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ORIGINAL ARTICLE
Year : 2019  |  Volume : 7  |  Issue : 3  |  Page : 83-86

Prevalence of body dysmorphic disorder among Saudis seeking facial plastic surgery


Medical Intern, King Faisal University, College of Medicine, Al Ahsa, Saudi Arabia

Date of Web Publication4-Nov-2019

Correspondence Address:
Zainab Salman Al Shuhayb
King Faisal University, Al Ahsa
Saudi Arabia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ssj.ssj_11_19

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  Abstract 

Importance: Nonpsychiatric physicians often encounter body dysmorphic disorder (BDD) which is a common psychiatric disorder. In the general population, BDD is estimated to affect 1%–2%. In esthetic specialties, however, rates are markedly higher.
Objective: This study aims to quantify the prevalence of BDD among people seeking facial plastic surgeries in Saudi Arabia because the literature is sparse in this field.
Design: This is a cross-sectional study, conducted in 2018 (October–December).
Setting: A self-administered web-based questionnaire was administered on 453 individuals, aged 18 years and older, of Saudi residence.
Participants: A total of 453 individuals, aged 18 years and older, of Saudi residence, were enrolled in the study.
Main Outcome(s) and Measure(s): The study has three main measures which are: (1) sociodemographic data, (2) previous and future plastic surgeries, and (3) the Body Dysmorphic Disorder Questionnaire.
Results: A total of 453 individuals were enrolled in this study. Of the total sample, 34.2% reported their desire to go for a facioplastic surgery in future, of which 14.19% fulfilled the criteria of BDD. Twenty-two individuals who fulfilled the criteria were all females (100%). All were relatively young, with 54.5% aging between 18 and 24 years of age, followed by 45.5% aging between 25 and 34 years of age. The majority were married 54.5%, with the rest being single. The majority of individuals (59.1%) live in cities, followed by 36.4% living in villages and 4.5% living in outskirts. Nearly 68.2% hold a college degree, followed by 27.3% holding a high school degree. The vast majority reported the desire to undergo a rhinoplasty (54.5%), followed by facial implants (9.1%), facelift (4.5%), eyebrow lift (4.5%), and cheek/jaw contouring (4.5%).
Conclusion: We report a prevalence of 14.19% among people seeking facial plastic surgery. This prevalence is warring, requiring special attention by facioplastic surgeons, plastic surgeons, and dermatologists, when dealing with patients. We recommend the screening of all patients to be a standard practice to ensure the best outcome possible.

Keywords: Body, disorder, dysmorphic, facial, surgery


How to cite this article:
Al Shuhayb ZS. Prevalence of body dysmorphic disorder among Saudis seeking facial plastic surgery. Saudi Surg J 2019;7:83-6

How to cite this URL:
Al Shuhayb ZS. Prevalence of body dysmorphic disorder among Saudis seeking facial plastic surgery. Saudi Surg J [serial online] 2019 [cited 2019 Dec 6];7:83-6. Available from: http://www.saudisurgj.org/text.asp?2019/7/3/83/270237


  Introduction Top


Nonpsychiatric physicians often encounter body dysmorphic disorder (BDD) which is a common psychiatric disorder.[1],[2] The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, defines BDD as a preoccupation with an imagined defect in appearance, with marked excessive concern toward slight physical anomalies. To fit the criteria, the preoccupation must cause clinically significant distress in social, occupational, or other areas of functioning.[3]

In the general population, BDD is estimated to affect 1%–2%.[2] In esthetic specialties, however, rates are markedly higher with a prevalence of 14.0% among cosmetic dermatology patients, 10% in the maxillofacial setting, 21% in patients seeking rhinoplasty,[4] and 13% in facial plastic surgery patients.[5],[6] The reported numbers differ greatly from study to study, which can be generally attributed to the lack of a formal unified screening method used.

BDD manifests as repetitive, compulsive behaviors that can be as mild as repetitive mirror checking, excessive grooming, and camouflage with makeup or clothes to as severe as repeatedly seeking unnecessary dermatological and plastic surgeries or even performing “do it yourself surgeries.”[7]

In a study of 250 adults with BDD, 75% of patients sought nonpsychiatric medical treatments. Of these, 72% of the procedures led to no change, and 16% led to a worsening of BDD symptoms.[8] This is of no surprise because these patients often possess unrealistic expectations about the outcomes of these surgeries and expect it to be the solution for everything there are dissatisfied with; when in reality, these patients need psychiatric treatment and highly unlikely to improve solely with cosmetic procedures.[9] Because of that, a diagnosis of BDD is generally considered a contraindication to plastic surgeries by the majority of surgeons. Other reasons include risk of violence against the surgeons and malpractice lawsuits.[10],[11],[12],[13],[14],[15],[16]

In Saudi Arabia, apart from one study conducted on 363 patients attending a dermatology clinic in Qassim, Saudi Arabia, in which 18.6% screened positive for BDD,[17] literature regarding BDD prevalence in cosmetic/plastic clinics is sparse and nearly nonexistent. Thus, this study aims to quantify the prevalence of BDD among people seeking facial plastic surgeries, in particular because they are considered to be the most common cosmetic surgeries sought by these patients.[18]


  Methods Top


Study type

This cross-sectional study was conducted in Saudi Arabia from December 1, 2018 to February 1, 2019.

Study size and population

A total of 453 adult Saudis (aged 18 and older) were recruited for the study. The sample size was calculated using Raosoft, an electronic sample size calculator.

Data collection

Data were collected using a self-administered web-based questionnaire.

The study has three main measures which are: (1) sociodemographic data, (2) previous and future plastic surgeries, and (3) The Body Dysmorphic Disorder Questionnaire (BDDQ).[19] The English BDDQ was translated by a bilingual expert and tested for validity which revealed acceptable internal consistency (Cronbach's α = 0.659).

Statistical analysis

Statistics were performed using the IBM SPSS Statistics version 22.0 software, IBM Corp., Armonk, NY, USA. Quantitative variables were presented as mean and standard deviation, and qualitative variables were presented as number with percentage. For correlation with categorical variables, Chi-square test was used, with the results presented in cross tables and clustered bar graphs, and t-test or one-way anova for correlation with continuous variables, with the results presented in tables. P < 0.05 was considered statistically significant.

Ethical statement

Ethical clearance was obtained from King Faisal University's Research Ethics Committee. Written informed consent was obtained as well from the participants in the introduction web page prior to involvement in the study.


  Results Top


A total of 453 individuals were enrolled in this study. To quantitate the prevalence of BDD, the question of future plastic surgery was the main outcome measure. Any individual fit for the criteria of diagnosis followed in the BDDQ was considered. The criteria are that the individual must answer yes to the two parts in the first question, a yes answer to any of the four parts of the third question, and an answer with B or C to the fourth question.

In our sample, 34.2% of the participants reported their desire to go for a facioplastic surgery in future; out of these, 14.19% fulfilled the criteria of BDD.

Sociodemographic descriptors

Twenty-two individuals who fulfilled the criteria were all females (100%). All were relatively young, with 54.5% aging between 18 and 24 years of age, followed by 45.5% aging between 25 and 34 years of age. The majority were married (54.5%), with the rest being single. The majority of the participants (59.1%) live in cities, followed by 36.4% living in villages and 4.5% living in outskirts. Nearly 68.2% hold a college degree, followed by 27.3% holding a high school degree [Table 1].
Table 1: Sociodemographic descriptors

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Type of desired surgical procedure

The vast majority reported the desire to undergo a rhinoplasty (54.5%), followed by facial implants (9.1%), facelift (4.5%), eyebrow lift (4.5%), and cheek/jaw contouring (4.5%), as shown in [Graph 1]1.




  Discussion Top


BDD appears to be common but appears to be underdiagnosed in noncosmetic surgery settings.[20],[21] In cosmetic surgery settings, rates of 6%,[22] 7%,[23] and 15%[24] have been reported. The present study reports a BDD prevalence of 14.19% in Saudis seeking facioplastic surgery. This finding is considerably higher than the number reported in one local study,[25] in which a prevalence of 6.63% was reported. Other studies do report a similarly high prevalence. In one study, a prevalence of 31.5% was reported among rhinoplasty candidates.[26]

All the individuals who fulfilled the criteria were of young age (mean age: 1.45). This might be explained by the fact that young people are more heavily exposed to social media and the portrayed exaggerated, unrealistic ideas of beauty and the standards of what is considered to be esthetically appealing and what is not urge them to undergo different cosmetic procedures.

All the individuals who fulfilled the criteria in our study were female. A number of studies have examined the gender differences among BDD patients. In general, BDD is believed to occur approximately equal between males and females. However, multiple studies report different incidences among male and female individuals. In one study of British patients, 76% of patients were female.[18] In contrast, a retrospective chart review study of fifty patients revealed that 62% of the individuals in their study were male.[27]

When the individuals were asked about which facioplastic procedure they are intending to do, the majority (54.5%) answered with “rhinoplasty.” The answer was not surprising because rhinoplasty is the most commonly preferred esthetic surgery by BDD patients.[18] Prevalence among rhinoplasty candidates has been reported to be 3.2% to 16.6%.[26],[27],[28],[29]


  Conclusion Top


A prevalence of 14.19% among people seeking facial plastic surgery has been reported. This prevalence is warring, requiring special attention by facioplastic surgeons, plastic surgeons, and dermatologists, when dealing with patients. We recommend the screening of all patients to be a standard practice to ensure the best outcome possible.

Limitations

The scale used is a screening scale for BDD; thus, the number provided could be an overestimation of the real prevalence.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

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Phillips KA. Body dysmorphic disorder: The distress of imagined ugliness. Am J Psychiatry 1991;148:1138-49.  Back to cited text no. 1
    
2.
Phillips KA. The Broken Mirror: Understanding and Treating Body Dysmorphic Disorder. New York: Oxford University Press; 1996.  Back to cited text no. 2
    
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American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). 4th ed. Washington, DC: American Psychiatric Association; 1994.  Back to cited text no. 3
    
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Woolley AJ, Perry JD. Body dysmorphic disorder: Prevalence and outcomes in an oculofacial plastic surgery practice. Am J Ophthalmol 2015;159:1058-64.e1.  Back to cited text no. 5
    
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Dey JK, Ishii M, Phillis M, Byrne PJ, Boahene KD, Ishii LE. Body dysmorphic disorder in a facial plastic and reconstructive surgery clinic: Measuring prevalence, assessing comorbidities, and validating a feasible screening instrument. JAMA Facial Plast Surg 2015;17:137-43.  Back to cited text no. 6
    
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Phillips KA, Dufresne RG. Body dysmorphic disorder. A guide for dermatologists and cosmetic surgeons. Am J Clin Dermatol 2000;1:235-43.  Back to cited text no. 7
    
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17.
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Perugi G, Akiskal HS, Lattanzi L, Cecconi D, Mastrocinque C, Patronelli A, et al. The high prevalence of “soft” bipolar (II) features in atypical depression. Compr Psychiatry 1998;39:63-71.  Back to cited text no. 19
    
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Sarwer DB, Whitaker LA, Pertschuk MJ, Wadden TA. Body image concerns of reconstructive surgery patients: An underrecognized problem. Ann Plast Surg 1998;40:403-7.  Back to cited text no. 21
    
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Sarwer DB, Wadden TA, Pertschuk MJ, Whitaker LA. Body image dissatisfaction and body dysmorphic disorder in 100 cosmetic surgery patients. Plast Reconstr Surg 1998;101:1644-9.  Back to cited text no. 22
    
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