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Psychopathology in Patients Requesting Non-Surgical Rejuvenation
William W. Dzwierzynski, M.D.1, Elizabeth Stern, PsychD2.
1Medical College of Wisconsin, Milwaukee, WI, USA, 2MATC, Milwaukee, WI, USA.

Purpose:
Increasing numbers of patients are seeking non-surgical cosmetic procedures. The relative low cost and perceived low risk have created consumer-driven demand in which physicians either make informal judgments about the mental status or fail to screen at all. Elective non-surgical cosmetic procedures are often performed in order to improve patient psychosocial functioning and quality of life; however, there is little medical or psychological literature describing the psychosocial characteristics of the non-surgical, aesthetic patient. Currently, the primary selection criterion is patient request. Research has demonstrated that judicious use of psychological screening methods can improve surgical outcomes as well as identify patients for whom surgical procedures are contraindicated. This patient group often includes individuals who present with excessive Body Dysmorphic Disorder (BDD), obsessive-compulsive disorder, personality disorders, significant quality of life issues, or other psychological problems for which psychiatric consultation is warranted. The purpose of the study is to examine the psychosocial profiles that are prevalent in patients seeking non- surgical aesthetic medical enhancements.
Methods:
An IRB approved study evaluated seeking nonsurgical rejuvenation procedures. Each patient completed a baseline demographic questionnaire and were administered a psychometric testing including the Quality of Life Inventory (QOLI), a 32-item self-report questionnaire that assesses importance and satisfaction across 16 life areas; the Body Dysmorphic Disorder Questionnaire (BDDQ) a self-reported questionnaire that screens for BDD based on DSM-IV criteria assessing concerns with parts of the body, impact of the preoccupations in daily life, and distress or impairment in social, occupational, or other important areas of functioning; and the Brief Symptom Inventory (BSI) a 53 item questionnaire which measures 9 areas of psychopathology. Data was compared to normative controls, medical patients and cosmetic surgical patients.
Results:
The study was completed by 35 patients, 32 (91%) female and 3 (9%) male. The average age was 46 (32-66). Previous cosmetic surgical procedures were performed in 9 (26%) patient had. Non surgical procedure performed included botulinum toxin injection, dermal fillers, tissue fillers, dermabrasion, chemical peels, and laser resurfacing.
BDDQ
A high probability of Body Dysmorphic Disorder (BDD) was seen in 3 (8.6%) patients. This was compared to an incidence of 1-2% in the general population, 4- 5% in patients seeking (non-cosmetic) medical treatment, and 7% in cosmetic surgery patients. Moderate probability of BDD was found in 5 (14.2%) patients.
QOLI
Clinical significant "very low" quality of life (T score <37) was found in 5 (14%) patients. The average QOLI score for the group was higher than the normative group 54.77 (p<.05).
BSI
Significant elevation (T score >70) was found on the BSI in 3 (9.4%) patients. The Global symptom index (GSI) was equal to the normative group
Conclusions:
The incidence of BDD, psychopathology, and low quality of life was elevated in patients seeking non-surgical rejuvenation. BDD is not a benign disorder, besides dissatisfaction with the procedure; depression, obsessive compulsive behavior, and a high suicide rate are seen in patients with BDD. Not only in surgical patients but those choosing non-surgical enhancements should be screened for psychopathology.


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