title: A Review of Body Dysmorphic Disorder in Aesthetic Surgery Patients and the Legal Implications.
abstract: BACKGROUND
  Body dysmorphic disorder (BDD) is an often under-recognized yet severe psychiatric illness. There is limited guidance for plastic surgeons in the USA in how to recognize and manage patients with BDD and protect themselves from potential litigation and harm. Therefore, in collaboration with legal counsel, we remind our profession of the serious nature of patients with BDD, provide warning signs for recognizing BDD, and critically evaluate the validity of informed consent and the legal ramifications of operating on such patients in the USA.
  
  
  METHODS
  A literature review was performed to clearly define the psychopathology of BDD and identify cases of patients with BDD who underwent cosmetic surgery resulting in potential threats to the surgeon. An additional search of the legal literature was performed in collaboration with legal counsel to identify key cases of patients with BDD attempting litigation following cosmetic surgery procedures.
  
  
  RESULTS
  The diagnostic criteria and psychopathology of BDD are presented. Warning signs are highlighted to alert the plastic surgeon to patients at high risk for BDD. Strategies for legal protection include a pre-procedure checklist for patients that are suspected of having a BDD diagnosis.
  
  
  CONCLUSIONS
  Body dysmorphic disorder is prevalent in the cosmetic surgery population. Patients with BDD often have a poor outcome following aesthetic surgery, which can result in a dangerous or even deadly situation for the surgeon. We aim to remind aesthetic plastic surgeons of the psychopathology, severity, and specific risks associated with operating on patients with BDD while suggesting specific protective strategies.
  
  
  METHODS
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authors.affiliation: Division of Plastic, Reconstructive, and Cosmetic Surgery, Department of Surgery, University of Illinois Hospital and Health Science System at Chicago, 820 S. Wood Street, Suite 515 Clinical Science North Building (M/C 958), Chicago, IL, 60612, USA.
authors.forename: Iliana E
authors.initials: IE
authors.lastname: Sweis
authors.affiliation: Division of Plastic, Reconstructive, and Cosmetic Surgery, Department of Surgery, University of Illinois Hospital and Health Science System at Chicago, 820 S. Wood Street, Suite 515 Clinical Science North Building (M/C 958), Chicago, IL, 60612, USA. jamiespitzmd@gmail.com.
authors.forename: Jamie
authors.identifier: http://orcid.org/0000-0002-0152-9278
authors.initials: J
authors.lastname: Spitz
authors.affiliation: Corboy and Demetrio Law Firm, Chicago, IL, USA.
authors.forename: David R
authors.initials: DR
authors.lastname: Barry
authors.affiliation: Division of Plastic, Reconstructive, and Cosmetic Surgery, Department of Surgery, University of Illinois Hospital and Health Science System at Chicago, 820 S. Wood Street, Suite 515 Clinical Science North Building (M/C 958), Chicago, IL, 60612, USA.
authors.forename: Mimis
authors.initials: M
authors.lastname: Cohen
mesh_terms: D000328:Adult; D057215:Body Dysmorphic Disorders / Q000175:diagnosis / Q000523:psychology* / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D061214:Patient Safety; D017060:Patient Satisfaction; D010817:Physician-Patient Relations; D015995:Prevalence; D018570:Risk Assessment; D013518:Surgery, Plastic / Q000331:legislation & jurisprudence* / Q000523:psychology / Q000706:statistics & numerical data*; D016896:Treatment Outcome; D014481:United States
keywords: Body dysmorphic disorder; Litigation; Protective strategies; Psychopathology