Faculty of Medicine, Ahvaz Jondishapour University of Medical Sciences, Ahvaz, Iran.
Aesthetic Plast Surg. 2011 Dec;35(6):989-94. doi: 10.1007/s00266-011-9718-8. Epub 2011 Apr 14.
Dissatisfaction with appearance is most pronounced in rhinoplasty patients compared to candidates for other aesthetic procedures. We aimed to test and introduce the Body Image Concern Inventory (BICI) as a self-report screening tool for identifying body dysmorphic disorder (BDD) among patients seeking rhinoplasty.
The surgeon completed a two-point defect severity scale in which a score of 1 represented no defect or one defect and a score of 2 represented more than one defect. Each of the 117 subjects with a score of 1 answered a questionnaire that was designed to obtain demographic data and completed the Persian version of the BICI. The psychiatrist, considering the patient's demographic data and blind to the BICI score, interviewed him/her using a semistructured diagnostic tool for BDD based on DSM-IV.
The validity of the Persian version of the BICI was calculated at 85%. The reliability of the Persian BICI items was tested and Cronbach's alpha was 0.90. The results of ROC analysis for the ideal cutoff point of the Persian BICI, based on the Youden index method and optimum sensitivity and specificity, revealed that the ideal cutoff point for positive or negative criterion of that questionnaire's result may be the total score of 42 (sensitivity, 93.5%; specificity, 80.8%) The diagnostic accuracy of the Persian BICI in comparison with the gold standard (psychiatric interview), according to the area under the ROC curve (AUC), was 91.4% (95% CI = 86-97%, P < 0.0001). The agreement of the results of the Persian BICI questionnaire with the psychiatric interview for diagnosis of BDD, according to kappa index, was 61.7% (P < 0.001), and the odds ratio (OR) of being diagnosed with BDD in a psychiatric interview for those with overall scores ≥42 for the Persian BICI was 47.7 (95% CI = 43-52).
The results of the present study emphasize the high rate of BDD (12.2%) in subjects seeking rhinoplasty. The BICI appears to be an internally consistent and valid brief multiple-choice instrument for assessing dysmorphic concern. To our knowledge, this is the first time that this measure has ever been used for identifying BDD patients in a rhinoplasty setting; it is also the first time that ROC analysis has been used for calculating and analyzing the results of BICI. Our study suggests that rhinoplasty surgeons could rely on the scores of the BICI to identify subjects with probable BDD among their consultants with no or one slight defect.
与寻求其他美容手术的患者相比，隆鼻患者对容貌的不满最为明显。我们旨在测试并引入身体意象担忧量表（BICI），作为一种自我报告的筛查工具，用于识别寻求隆鼻的患者是否存在躯体变形障碍（BDD）。
外科医生完成了两点缺陷严重程度量表，其中 1 分表示无缺陷或 1 个缺陷，2 分表示多个缺陷。每个得分 1 的 117 名受试者回答了一份问卷，旨在获取人口统计学数据，并完成了波斯语版的 BICI。精神科医生根据 DSM-IV ，考虑到患者的人口统计学数据，并对 BICI 评分不了解，使用基于躯体变形障碍的半结构化诊断工具对患者进行访谈。
波斯语版 BICI 的有效性计算为 85%。测试了波斯语 BICI 项目的可靠性，Cronbach's alpha 为 0.90。根据 Youden 指数法和最佳灵敏度和特异性，对基于 ROC 分析的波斯语 BICI 理想截断点进行了分析，结果表明，该问卷结果的阳性或阴性标准的理想截断点可能是总分 42（灵敏度为 93.5%；特异性为 80.8%）。根据 ROC 曲线下面积（AUC），与金标准（精神科访谈）相比，波斯语 BICI 的诊断准确性为 91.4%（95%CI=86-97%，P<0.0001）。根据 Kappa 指数，波斯语 BICI 问卷的结果与精神科访谈对 BDD 的诊断一致性为 61.7%（P<0.001），对于 BICI 总分≥42 的患者，在精神科访谈中被诊断为 BDD 的几率比（OR）为 47.7（95%CI=43-52）。
本研究结果强调了寻求隆鼻的患者中 BDD（12.2%）的高发生率。BICI 似乎是一种内部一致且有效的简短多项选择工具，用于评估畸形关注。据我们所知，这是该测量首次用于识别隆鼻环境中的 BDD 患者；这也是首次使用 ROC 分析来计算和分析 BICI 的结果。我们的研究表明，隆鼻外科医生可以依靠 BICI 的分数来识别他们的顾问中可能患有 BDD 的患者，这些顾问的缺陷为无或轻微缺陷。
