title: Support system for decision making in the identification of risk for body dysmorphic disorder: a fuzzy model.
abstract: OBJECTIVE
  To develop a fuzzy linguistic model to quantify the level of distress of patients seeking cosmetic surgery. Body dysmorphic disorder (BDD) is a mental condition related to body image relatively common among cosmetic surgery patients; it is difficult to diagnose and is a significant cause of morbidity and mortality. Fuzzy cognitive maps are an efficient tool based on human knowledge and experience that can handle uncertainty in identifying or grading BDD symptoms and the degree of body image dissatisfaction. Individuals who seek cosmetic procedures suffer from some degree of dissatisfaction with appearance.
  
  
  METHODS
  A fuzzy model was developed to measure distress levels in cosmetic surgery patients based on the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), diagnostic criterion B for BDD. We studied 288 patients of both sexes seeking abdominoplasty, rhinoplasty, or rhytidoplasty in a university hospital.
  
  
  RESULTS
  Patient distress ranged from "none" to "severe" (range=7.5-31.6; cutoff point=18; area under the ROC curve=0.923). There was a significant agreement between the fuzzy model and DSM-IV criterion B (kappa=0.805; p<0.001).
  
  
  CONCLUSIONS
  The fuzzy model measured distress levels with good accuracy, indicating that it can be used as a screening tool in cosmetic surgery and psychiatric practice.
authors.affiliation: Division of Plastic Surgery, Universidade Federal de São Paulo UNIFESP, São Paulo, SP, Brazil. mjbrito@infinitetrans.com
authors.forename: Maria José Azevedo
authors.initials: MJ
authors.lastname: de Brito
authors.forename: Fábio Xerfan
authors.initials: FX
authors.lastname: Nahas
authors.forename: Neli Regina Siqueira
authors.initials: NR
authors.lastname: Ortega
authors.forename: Táki Athanássios
authors.initials: TA
authors.lastname: Cordás
authors.forename: Gal Moreira
authors.initials: GM
authors.lastname: Dini
authors.forename: Miguel Sabino
authors.initials: MS
authors.lastname: Neto
authors.forename: Lydia Masako
authors.initials: LM
authors.lastname: Ferreira
mesh_terms: D061645:Abdominoplasty / Q000009:adverse effects*; D000328:Adult; D057215:Body Dysmorphic Disorders / Q000175:diagnosis / Q000209:etiology* / Q000523:psychology*; D001828:Body Image; D003657:Decision Making; D005260:Female; D017143:Fuzzy Logic; D006801:Humans; D008297:Male; D015233:Models, Statistical; D012225:Rhinoplasty / Q000009:adverse effects*; D015361:Rhytidoplasty / Q000009:adverse effects*; D013518:Surgery, Plastic; D011795:Surveys and Questionnaires
keywords: Body dysmorphic disorders; Fuzzy logic; Investigative techniques; Plastic surgery; Psychiatry; Somatoform disorders