Joseph Andrew W, Ishii Lisa, Joseph Shannon S, Smith Jane I, Su Peiyi, Bater Kristin, Byrne Patrick, Boahene Kofi, Papel Ira, Kontis Theda, Douglas Raymond, Nelson Christine C, Ishii Masaru
Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Division of Oculoplastic Surgery, Kellogg Eye Center, University of Michigan Medical School, Ann Arbor.
JAMA Facial Plast Surg. 2017 Jul 1;19(4):269-274. doi: 10.1001/jamafacial.2016.1535.
Body dysmorphic disorder (BDD) is a relative contraindication for facial plastic surgery, but formal screening is not common in practice. The prevalence of BDD in patients seeking facial plastic surgery is not well documented.
To establish the prevalence of BDD across facial plastic and oculoplastic surgery practice settings, and estimate the ability of surgeons to screen for BDD.
DESIGN, SETTING, AND PARTICIPANTS: This multicenter prospective study recruited a cohort of 597 patients who presented to academic and private facial plastic and oculoplastic surgery practices from March 2015 to February 2016.
All patients were screened for BDD using the Body Dysmorphic Disorder Questionnaire (BDDQ). After each clinical encounter, surgeons independently evaluated the likelihood that a participating patient had BDD. Validated instruments were used to assess satisfaction with facial appearance including the FACE-Q, Blepharoplasty Outcomes Evaluation (BOE), Facelift Outcomes Evaluation (FOE), Rhinoplasty Outcomes Evaluation (ROE), and Skin Rejuvenation Outcomes Evaluation (SROE).
Across participating practices (9 surgeons, 3 sites), a total of 597 patients were screened for BDD: 342 patients from site 1 (mean [SD] age, 44.2 [16.5] years); 158 patients, site 2 (mean [SD] age, 46.0 [16.2] years), site 3, 97 patients (mean [SD] age, 56.3 [15.5] years). Overall, 58 patients [9.7%] screened positive for BDD by the BDDQ instrument, while only 16 of 402 patients [4.0%] were clinically suspected of BDD by surgeons. A higher percentage of patients presenting for cosmetic surgery (37 of 283 patients [13.1%]) compared with those presenting for reconstructive surgery (21 of 314 patients [6.7%]) screened positive on the BDDQ (odds ratio, 2.10; 95% CI, 1.20-3.68; P = .01). Surgeons were only able to correctly identify 2 of 43 patients (4.7%) who screened positive for BDD on the BDDQ, and the positive likelihood ratio was only 1.19 (95% CI, 0.28-5.07). Patients screening positive for BDD by the BDDQ had lower satisfaction with their appearance as measured by the FACE-Q, ROE, BOE, SROE, and FOE.
Body dysmorphic disorder is a relatively common condition across facial plastic and oculoplastic surgery practice settings. Patients who screen positive on the BDDQ have lower satisfaction with their facial appearance at baseline. Surgeons have a poor ability to screen for patients with BDD when compared with validated screening instruments such as the BDDQ. Routine implementation of validated BDD screening instruments may improve patient care.
NA.
躯体变形障碍（BDD）是面部整形手术的相对禁忌证，但在实际操作中正式筛查并不常见。寻求面部整形手术患者中BDD的患病率尚无充分记录。
确定面部整形和眼部整形手术机构中BDD的患病率，并评估外科医生筛查BDD的能力。
设计、地点和参与者：这项多中心前瞻性研究招募了597名患者，这些患者于2015年3月至2016年2月就诊于学术性和私立面部整形及眼部整形手术机构。
使用躯体变形障碍问卷（BDDQ）对所有患者进行BDD筛查。每次临床会诊后，外科医生独立评估参与患者患有BDD的可能性。使用经过验证的工具评估对面部外观的满意度，包括面部质量问卷（FACE-Q）、眼睑成形术效果评估（BOE）、面部提升术效果评估（FOE）、隆鼻术效果评估（ROE）和皮肤年轻化效果评估（SROE）。
在参与研究的机构（9名外科医生，3个地点）中，共对597名患者进行了BDD筛查：来自地点1的342名患者（平均[标准差]年龄，44.2[16.5]岁）；地点2的158名患者（平均[标准差]年龄，46.0[16.2]岁），地点3的97名患者（平均[标准差]年龄，56.3[15.5]岁）。总体而言,58名患者（9.7%）通过BDDQ工具筛查出BDD呈阳性，而在402名患者中只有16名（4.0%）被外科医生临床怀疑患有BDD。与接受重建手术的患者（314名患者中的21名[6.7%]）相比，接受美容手术的患者（283名患者中的37名[13.1%]）在BDDQ上筛查呈阳性的比例更高（优势比，2.10；95%置信区间，1.20 - 3.68；P = 0.01）。外科医生仅能正确识别在BDDQ上筛查出BDD呈阳性的43名患者中的2名（4.7%），阳性似然比仅为1.19（95%置信区间，0.28 - 5.07）。通过BDDQ筛查出BDD呈阳性的患者在FACE-Q、ROE、BOE、SROE和FOE评估中对其外观的满意度较低。
躯体变形障碍在面部整形和眼部整形手术机构中是一种相对常见的病症。在BDDQ上筛查呈阳性的患者在基线时对面部外观的满意度较低。与经过验证的筛查工具如BDDQ相比，外科医生筛查BDD患者的能力较差。常规实施经过验证的BDD筛查工具可能会改善患者护理。
无。
