title: Prevalence of Body Dysmorphic Disorder and Surgeon Diagnostic Accuracy in Facial Plastic and Oculoplastic Surgery Clinics.
abstract: OBJECTIVE
  Body dysmorphic disorder (BDD) is a relative contraindication for facial plastic surgery, but formal screening is not common in practice. The prevalence of BDD in patients seeking facial plastic surgery is not well documented.
  
  
  OBJECTIVE
  To establish the prevalence of BDD across facial plastic and oculoplastic surgery practice settings, and estimate the ability of surgeons to screen for BDD.
  
  
  METHODS
  This multicenter prospective study recruited a cohort of 597 patients who presented to academic and private facial plastic and oculoplastic surgery practices from March 2015 to February 2016.
  
  
  METHODS
  All patients were screened for BDD using the Body Dysmorphic Disorder Questionnaire (BDDQ). After each clinical encounter, surgeons independently evaluated the likelihood that a participating patient had BDD. Validated instruments were used to assess satisfaction with facial appearance including the FACE-Q, Blepharoplasty Outcomes Evaluation (BOE), Facelift Outcomes Evaluation (FOE), Rhinoplasty Outcomes Evaluation (ROE), and Skin Rejuvenation Outcomes Evaluation (SROE).
  
  
  RESULTS
  Across participating practices (9 surgeons, 3 sites), a total of 597 patients were screened for BDD: 342 patients from site 1 (mean [SD] age, 44.2 [16.5] years); 158 patients, site 2 (mean [SD] age, 46.0 [16.2] years), site 3, 97 patients (mean [SD] age, 56.3 [15.5] years). Overall, 58 patients [9.7%] screened positive for BDD by the BDDQ instrument, while only 16 of 402 patients [4.0%] were clinically suspected of BDD by surgeons. A higher percentage of patients presenting for cosmetic surgery (37 of 283 patients [13.1%]) compared with those presenting for reconstructive surgery (21 of 314 patients [6.7%]) screened positive on the BDDQ (odds ratio, 2.10; 95% CI, 1.20-3.68; P = .01). Surgeons were only able to correctly identify 2 of 43 patients (4.7%) who screened positive for BDD on the BDDQ, and the positive likelihood ratio was only 1.19 (95% CI, 0.28-5.07). Patients screening positive for BDD by the BDDQ had lower satisfaction with their appearance as measured by the FACE-Q, ROE, BOE, SROE, and FOE.
  
  
  CONCLUSIONS
  Body dysmorphic disorder is a relatively common condition across facial plastic and oculoplastic surgery practice settings. Patients who screen positive on the BDDQ have lower satisfaction with their facial appearance at baseline. Surgeons have a poor ability to screen for patients with BDD when compared with validated screening instruments such as the BDDQ. Routine implementation of validated BDD screening instruments may improve patient care.
  
  
  METHODS
  NA.
authors.affiliation: Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Andrew W
authors.initials: AW
authors.lastname: Joseph
authors.affiliation: Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Lisa
authors.initials: L
authors.lastname: Ishii
authors.affiliation: Division of Oculoplastic Surgery, Kellogg Eye Center, University of Michigan Medical School, Ann Arbor.
authors.forename: Shannon S
authors.initials: SS
authors.lastname: Joseph
authors.affiliation: Division of Oculoplastic Surgery, Kellogg Eye Center, University of Michigan Medical School, Ann Arbor.
authors.forename: Jane I
authors.initials: JI
authors.lastname: Smith
authors.affiliation: Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Peiyi
authors.initials: P
authors.lastname: Su
authors.affiliation: Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Kristin
authors.initials: K
authors.lastname: Bater
authors.affiliation: Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Patrick
authors.initials: P
authors.lastname: Byrne
authors.affiliation: Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Kofi
authors.initials: K
authors.lastname: Boahene
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland4Facial Plastic Surgicenter, Baltimore, Maryland.
authors.forename: Ira
authors.initials: I
authors.lastname: Papel
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland4Facial Plastic Surgicenter, Baltimore, Maryland.
authors.forename: Theda
authors.initials: T
authors.lastname: Kontis
authors.affiliation: Division of Oculoplastic Surgery, Kellogg Eye Center, University of Michigan Medical School, Ann Arbor.
authors.forename: Raymond
authors.initials: R
authors.lastname: Douglas
authors.affiliation: Division of Oculoplastic Surgery, Kellogg Eye Center, University of Michigan Medical School, Ann Arbor.
authors.forename: Christine C
authors.initials: CC
authors.lastname: Nelson
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Masaru
authors.initials: M
authors.lastname: Ishii
mesh_terms: D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D019882:Blepharoplasty / Q000523:psychology* / Q000706:statistics & numerical data*; D057215:Body Dysmorphic Disorders / Q000175:diagnosis* / Q000453:epidemiology* / Q000523:psychology; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D016013:Likelihood Functions; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D016017:Odds Ratio; D010549:Personal Satisfaction; D058629:Plasma Skin Regeneration / Q000523:psychology* / Q000706:statistics & numerical data*; D011446:Prospective Studies; D011594:Psychometrics / Q000706:statistics & numerical data; D019651:Plastic Surgery Procedures / Q000523:psychology* / Q000706:statistics & numerical data*; D015361:Rhytidoplasty / Q000523:psychology* / Q000706:statistics & numerical data*; D012680:Sensitivity and Specificity; D011795:Surveys and Questionnaires