Main Article Content
psychopathology, plastic surgery, reconstructive surgical procedures, body image, psychiatry
Objectives: Dissatisfaction with body image is common in patients seeking corrective plastic surgery. However, surgery may not be suitable for every patient. Surgery can enhance quality of life in mentally healthy patients but those with psychopathology such as body dysmorphic disorder (BDD) tend to have poorer outcomes. For these patients, surgery is not always recommended and psychiatric care can have a useful role. This paper aimed to estimate the rates of psychopathology in a select group of elective plastic surgery candidates and discuss the role of preoperative psychoplastic referral in triaging these candidates.
Method: A retrospective cohort study of patients considering elective surgery at Flinders Medical Centre in South Australia referred by their surgeon for psychoplastic evaluation from 2010 to 2016. Medical records were reviewed to determine compliance with psychiatric referral, the number and types of psychiatric diagnosis and rates of subsequent surgery.
Results: We found 83 per cent (54/65) of surgical candidates assessed by our psychiatrist had a mental illness. Post-traumatic stress disorder (n=19, 34.5%) and major depressive disorder (n=19, 34.5%) were most common. Nine patients (13.6%) were diagnosed with BDD. A total of 57 (87.7%) patients were considered to need some kind of psychiatric care to improve potential surgery outcomes.
Conclusions: In our study, the rate of psychopathology in patients referred for psychiatric evaluation suggests that careful screening is important for clinical decision making. A combined surgical /psychiatric approach is effective in ensuring vulnerable patients are identified and managed appropriately.
2. de Brito MJ, Nahas FX, Barbosa MV, Dini GM, Kimura AK, Farah AB, Ferreira LM. Abdominoplasty and its effect on body image, self-esteem, and mental health. Ann Plast Surg. 2010;65(1):5–10. https://doi.org/10.1097/SAP.0b013e3181bc30f7 PMid:20467297
3. Sarwer DB, Crerand CE. Body image and cosmetic medical treatments. Body Image. 2004;1(1):99–111. https://doi.org/10.1016/S1740-1445(03)00003-2
4. Brunton G, Paraskeva N, Caird J, Bird KS, Kavanagh J, Kwan I, Stansfield C, Rumsey N, Thomas J. Psychosocial predictors, assessment, and outcomes of cosmetic procedures: a systematic rapid evidence assessment. Aesthetic Plast Surg. 2014;38(5):1030–040. https://doi.org/10.1007/s00266-014-0369-4 PMid:24962402
5. Phillips KA, Grant J, Siniscalchi J, Albertini RS. Surgical and nonpsychiatric medical treatment of patients with body dysmorphic disorder. Psychosomatics. 2001;42(6):504–10. https://doi.org/10.1176/appi.psy.42.6.504 PMid:11815686
6. Sweis IE, Spitz J, Barry DR, Jr., Cohen M. A review of body dysmorphic disorder in aesthetic surgery patients and the legal implications. Aesthetic Plast Surg. 2017;41(4):949–54. https://doi.org/10.1007/s00266-017-0819-x PMid:28204935
7. Vindigni V, Pavan C, Semenzin M, Grana S, Gambaro F, Marini M, Bassetto F, Mazzoleni F. The importance of recognizing body dysmorphic disorder in cosmetic surgery patients: do our patients need a preoperative psychiatric evaluation? Eur J Plast Surg. 2002;25:305–08. https://doi.org/10.1007/s00238-002-0410-8
8. Hayashi K, Miyachi H, Nakakita N, Akimoto M, Aoyagi K, Miyaoka H, Uchinuma E. Importance of a psychiatric approach in cosmetic surgery. Aesthet Surg J. 2007;27(4):396–401. https://doi.org/10.1016/j.asj.2007.05.010 PMid:19341667
9. Sarwer DB, Whitaker LA, Wadden TA, Pertschuk MJ. Body image dissatisfaction in women seeking rhytidectomy or blepharoplasty. Aesthet Surg J. 1997;17(4):230–34. https://doi.org/10.1016/S1090-820X(97)80004-0
10. Sarwer DB, Whitaker LA, Pertschuk MJ, Wadden TA. Body image concerns of reconstructive surgery patients: an underrecognized problem. Ann Plast Surg. 1998;40(4):403–07. https://doi.org/10.1097/00000637-199804000-00014 PMid:9555996
11. Crittenden T, Watson DI, Ratcliffe J, Griffin PA, Dean NR. Does breast reduction surgery improve health-related quality of life? A prospective cohort study in Australian women. BMJ Open. 2020;10(2):e031804. https://doi.org/10.1136/bmjopen-2019-031804 PMid:32071171 PMCid:PMC7044824
12. Javo IM, Sorlie T. Psychosocial characteristics of young Norwegian women interested in liposuction, breast augmentation, rhinoplasty, and abdominoplasty: a population-based study. Plast Reconstr Surg. 2010;125(5):1536–543. https://doi.org/10.1097/PRS.0b013e3181d5135a PMid:20440172
13. Saariniemi KM, Salmi AM, Peltoniemi HH, Helle MH, Charpentier P, Kuokkanen HO. Abdominoplasty improves quality of life, psychological distress, and eating disorder symptoms: a prospective study. Plast Surg Int. 2014;2014:197232. https://doi.org/10.1155/2014/197232 PMid:25506426 PMCid:PMC4259081
14. Government of South Australia, South Australian Health. Elective surgery policy framework and associated procedural guidelines 2011 [PDF on Internet]. Adelaide: Australia [Updated February 2018; cited 15 February 2021]. Available from: https://www.sahealth.sa.gov.au/wps/wcm/connect/public+content/sa+health+internet/resources/policies/elective+surgery+policy+framework+and+associated+procedural+guidelines.
15. Panayi A. The prevalence of body dysmorphic disorder in patients undergoing cosmetic surgery: a systematic review. Psychiatr Danub. 2015 Suppl 1;27:S438–44.
16. de Brito MJ, Nahas FX, Cordas TA, Tavares H, Ferreira LM. Body dysmorphic disorder in patients seeking abdominoplasty, rhinoplasty, and rhytidectomy. Plast Reconstr Surg. 2016;137(2):462–71. https://doi.org/10.1097/01.prs.0000475753.33215.8f PMid:26818280
17. Crerand CE, Franklin ME, Sarwer DB. Body dysmorphic disorder and cosmetic surgery. Plast Reconstr Surg. 2006;118(7):167e–80e. https://doi.org/10.1097/01.prs.0000242500.28431.24 PMid:17102719
18. Sarwer DB, Crerand CE. Body dysmorphic disorder and appearance enhancing medical treatments. Body Image. 2008;5(1):50–8. https://doi.org/10.1016/j.bodyim.2007.08.003 PMid:18255365
19. Shridharani SM, Magarakis M, Manson PN, Rodriguez ED. Psychology of plastic and reconstructive surgery: a systematic clinical review. Plast Reconstr Surg. 2010;126(6):2243–251. https://doi.org/10.1097/PRS.0b013e3181f445ae PMid:21124167
20. Di Mattei VE, Bagliacca EP, Ambrosi A, Lanfranchi L, Preis FB, Sarno L. The impact of cosmetic plastic surgery on body image and psychological well-being: a preliminary study. Int J Psychol Behav Anal. 2015;1(1):103–08. https://doi.org/10.15344/2455-3867/2015/103
21. Mulkens S, Bos AE, Uleman R, Muris P, Mayer B, Velthuis P. Psychopathology symptoms in a sample of female cosmetic surgery patients. J Plast Reconstr Aesthet Surg. 2012;65(3):321–27. https://doi.org/10.1016/j.bjps.2011.09.038 PMid:22030078
22. Herruer JM, Prins JB, van Heerbeek N, Verhage-Damen GW, Ingels KJ. Negative predictors for satisfaction in patients seeking facial cosmetic surgery: a systematic review. Plast Reconstr Surg. 2015;135(6):1596–605. https://doi.org/10.1097/PRS.0000000000001264 PMid:26017596
23. Crerand CE, Phillips KA, Menard W, Fay C. Nonpsychiatric medical treatment of body dysmorphic disorder. Psychosomatics. 2005;46(6):549–55. https://doi.org/10.1176/appi.psy.46.6.549 PMid:16288134 PMCid:PMC1351255
24. American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 5th ed. Arlington, Texas USA: American Psychiatric Association, 2013.
25. Jang BB, Bhavsar D. The prevalence of psychiatric disorder among elective plastic surgery procedure patients. Plast Reconstr Surg Glob Open. 2017;5:84–85. https://doi.org/10.1097/01.GOX.0000526284.50160.f1 PMCid:PMC5636404
26. The National Institute of Mental Health. Major depression: prevalence of major depressive episodes among adults 2017 [web page]. Bethesda: US Department of Health and Human Services. [Cited 15 February 2021] Available from: https://www.nimh.nih.gov/health/statistics/major-depression.shtml.
27. The National Institute of Mental Health. Any anxiety disorder: prevalence of any anxiety disorder among adults 2017 [web page]. Bethesda: US Department of Health and Human Services. [Cited 15 February 2021] Available from: https://www.nimh.nih.gov/health/statistics/any-anxiety-disorder.shtml.
28. Higgins S, Wysong A. cosmetic surgery and body dysmorphic disorder—an update. Int J Womens Dermatol. 2018;4(1):43–48. https://doi.org/10.1016/j.ijwd.2017.09.007 PMid:29872676 PMCid:PMC5986110
29. Felix GA, de Brito MJ, Nahas FX, Tavares H, Cordas TA, Dini GM, Ferreira LM. Patients with mild to moderate body dysmorphic disorder may benefit from rhinoplasty. J Plast Reconstr Aesthet Surg. 2014;67(5):646–54. https://doi.org/10.1016/j.bjps.2014.01.002 PMid:24508222
30. Danesh M, Beroukhim K, Ngyuen C, Levin E, Koo J. Body dysmorphic disorder screening tools for the dermatologist: a systematic review. Pract Dermatol. 2015 Feb;11(2):44–49.
31. Phillips KA. The broken mirror: understanding and treating body dysmorphic disorder. Oxford, UK: Oxford University Press, 2005. p 353–432.
32. Phillips KA, Hollander E, Rasmussen SA, Aronowitz BR, DeCaria C, Goodman WK. A severity rating scale for body dysmorphic disorder: development, reliability, and validity of a modified version of the Yale-Brown obsessive compulsive scale. Psychopharmacol Bull. 1997;33(1):17–22.