Comparison with other studies
The 38% prevalence of BDD detected on pre-operative BDDQ is similar to other studies; 32% prevalence was found by Joseph et al in a sample of 34 patients presenting for septorhinoplasty, screened with BDDQ, and 31.5% in 130 screened patients by Fathololoomi et al Other studies give a much lower BDD prevalence in patients presenting for rhinoplasty (1.8 -31.5%) , probably because of different methods of screening and patient demographics. An uneven gender split may alter the rate detected, as BDD prevalence is known to be higher in females . Prevalence of BDD in the general population has been found to be around 2% and was 0% in our control cohort.
The 50% prevalence of BDD in our female patients is similar to the 45% prevalence found by Joseph et al . BDD or symptoms of BDD may not be static. Our data shows that BDD diagnosis on BDDQ reduced following septorhinoplasty. Despite this, surgeons should remain cautious about operating on any patient who screens positive on BDDQ. Other factors should also be taken into account, including patient demographics, patient expectations, previous surgery and overall psychological stability. Our data suggests that particular caution should be applied to male patients and those over the age of 30; groups who were less satisfied with the post-operative result in our series.
There is some data that patients presenting for ‘aesthetic rhinoplasty’ are more likely to have psychological problems. A study of 597 patients attending facial plastic surgery clinics showed 13.1% screened positive on BDDQ if presenting with cosmetic concerns compared with 6.7% in those presenting for reconstructive surgery . Although our sample size was small, this was confirmed in our series. Of the three patients presenting primarily for aesthetic concerns, two had BDD on BDDQ and the third scored borderline for BDD. Post-operative patient satisfaction was high in all three of these patients post-operatively and the BDDQ became negative. This highlights the importance of a multi-faceted assessment of the patient.
Some patients may be knowledgeable about the screening tools in use and may doctor their responses in order to avoid screening positive for BDD. If there is any doubt about proceeding with surgery, the patient should be considered for clinical psychology assessment, although difficult to access in a National Health Service setting.