16 August 2010

Body dysmorphia unimproved by cosmetic surgery

by Kate Melville

A new study appearing in the Annals of Plastic Surgery has found that while many who suffer from body dysmorphic disorder (BDD) seek cosmetic procedures, only 2 percent of procedures actually reduced the severity of the psychiatric disorder. Physicians, however, continue to provide requested surgeries to people suffering from the condition despite the likelihood of a poor outcome.

"BDD is a psychiatric disorder characterized by a preoccupation with an imagined or slight defect in appearance which causes clinically significant distress or functional impairment. A majority of these individuals believe they have an actual deformity that can be corrected by cosmetic treatments to fix these perceived defects rather than seeking psychiatric intervention," explained study co-author Katharine A. Phillips, from Rhode Island Hospital.

Phillips and her co-author, Canice Crerand, reported in previous studies that BDD appears relatively common among individuals who receive cosmetic surgery, with reported rates of 7 to 8 percent in the United States. In their new study, the researchers report that in a study of 200 individuals with BDD, 31 percent sought and 21 percent received surgical treatment for BDD symptoms. However, nearly all of these individuals continued to have BDD symptoms after the surgery, and some actually developed new appearance preoccupations.

They also note that in a survey of nearly 300 cosmetic surgeons, 65 percent reported treating patients with BDD, yet only 1 percent of the cases resulted in BDD symptom improvement. "These findings, coupled with reports of lawsuits and occasionally violence perpetrated by persons with BDD towards physicians, have led some to believe that BDD is a contraindication for cosmetic treatment," noted Phillips.

Phillips says that the most common surgical procedures sought were rhinoplasty and breast augmentation, while the most common minimally invasive treatments were collagen injections and microdermabrasion. Three quarters of all the requested procedures involved facial features.

In terms of long-term outcomes from the procedures, only 25 percent of the patients showed an improvement in their appraisal of the treated body part. However, as noted by co-author Crerand, "Only two percent of surgical or minimally invasive procedures led to longer-term improvement in overall BDD symptoms."

Phillips and Crerand believe that treating the disorder from a psychiatric perspective may be a better option than surgery. "The findings indicate that there is a clear need to further investigate this topic in prospective studies. In the meantime, physicians need to be aware that psychiatric treatments for BDD such as serotonin reuptake inhibitors and cognitive behavioral therapy appear to be effective for what can be a debilitating disorder," they conclude.

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Source: Annals of Plastic Surgery