Screening for Body Dysmorphic Disorder among Patients Seeking Dermatological and Cosmetic Care: A Cross-sectional Study

Body dysmorphic disorder symptoms in patients with melasma

BACKGROUND

Body dysmorphic disorder (BDD) is a psychiatric condition characterized by extreme preoccupation with non-existent or minor defects in appearance, disrupting daily functioning. Melasma is a common concern among BDD patients with dermatological conditions. This study aimed to estimate the incidence and characteristics of BDD in patients with melasma, and compare the psychological condition of patients and age- and sex-matched healthy controls.

METHODS

Patients with melasma and healthy controls were screened using the BDD Questionnaire (BDDQ), Self-rating Anxiety Scale (SAS), and Self-rating Depression Scale (SDS). A questionnaire was administered to collect demographic information and clinical characteristics. Standard statistical tests were conducted, such as descriptive analysis, chi-square, and nonparametric tests. The level of statistical significance for all tests was set at a P < 0.05.

RESULTS

Among the 470 patients with melasma included in the study, 53 were positive for BDDQ in the preliminary screening and were associated with a history of treatment, higher Melasma Area and Severity Index (MASI), and Melasma Quality of Life (MELASQoL) scores, and higher SAS and SDS scores. The positive rate of BDDQ ranged from 0.4%, using the most stringent criteria to assess melasma severity, to 11.3%, without using objective criteria. Compared to healthy controls, patients with melasma had a higher positive rate of BDDQ and higher SAS and SDS scores.

CONCLUSION

In patients with melasma who exaggerate the severity of the disease, psychiatric treatment and the patient-physician relationship have a positive effect. This study assessed the positive rate of BDDQ in melasma and proposed the feasibility of psychiatric treatment for patients with melasma.

Evidence-based review: Screening body dysmorphic disorder in aesthetic clinical settings

BACKGROUND

Body dysmorphic disorder (BDD) is a psychiatric disturbance with high incidence in aesthetic clinical settings. Early recognition may avoid unnecessary elective procedures with ethical and medicolegal consequences.

AIMS

To identify validated BDD screening tools and critically appraise current literature regarding its implementation and efficacy in aesthetic medicine and surgery scenarios, with the purpose of transposing the findings to the broad clinical settings in the field.

METHODS

Data was collected using advanced search from PubMed (MEDLINE). Having satisfied the search parameters, 12 studies referring BDD definition according to Diagnostic and Statistical Manual of Mental Disorder (DSM-5) criteria and including a BDD screening tool in clinical aesthetic settings were selected.

RESULTS

While BDD screening enables the recognition of at-risk individuals, further work is required to uncover the best screening tool for general aesthetic clinical practice. Level III evidence favored BDD Questionnaire (BDDQ)/BDDQ-Dermatology Version (DV), and The Dysmorphic Concern Questionnaire (DCQ) among the limited available validated screening instruments to be used outside the psychiatric environment. Based on level II self-classification, one study selected BDDQ-Aesthetic Surgery (AS) version for rhinoplasty patients. The validation process of both BDDQ-AS and Cosmetic Procedure Screening Questionnaire (COPS) had limitations. For BDD screening potential in avoiding postoperative complications, the limited studies found evaluating the outcomes following aesthetic treatments using validated BDD screening measures showed a trend toward less satisfaction with aesthetic treatment outcome among positive screening population against non-BDD counterparts.

CONCLUSION

Further research is necessary to establish more effective methods to identify BDD and evaluate the impact of positive findings on aesthetic intervention outcomes. Future studies may elucidate which BDD characteristics best predict a favorable outcome and provide high-quality evidence for standardized protocols in research and clinical practice.