients presenting for orthognathic surgery.
Methods: In 4 non-academic hospitals a validated questionnaire was distributed among patients presenting for orthognathic surgery. Additionally, the OMF surgeon involved graded the severity of the perceived physical deformation on a 4-point Likert scale, as an imperative aspect of BDD is the absence of a clearly visible defect. By combining the severity score with data from the questionnaire, patients could be screened for suffering from BDD. Patients that screened positive for BDD in the questionnaire but had a clearly visible deformity were classified as suffering from Body Dysmorphic like Disorder with Actual Flaws (BDD-AF). Data were collected and analyzed using SPSS statistics. Fisher’s Exact Test was used to compare patients with and without BDD and patients with and without BDD-AF.
Results: In total, 427 patients were included in this study. Among them, 42 patients (9.8%) reported symptoms of severe psychological distress corresponding with the DSM-IV criteria of BDD. Only 13 patients (3%) screened positive for BDD, as 29 patients (6.8%) were graded with a severity score of 3 or higher. These patients were labeled as suffering from BDD-AF. The mean time since onset of the maxillofacial deformity in BDD patients was significantly longer than in patients without BDD. Moreover, statistically significant associations were found between screening positive for BDD and complaints of impairment in social and occupational activities, repetitive behavior (frequent checking) and deliberately hiding the deformity. Additionally, BDD patients felt that friends and family were concerned about them and others were staring at their perceived deformity. Notably, an association was found between screening positive for BDD and expecting life to change drastically after orthognathic surgery. Patients with BDD-AF reported the same psychological complaints as patients with BDD. In addition to this, a statistically significant association was found between BDD-AF and being unsatisfied with overall physical appearance and attractiveness, feeling ashamed of one’s physical appearance, behavior of avoidance resulting from the perceived deformity, spending more time on physical appearance than desired and attempting to reassure oneself.
Conclusions: Almost 10% of patients presenting for orthognathic surgery suffer from severe and disabling psychological distress. In only 3% this can be attributed to BDD. An additional 6.8% suffer from BDD-AF. These results show that the prevalence of BDD among patients presenting for orthognathic surgery is not significantly higher than the prevalence of BDD in the general population. It is important to include patients with BDD-AF in further research.

Article: The Prevalence of Body Dysmorphic Disorder Among Patients Presenting for Orthognathic Surgery.
Authors: J Duininck and AG Becking.