title: Body dysmorphic disorder in patients undergoing septorhinoplasty surgery: should we be performing routine screening?
abstract: OBJECTIVE
  Body dysmorphic disorder (BDD) is defined as having a preoccupation with a perceived flaw in one's appearance, which appears slight to others and significantly interferes with a person's functioning. When undetected in septorhinoplasty patients, it will often lead to poor outcomes.
  
  
  METHODS
  We performed a prospective cohort study to determine the prevalence of BDD in our patients and whether surgical correction could be considered.
  
  
  METHODS
  We recruited 34 patients being considered for septorhinoplasty in a tertiary referral rhinology clinic and a control group of 50 from the otology clinic giving a total of 84.
  
  
  METHODS
  Participants completed the Body Dysmorphic Disorder Questionnaire (BDDQ), the sino-nasal outcome test-23 (SNOT-23) and underwent nasal inspiratory peak flow (NIPF). Those found to be at high risk for BDD were referred to a clinical psychologist.
  
  
  RESULTS
  Of the septorhinoplasty patients, 11 (32%) were high risk for BDD. Following psychological assessment, 7 (63%) patients were felt to be unsuitable for surgery and were offered psychological therapy. SNOT-23 scores were significantly higher in the BDD group indicating a negative impact on quality of life. NIPF readings were not significantly different in the BDD group compared to the control group.
  
  
  CONCLUSIONS
  The BDDQ is a valid tool for identifying patients at risk of BDD. A close working relationship with clinical psychology has been advantageous to help the selection process of candidates for surgery when there is a high risk of BDD.
authors.affiliation: Department of Rhinology and Facial Plastics Surgery, Royal National Throat Nose and Ear Hospital, London, UK.
authors.forename: J
authors.initials: J
authors.lastname: Joseph
authors.affiliation: Department of Rhinology and Facial Plastics Surgery, Royal National Throat Nose and Ear Hospital, London, UK.
authors.forename: P
authors.initials: P
authors.lastname: Randhawa
authors.affiliation: Department of Rhinology and Facial Plastics Surgery, Royal National Throat Nose and Ear Hospital, London, UK.
authors.forename: S A
authors.initials: SA
authors.lastname: Hannan
authors.affiliation: Department of Rhinology and Facial Plastics Surgery, Royal National Throat Nose and Ear Hospital, London, UK.
authors.forename: J
authors.initials: J
authors.lastname: Long
authors.affiliation: Department of Rhinology and Facial Plastics Surgery, Royal National Throat Nose and Ear Hospital, London, UK.
authors.forename: S
authors.initials: S
authors.lastname: Goh
authors.affiliation: Department of Rhinology and Facial Plastics Surgery, Royal National Throat Nose and Ear Hospital, London, UK.
authors.forename: N
authors.initials: N
authors.lastname: O'Shea
authors.affiliation: Department of Rhinology and Facial Plastics Surgery, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK.
authors.forename: H
authors.initials: H
authors.lastname: Saleh
authors.affiliation: Department of Plastic and Reconstructive Surgery, Royal Free London NHS Foundation Trust, London, UK.
authors.forename: E
authors.initials: E
authors.lastname: Hansen
authors.affiliation: The Institute of Psychiatry, Psychology and Neuroscience, King's College London and the South London and Maudsley NHS Foundation Trust, London, UK.
authors.forename: D
authors.initials: D
authors.lastname: Veale
authors.affiliation: Department of Rhinology and Facial Plastics Surgery, Royal National Throat Nose and Ear Hospital, London, UK.|The Ear Institute, UCL, London, UK.
authors.forename: P
authors.initials: P
authors.lastname: Andrews
mesh_terms: D000328:Adult; D057215:Body Dysmorphic Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D009667:Nose Deformities, Acquired / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D057234:Preoperative Period; D015995:Prevalence; D011446:Prospective Studies; D011788:Quality of Life; D012225:Rhinoplasty; D011795:Surveys and Questionnaires; D006113:United Kingdom / Q000453:epidemiology