Screening Tools for Body Dysmorphic Disorder in a Cosmetic Surgery Setting

Objectives/Hypothesis: Body dysmorphic disorder (BDD) is a well-established psychiatric disorder characterized by a marked, distressing, and impairing preoccupation with an imagined or slight defect in appearance. Despite the growing interest in and awareness of aesthetic surgeons for BDD, diagnosing BDD during a preoperative consultation remains challenging. This review provides an overview of the existing screening tools for BDD and assesses their quality and feasibility in an aesthetic surgery population. Study Design: Systematic review. Methods: An electronic bibliographic search was conducted to identify all screening tools for BDD in a cosmetic setting. We investigated their development and validation processes and investigated whether the screening tool had a predictive value on subjective outcomes after treatment. Results: We identified six different screening tools for BDD in a cosmetic setting. Only two of them were validated in a cosmetic dermatology setting: the Body Dysmorphic Disorder Questionnaire-Dermatology Version (BDDQ-DV) and the Dysmorphic Concern Questionnaire (DCQ). Outside the dermatologic surgery setting, no screening tools were validated. For the BDDQ-DV, no influence on subjective outcome after cosmetic treatment was found. Conclusions: The limited availability of good screening tools for BDD in patients seeking aesthetic surgery stands in remarkable contrast to the estimated high prevalence of BDD in this setting. Among the currently used screening tools, the BDDQ-DV and the DCQ seem the most suitable for further research on prevalence of BDD in cosmetic surgery and the impact of BDD on treatment outcome.