Skip to main content
NCBI home page
Healthcare logoLink to Healthcare
. 2024 Jul 4;12(13):1333. doi: 10.3390/healthcare12131333

Body Dysmorphic Disorder in Aesthetic and Reconstructive Plastic Surgery—A Systematic Review and Meta-Analysis

Joseph D Kaleeny 1, Jeffrey E Janis 1,*
Editor: Erich Kasten1
PMCID: PMC11241264  PMID: 38998867

Abstract

(1) Background: Body dysmorphic disorder (BDD) presents significant challenges in aesthetic and reconstructive plastic surgery, impacting patient outcomes and well-being. Understanding its prevalence and associated factors is crucial for effective patient care. (2) Methods: A systematic review of national and international databases on body dysmorphic disorder, plastic surgery, cosmetic surgery, reconstructive surgery, and prevalence yielded 999 studies between 1878 and April 2024. Inclusion criteria focused on studies reporting prevalence while excluding those with small sample sizes (<20 participants), unclear diagnostic criteria for BDD, and non-English accessibility. (3) Results: A meta-analysis using a random effects model was conducted on 65 studies involving 17,107 patients to estimate the prevalence of BDD. The overall estimated prevalence of BDD was 18.6%; 10,776 (62.9%) were females, with a mean age of 35.5 ± 11.7 years. Subgroup meta-analysis found significant variability in effect sizes across countries and types of specialty, of which Brazil showed the highest proportion and dermatology exhibited the smallest. Meta-regression analysis found no significant relationship between the year of publication and prevalence rates. (4) Conclusions: Our findings update the current literature on BDD prevalence in aesthetic and reconstructive plastic surgery. We emphasize the importance of proactive screening and multidisciplinary care approaches to address the complex challenges posed by patients with BDD. Further research is needed to explore evolving trends in BDD prevalence and factors influencing its expression across different cultural contexts.

Keywords: body dysmorphic disorder, plastic surgery, prevalence, meta-analysis

1. Introduction

Body dysmorphic disorder (BDD), characterized by an overwhelming concern over perceived flaws in physical appearance, represents a complex psychiatric condition with significant implications for individuals’ psychological well-being and social functioning [1]. Enrico Morselli, an Italian psychiatrist in 1891, first coined the term ‘dysmorphophobia,’ derived from the Greek word ‘dysmorfia’, meaning ugliness, to describe people who perceive themselves as flawed but have no apparent physical deformities [2,3]. This early recognition laid the foundation for understanding and diagnosing BDD, highlighting the enduring significance of addressing distorted body image perceptions in mental health discourse.

Recently, epidemiologic studies have reported a prevalence of BDD ranging from 0.7% to 2.4% in the general population [4,5,6]. With a considerable population affected, treating and managing patients with BDD presents unique challenges for providers of stigma, diagnostic barriers, treatment resistance, access to specialized care, and long-term recovery [7,8]. In an attempt to address perceived imperfections, patients with BDD will often request cosmetic and reconstructive plastic surgery, the prevalence of which among these individuals is the subject of clinical interest and debate [9,10].

Cosmetic surgeries and procedures in patients with BDD present complex challenges, although historically have been considered a clear contraindication [11,12]. Despite the potential benefits of plastic surgery in addressing physical concerns, individuals with BDD may experience dissatisfaction with surgical outcomes, irrespective of the quality of technical execution or subsequent results, or pursue unnecessary procedures that can exacerbate their psychological distress [13]. This emphasizes the importance of understanding the prevalence of BDD among patients seeking intervention. Recent systematic reviews and meta-analyses have sought to determine the prevalence of patients with BDD in dermatologic and aesthetic settings which have shown rates ranging from 12.65% to 19.2% [14,15,16]. We aim to update these with more recent findings across a more diverse population with a broader range of variables considered, providing comprehensive and valuable insights into the complex relationship of BDD prevalence in plastic surgery.

2. Materials and Methods

2.1. Literature Search Strategy

A systematic literature search was conducted to identify relevant studies on the prevalence of BDD among patients presenting for cosmetic and reconstructive plastic surgery. We followed the guidelines outlined in the PRISMA statement (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) to ensure transparency and comprehensive reporting. The search was performed in electronic databases, including Cochrane, Embase, ScienceDirect, Scopus, PubMed, Web of Science, PsycINFO, and Google Scholar. The search strategy utilized a combination of Latin keywords related to body dysmorphic disorder, plastic surgery, cosmetic surgery, reconstructive surgery, and prevalence. The search was restricted to studies accessible in English between 1878 and through April 2024.

2.2. Study Selection

The search results were screened for eligibility based on predefined inclusion and exclusion criteria. Studies were included if they reported data on the prevalence of BDD among patients with cosmetic or reconstructive plastic surgery, including papers within specialties of dermatology, oral-maxillofacial surgery (OMFS), and otolaryngology (ENT) who perform similar procedures. Exclusion criteria included cases unrelated to the topic, studies with small sample sizes (<20 participants), studies lacking clear diagnostic criteria for BDD, studies with incomplete or missing data, and studies inaccessible in English. In the initial search, 999 articles were identified, of which 336 were duplicates and were removed. A total of 663 were screened by title and abstract, of which 111 were sought for retrieval and entered the qualitative third-phase assessment. Sixty-five records published between 1998 and 2024 were included in the final analysis (Figure 1).

Figure 1.

Figure 1

Open in a new tab

Flow diagram of study selection.

2.3. Quality Assessment

To ensure the quality and transparency of our systematic review and meta-analysis, we employed the combined cohort, case-control, and cross-sectional Strengthening the Reporting of Observational Studies in Epidemiology for Cross-Sectional Study (STROBE) checklist [17]. This facilitated the evaluation of the methodological quality of included non-randomized studies by assessing key domains such as selection, comparability, and outcome ascertainment. Articles meeting six to seven criteria were classified as high-quality, while those meeting less than two and between two and five criteria out of the seven were considered medium and low methodological quality articles, respectively [10,15].

2.4. Data Extraction

Data were extracted from included studies using a standardized data extraction form. Extracted data included study characteristics (e.g., first author’s name, publication year, country of origin) and participant characteristics (e.g., sample size, mean age, BDD prevalence, and patient sex).

2.5. Ethical Considerations

This study involved the analysis of previously published data; no ethical approval was required. All data were retrieved from publicly available sources, and confidentiality of study participants was maintained throughout the analysis.

2.6. Data Synthesis and Analysis

A meta-analysis was planned to estimate the pooled prevalence of BDD among patients across included studies, utilizing Stata/BE 18.0 software. Prevalence variance was computed using the binomial distribution variance formula, with the weighted mean employed to aggregate prevalence rates from various studies. A test of homogeneity was performed to assess heterogeneity, and the I2 index categorized it into low, moderate, or high levels. Additionally, meta-regression analysis was conducted to explore the correlation between BDD prevalence and study year/sample size. Egger’s test, along with its corresponding funnel plot, was applied to examine publication bias. A leave-one-out meta-analysis was conducted to assess the stability of the pooled effect size estimate. Subgroup meta-analyses by country and type of specialty were performed to explore variability in effect sizes across different subgroups. Bias assessment tests were also performed to indicate small-study effects. Additionally, a trim-and-fill analysis was conducted to assess the impact of publication bias on the observed results.

3. Results

A meta-analysis was conducted across 65 studies to estimate the prevalence of BDD in plastic surgery patients. The articles encompassed a total of 17,107 participants (10,776 female, 62.9%), with a mean age of 35.5 ± 11.7 years (Table 1). Table 2 and Forest Plot, Figure 2 present the prevalence estimates, 95% confidence intervals (CI), and weights assigned to each study, calculated using a random-effects model. The overall estimated prevalence of BDD was 18.6% (95% CI: [15.1%, 22.4%]).

Table 1.

Characteristics of meta-analysis studies with prevalence of body dysmorphic disorder (BDD). Body Dysmorphic Disorder Questionnaire (BDDQ), Body Dysmorphic Disorder Questionnaire—Dermatology Version (BDDQ-DV), Body Dysmorphic Disorder Questionnaire—Aesthetic Version (BDDQ-AS), Body Dysmorphic Symptoms (BDD-S), Body Dysmorphic Disorder Examination—Self Report (BDDE-SR), Body Dysmorphic Symptom Scale (BDSS), Body Dysmorphic Metacognition Questionnaire (BDMÇQ), Body Image Concern Inventory (BICI), Body Shape Questionnaire-16 (BSQ-16), Dysmorphic Concerns Questionnaire (DCQ), Structured Clinical Interview for DSM-IV Axis I/II Disorders (SCID-I/II), Mini International Neuropsychiatric Interview Plus (MINIPLUS), Diagnostic and Statistical Manual of Mental Disorders, fourth edition, text revision (DSM IV-TR), Self-Rating Scale of Body Image (SSBI), Body Dysmorphic Questionnaire-Aesthetic Surgery (BDDQ-AS), and Mandatory Psychiatry Evaluation (MPE).

First Author, Year Ref Sample Size Total Population Type Female N Male N Mean Age ± SD Screening Tool BDD Total, % Type of Specialty Country Quality
Aghsaghloo, 2023 [18] 100 Rhinoplasty 68 32 29.4 ± 8.2 Y-BOCS 28.0% Plastic Surgery Iran High
Akinboro, 2019 [19] 114 Dermatologic 67 47 37.0 ± 17.5 Y-BOCS 36.0% Dermatology Nigeria High
Al Shuhayb, 2023 [20] 412 Dermatologic 301 111 - BDDQ 9.5% Dermatology Saudi Arabia High
Alavi, 2011 [21] 306 Rhinoplasty 245 61 23.0 ± 4.9 DSM IV-TR 24.5% Plastic Surgery Iran High
Aldukhi, 2021 [22] 250 Dermatologic 224 26 33.2 ± 11.4 BDDQ-DV 20.0% Dermatology Saudi Arabia High
Almuhanna, 2022 [23] 220 Aesthetics 220 0 - Y-BOCS 20.5% Plastic Surgery Saudi Arabia High
Altamura, 2001 [24] 478 Aesthetics 364 114 32.4 ± 11.5 Y-BOCS 6.3% Plastic Surgery Italy High
Aouizerate, 2003 [25] 132 Aesthetics 124 8 40.6 ± 12.9 DSM IV-TR 9.1% Plastic Surgery France Medium
Bahlol, 2023 [26] 100 Aesthetics 70 30 28.3 ± 8.5 BDDQ 60.0% Plastic Surgery Iraq Medium
Baykal, 2015 [27] 56 Rhinoplasty 31 25 27.9 BDDQ 46.4% Plastic Surgery Turkey High
Bellino, 2006 [28] 66 Aesthetics 57 9 43.4 ± 12.1 Y-BOCS 16.7% Plastic Surgery Italy High
Bowe, 2006 [29] 128 Dermatologic 92 36 24.1 ± 8.3 BDDE-SR 14.1% Dermatology USA High
Brohede, 2017 [30] 425 Dermatologic 425 0 39.7 ± 12.2 BDDQ 5.0% Dermatology Sweden High
Callaghan, 2011 [31] 544 Aesthetics 373 171 19.3 ± 3.1 BDDQ 10.1% Plastic Surgery USA High
Castle, 2004 [32] 137 Aesthetics 119 18 40.2 ± 10.4 DCQ 2.9% Plastic Surgery Australia High
Cerea, 2022 [33] 69 Aesthetics 62 7 39.8 ± 14.2 BDD-S 34.8% Plastic Surgery Italy Medium
Collins, 2014 [34] 99 Reconstructive 53 46 26.7 BDDE-SR 13.0% OMFS USA High
Conrado, 2010 [35] 300 Dermatologic 279 21 42.2 BDDQ 9.1% Dermatology Brazil Medium
Crerand, 2004 [36] 91 Aesthetics 48 43 34.6 ± 15.9 BDDE 7.7% Plastic Surgery USA High
de Brito, 2016 [37] 300 Aesthetics 256 44 38.5 ± 11.3 BDDE 51.5% Plastic Surgery Brazil Medium
de Brito, 2016 [38] 90 Aesthetics 84 6 38.0 ± 11.0 BDDE 57.0% Plastic Surgery Brazil Medium
de Souza, 2021 [39] 88 Rhinoplasty 66 22 - BDSS 35.1% Plastic Surgery Brazil Medium
Dey, 2015 [40] 234 Aesthetics 157 77 47.0 ± 16.0 BDDQ 6.8% Plastic Surgery USA High
Dobosz, 2022 [41] 199 Aesthetics 189 3 - Custom 15.6% Dermatology Poland High
GH, 2017 [42] 60 Rhinoplasty 24 36 26.7 ± 6.9 BICI 20.0% Plastic Surgery Iran High
Hayashi, 2007 [43] 140 Aesthetics 124 16 38.4 DSM IV-TR 7.8% Plastic Surgery Japan High
Hohenberger, 2023 [44] 259 Aesthetics 151 108 29.6 ± 16.0 BDDQ-AS 32.5% ENT Germany High
Hsu, 2009 [45] 396 Dermatologic - - - Custom 29.4% Dermatology Singapore High
Ishigooka, 1998 [46] 415 Aesthetics 285 130 35.0 ± 13.7 Not specified 4.8% Plastic Surgery Japan High
Jeremy, 2014 [47] 47 Rhinoplasty 20 27 31.1 BDDQ 15.0% Plastic Surgery Singapore High
Joseph, 2017 [48] 597 Aesthetics 398 197 46.6 ± 16.3 BDDQ 9.7% Plastic Surgery USA High
Joseph, 2017 [49] 84 Aesthetics 39 45 45.7 ± 18.7 BDDQ 32.0% ENT UK High
Kacar, 2014 [50] 318 Dermatologic 212 106 32.9 ± 11.5 BDDE-SR 6.2% Dermatology Turkey High
Kashan, 2021 [51] 46 Aesthetics 26 20 42.9 BDDQ 16.7% OMFS USA Medium
Lai, 2010 [52] 763 Aesthetics 671 92 - DSM IV-TR 7.7% Plastic Surgery Taiwan High
Matcalfe, 2014 [53] 188 Reconstructive 188 0 51.0 ± 10.0 DCQ 17.0% Plastic Surgery USA High
Moroco, 2022 [54] 242 General 151 91 53.7 ± 17.3 BDDQ 6.2% ENT USA High
Mortada, 2020 [55] 344 Aesthetics 296 48 39.7 ± 13.8 BDDQ 19.2% Plastic Surgery Saudi Arabia High
MR, 2013 [56] 130 Rhinoplasty 99 31 26.4 ± 6.3 BDDQ 31.5% Plastic Surgery Iran High
Murshidi, 2024 [57] 1500 Dermatologic 1140 360 29.3 ± 14.8 DCQ 11.7% Dermatology Jordan High
Omar, 2019 [58] 59 Rhinoplasty 48 11 26.4 ± 4.8 SCID-I/II 10.2% Plastic Surgery Egypt Medium
Pavan, 2006 [59] 27 Aesthetics 23 4 35.2 ± 12.8 MINIPLUS 37.0% Plastic Surgery Italy High
Phillips, 2000 [60] 268 Dermatologic 187 81 42.8 ± 16.0 BDDQ 11.9% Dermatology USA High
Picavet, 2011 [61] 226 Rhinoplasty 124 102 33.0 ± 16.0 Y-BOCS 33.0% ENT Belgium High
Pikoos, 2021 [62] 154 Aesthetics 154 0 44.9 ± 11.6 BDDQ-DV 25.0% Plastic Surgery Australia High
Rabaioli, 2020 [63] 131 Rhinoplasty 78 53 36.3 ± 14.1 BDDE 38.0% Plastic Surgery Brazil High
Ramos, 2019 [64] 50 Rhinoplasty 39 11 32.3 ± 11.0 Y-BOCS 48.0% Plastic Surgery Brazil Medium
Saeed, 2021 [65] 110 Rhinoplasty 110 0 - DCQ 41.8% Plastic Surgery Pakistan Medium
Sahraian, 2022 [66] 380 Rhinoplasty 210 170 - BDMÇQ 43.4% Plastic Surgery Iran Medium
Sarwer, 1998 [67] 132 Aesthetics 100 32 - BDDE-SR 12.9% Plastic Surgery USA High
Shandilya, 2024 [68] 892 Rhinoplasty - - - MPE 2.5% Plastic Surgery Ireland High
Stevens, 2023 [69] 175 Aesthetics 121 54 57.5 DCQ 9.1% Plastic Surgery USA High
Taziki, 2015 [70] 250 Rhinoplasty 220 30 24 ± 4.7 DCQ 18.0% Plastic Surgery Iran High
Thanveer, 2016 [71] 177 Dermatologic 95 82 30.5 ± 9.9 BDDQ-DV 4.5% Dermatology India Medium
Uzun, 2003 [72] 159 Dermatologic 77 82 19.5 ± 3.9 SCID-I/II 8.8% Dermatology Turkey High
Veale, 2003 [73] 29 Rhinoplasty 22 7 38.0 ± 12.8 Y-BOCS 20.7% Plastic Surgery UK High
Vindigni, 2002 [74] 56 Aesthetics 45 11 36.3 ± 13.0 MINIPLUS 53.0% Plastic Surgery Italy Medium
Vulink, 2006a [75] 530 Aesthetics - - 33.6 ± 14.9 BDDE-SR 8.5% Dermatology Netherlands Medium
Vulink, 2006b [75] 475 Dermatologic - - 34 ± 14.7 BDDE-SR 3.2% Plastic Surgery Netherlands Medium
Wang, 2016 [76] 106 Aesthetics 106 0 33.1 ± 12.4 BDDE 14.2% Plastic Surgery China Medium
Wei, 2023 [77] 488 Aesthetics 367 121 - BBDQ-AS 41.0% Plastic Surgery USA High
Wei, 2023 [78] 415 Aesthetics 304 111 37.0 BBDQ-AS 43.9% Plastic Surgery USA High
Woolley, 2015 [79] 728 General - - - DCQ 6.9% Plastic Surgery USA High
Yu, 2023 [80] 211 Rhinoplasty 151 60 - SSBI 7.3% Plastic Surgery China High
Yurtsever, 2022 [81] 412 Dermatologic 397 15 35.8 ± 7.6 BSQ-16 7.3% Dermatology Poland High
Open in a new tab

Table 2.

Results of Meta-Analysis. BDD prevalence in individuals of studies with 95% confidence intervals.

Study Proportion % [95% conf. Interval] Weight
Aghsaghloo, (2023) [18] 0.280 0.196, 0.372 1.51
Akinboro, (2019) [19] 0.360 0.274, 0.451 1.53
Al Shuhayb, (2023) [20] 0.095 0.068, 0.125 1.59
Alavi, (2011) [21] 0.245 0.198, 0.295 1.58
Aldukhi, (2021) [22] 0.200 0.153, 0.252 1.58
Almuhanna, (2022) [23] 0.205 0.154, 0.261 1.57
Altamura, (2001) [24] 0.063 0.043, 0.087 1.60
Aouizerate, (2003) [25] 0.091 0.047, 0.147 1.54
Bahlol, (2023) [26] 0.600 0.502, 0.694 1.51
Baykal, (2015) [27] 0.464 0.334, 0.596 1.44
Bellino, (2006) [28] 0.167 0.085, 0.268 1.46
Bowe, (2006) [29] 0.141 0.086, 0.207 1.54
Brohede, (2017) [30] 0.050 0.031, 0.073 1.60
Callaghan, (2011) [31] 0.101 0.077, 0.128 1.60
Castle, (2004) [32] 0.029 0.006, 0.065 1.54
Cerea, (2022) [33] 0.348 0.239, 0.465 1.47
Collins, (2014) [34] 0.130 0.070, 0.204 1.51
Conrado, (2010) [35] 0.091 0.061, 0.126 1.58
Crerand, (2004) [36] 0.077 0.030, 0.142 1.50
de Brito, (2016) [37] 0.515 0.458, 0.571 1.58
de Brito, (2016) [38] 0.570 0.466, 0.671 1.50
de Souza, (2021) [39] 0.351 0.254, 0.454 1.50
Dey, (2015) [40] 0.068 0.039, 0.104 1.57
Dobosz, (2022) [41] 0.156 0.109, 0.210 1.57
Ghazizadeh Hashemi, (2017) [42] 0.200 0.107, 0.312 1.45
Hayashi, (2007) [43] 0.078 0.039, 0.129 1.54
Hohenberger, (2023) [44] 0.325 0.269, 0.383 1.58
Hsu, (2009) [45] 0.294 0.250, 0.340 1.59
Ishigooka, (1998) [46] 0.048 0.029, 0.071 1.59
Jeremy, (2014) [47] 0.150 0.060, 0.268 1.41
Joseph, (2017) [48] 0.097 0.074, 0.122 1.60
Joseph, (2017) [49] 0.320 0.224, 0.424 1.49
Kacar, (2014) [50] 0.062 0.038, 0.091 1.59
Kashan, (2021) [51] 0.167 0.071, 0.290 1.40
Lai, (2010) [52] 0.077 0.059, 0.097 1.61
Matcalfe, (2014) [53] 0.170 0.119, 0.227 1.56
Moroco, (2022) [54] 0.062 0.035, 0.096 1.57
Mortada, (2020) [55] 0.192 0.152, 0.235 1.59
MR, (2013) [56] 0.315 0.238, 0.398 1.54
Murshidi, (2024) [57] 0.117 0.101, 0.134 1.61
Omar, (2019) [58] 0.102 0.036, 0.194 1.44
Pavan, (2006) [59] 0.370 0.196, 0.562 1.28
Philips, (2000) [60] 0.119 0.083, 0.161 1.58
Picavet, (2011) [61] 0.330 0.270, 0.393 1.57
Pikoos, (2021) [62] 0.250 0.185, 0.322 1.55
Rabaioli, (2020) [63] 0.380 0.299, 0.465 1.54
Ramos, (2019) [64] 0.480 0.342, 0.620 1.42
Saeed, (2021) [65] 0.418 0.327, 0.512 1.52
Sahraian, (2022) [66] 0.434 0.384, 0.484 1.59
Sarwer, (1998) [67] 0.129 0.077, 0.192 1.54
Shandilya, (2024) [68] 0.025 0.016, 0.036 1.61
Stevens, (2023) [69] 0.091 0.052, 0.139 1.56
Taziki, (2015) [70] 0.180 0.135, 0.230 1.58
Thanveer, (2016) [71] 0.045 0.019, 0.081 1.56
Uzun, (2003) [72] 0.088 0.048, 0.138 1.55
Veale, (2003) [73] 0.207 0.076, 0.376 1.30
Vindigni, (2002) [74] 0.530 0.398, 0.660 1.44
Vulink, (2006a) [75] 0.085 0.063, 0.110 1.60
Vulink, (2006b) [75] 0.032 0.018, 0.050 1.60
Wang, (2016) [76] 0.142 0.081, 0.216 1.52
Wei, (2023) [77] 0.410 0.367, 0.454 1.60
Wei, (2023) [78] 0.439 0.392, 0.487 1.59
Woolley, (2015) [79] 0.069 0.052, 0.089 1.61
Yu, (2023) [80] 0.073 0.041, 0.112 1.57
Yurtsever, (2022) [81] 0.073 0.050, 0.100 1.59
Invftukey (theta) 0.186 0.151 0.224
Open in a new tab

Test of theta = 0: z = 17.19, Prob > |z| = 0.0000. Test of homogeneity: Q = chi2(64) = 2120.63, Prob > Q = 0.0000.

Figure 2.

Figure 2

Open in a new tab

Forest Plot of Meta-Analysis. The square point of each line represents the BDD prevalence of each study. The diamond at the bottom represents the pooled effect estimate, with its width indicating the overall precision of the meta-analysis [18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62,63,64,65,66,67,68,69,70,71,72,73,74,75,76,77,78,79,80,81].

The test of homogeneity indicated significant heterogeneity across studies (Q = χ2 (64) = 2120.63, <0.0001), supporting the utilization of a random-effects model. The estimated tau2 of 0.1369 indicates variability beyond chance. The I2 statistic, representing the percentage of total variation across studies due to heterogeneity, was calculated to be 97.27%, further indicating high heterogeneity, also demonstrated by the Galbraith Plot (Figure 3). The 95% prediction interval for the true underlying effect size (invftukey (θ)) was estimated to be [0.153, 1.644]. The test of θ = 0 yielded a statistically significant result (t (65) = 17.18, p < 0.0001), suggesting the observed effect size is unlikely to be due to chance alone.

Figure 3.

Figure 3

Open in a new tab

Galbraith Plot. This plot shows the relationship between study effect sizes and their precision. Points closer to the regression line indicate higher precision, suggesting more reliable estimates.

Sensitivity analysis was conducted to assess the impact of different fixed values for tau (0.75, 0.50, and 0.25) on between-study variance and heterogeneity in the analysis. When tau was fixed at 0.75, a high level of between-study variance (tau2 = 0.75) and significant heterogeneity (I2 = 99.49%, H2 = 196.10) were observed. The effect across studies remained statistically significant (p < 0.0001), however. Fixing tau at 0.50 resulted in decreased between-study variance (tau2 = 0.50) and reduced heterogeneity (I2 = 99.24%, H2 = 131.07), while the effect remained significant (p < 0.0001). Finally, fixing tau at 0.25 further reduced between-study variance (tau2 = 0.25) and led to decreased heterogeneity (I2 = 98.49%, H2 = 66.03), indicating a trend towards homogeneity. Additionally, proportions of total variance and prediction intervals remained relatively stable, suggesting increased precision in predicting the true effect size in future studies.

A leave-one-out meta-analysis was performed to evaluate the stability of the pooled effect size estimate. The proportion of the effect size ranged from 0.151 to 0.224 when individual studies were excluded. All changes were statistically significant (p < 0.001).

A subgroup meta-analysis investigated the distribution of effect sizes across diverse subgroups delineated by country and type of specialty (Table 3). The proportion of effect sizes displayed significant variability across different countries (p < 0.001) alongside substantial observed heterogeneity (I2 = 97.27%). Brazil exhibited the highest proportion, with a Freeman–Tukey’s p-value of 0.384, whereas Ireland had the lowest at 0.025. Heterogeneity across countries ranged widely from 0% to 97.60%. Within the spectrum of surgical types, dermatology presented the smallest proportion (0.121), contrasting with plastic surgery, which displayed the highest (0.216). Heterogeneity within surgical types demonstrated a range from 0% to 97.47%. Furthermore, tests of group differences unveiled significant variation both across countries (p < 0.001) and types of specialty (p = 0.022).

Table 3.

Results of Subgroup Meta-analysis.

Group No. of
Studies Proportion [95% conf. Interval] p-Value
Country
Australia 2 0.117 0.000, 0.406 0.070
Belgium 1 0.330 0.270, 0.393 0.000
Brazil 6 0.384 0.235, 0.545 0.000
China 2 0.102 0.044, 0.179 0.000
Egypt 1 0.102 0.036, 0.194 0.000
France 1 0.091 0.047, 0.147 0.000
Germany 1 0.325 0.269, 0.383 0.000
India 1 0.045 0.019, 0.081 0.000
Iran 6 0.275 0.202, 0.355 0.000
Iraq 1 0.600 0.502, 0.694 0.000
Ireland 1 0.025 0.016, 0.036 0.000
Italy 5 0.270 0.114, 0.462 0.000
Japan 2 0.058 0.032, 0.090 0.000
Jordan 1 0.117 0.101, 0.134 0.000
Netherlands 2 0.056 0.015, 0.118 0.000
Nigeria 1 0.360 0.274, 0.451 0.000
Pakistan 1 0.418 0.327, 0.512 0.000
Poland 2 0.109 0.042, 0.204 0.000
Saudi Arabia 4 0.169 0.116, 0.229 0.000
Singapore 2 0.231 0.109, 0.379 0.000
Sweden 1 0.050 0.031, 0.073 0.000
Taiwan 1 0.077 0.059, 0.097 0.000
Turkey 3 0.172 0.012, 0.450 0.013
United Kingdom 2 0.283 0.189, 0.388 0.000
United States 15 0.140 0.092, 0.197 0.000
Type of Specialty
Dermatology 15 0.121 0.084, 0.163 0.000
ENT 4 0.217 0.062, 0.432 0.000
OMFS 2 0.140 0.087, 0.203 0.000
Plastic Surgery 44 0.216 0.155, 0.228 0.000
Overall
invftukey (theta) 65 0.186 0.151, 0.224 0.000
Open in a new tab

A meta-regression analysis was conducted to explore the relationship between the prevalence of BDD, sample size, and the year of study. The findings revealed a significant negative relationship between total sample size and effect sizes (coefficient = −0.00112, p < 0.001), suggesting that larger studies tend to yield smaller effect sizes. Conversely, a positive association was observed between the number of events and effect sizes (coefficient = 0.00656, p < 0.001), indicating that studies with more events tend to report larger effect sizes. However, no statistically significant relationship was found between the year of publication and effect sizes (p = 0.089). The intercept, representing the effect size when all predictors are zero, was not statistically significant (p = 0.114), implying no meaningful effect size under those conditions. Despite these predictors, substantial residual heterogeneity remained, suggesting the presence of unaccounted factors influencing effect sizes.

A bias assessment using the Egger regression test to evaluate the presence of small-study effects is demonstrated in Figure 4. The Egger regression test for small-study effects indicates a statistically significant outcome (t = 3.39, p = 0.0012), suggesting evidence of small-study effects in the included studies. The estimated coefficient (β1) was found to be 4.30 (SE = 1.267), indicating a bias towards larger effect sizes in smaller studies. A nonparametric trim-and-fill analysis of publication bias was conducted. The observed effect size was found to be 0.898 (95% confidence interval: 0.806 to 0.991). No imputed studies were added during the analysis, suggesting that the observed effect size remained unchanged even after considering potential publication bias.

Figure 4.

Figure 4

Open in a new tab

Funnel Plot. The plot shows study size versus effect size. Symmetry indicates no publication bias; asymmetry suggests potential bias.

4. Discussion

The complex interplay of genetic, biological, and environmental factors in BDD remains unclear, but individuals often turn to plastic surgery as a solution to alleviate perceived flaws [82]. As societal attitudes toward physical appearance and cosmetic procedures continue to evolve, the demand for plastic and reconstructive surgery surges [83]. Understanding the prevalence of BDD among individuals pursuing such procedures becomes increasingly crucial for healthcare providers, especially plastic surgeons. To explore the prevalence of BDD in this population, our study drew data from 65 studies globally, including over 17,000 individuals. We revealed that the overall estimated prevalence was 18.6%, similar to previously reported rates, and substantially higher than the general population of less than 3%.

Our study demonstrated significant variability across different specialties and countries. Patients pursuing treatment presenting through dermatology exhibited a relatively smaller prevalence compared to others. In one cross-sectional study across 17 European countries in dermatology outpatient clinics, Schut et al. reported a prevalence of BDD among 5487 patients at 10.5%, similar to our results of 12.1% among 5588 globally [84]. This consistency emphasizes the need for comprehensive screening and management protocols across medical specialties to ensure early detection and appropriate support for individuals affected by BDD. Further, across countries, while the vast majority of studies were published in the United States, Brazil showed a larger effect size on average. These disparities stress the complex relationship of cultural, social, and healthcare system factors in shaping the prevalence and expression of BDD.

Investigating factors such as the study year, we observed no clear increased trend in BDD prevalence over time. While a potential positive association emerged, it lacked statistical significance. This finding raises intriguing questions about the stability of BDD rates amidst the growing popularity of plastic surgery and cosmetic procedures. One explanation might lie in the increasing societal acceptance and accessibility of cosmetic procedures, driven by advancements in plastic surgery techniques and the influence of social media and celebrity culture [85]. These questions garner depth and resonance in light of a recent video documentary featuring Professor Mark B. Constantian, MD, FACS. He engaged in a profound conversation with a patient grappling with severe BDD, ultimately unveiling a journey towards self-acceptance and healing [86]. He described BDD as a spectrum where the desire for surgery often originates from the perceived significance of imperfections. This fosters dissatisfaction, impacting psychological and social well-being [87]. Dr. Constantian observed the patient’s evolution from broad self-loathing to a specific focus on one body part, akin to examining it through a magnifying glass. Despite encountering post-surgical dissatisfaction, similar to many patients with BDD, the patient demonstrated resilience by actively pursuing self-improvement.

Given the profound impact of BDD on individuals and the rarity to resolve, our study underscores the critical need for preoperative screening and ongoing support mechanisms that can enhance patient outcomes and satisfaction [88]. Although recent studies have sought to identify validated BDD screening tools, like the Body Dysmorphic Disorder Questionnaire (BDDQ) and the Dysmorphic Concern Questionnaire (DCQ), across various specialties related to plastic and dermatologic settings, they have ultimately demonstrated varying criteria, regional preferences, an absence of uniform guidelines and the need for further development based on DSM-V [89,90]. In addition to early detection and timely psychiatric referrals, holistic management of BDD necessitates ongoing multidisciplinary support, empathetic counseling, setting realistic expectations, and therapeutic options such as selective serotonin reuptake inhibitors and cognitive behavioral therapy [91]. Furthermore, longitudinal studies tracking changes in BDD prevalence over time and across different cultural contexts can offer insight into evolving trends and patterns in body image perceptions, guiding more effective interventions and support strategies.

Limitations

Several limitations arose which included potential sampling bias due to missed or excluded studies, generalizability, and publication bias skewing prevalence estimates. Language and publication biases may arise from the focus on English publications. Various assessment tools exist for diagnosing BDD, potentially leading to inconsistencies in prevalence estimates across studies. Tools such as the BDDQ and the DCQ are commonly used but may vary in sensitivity and specificity, influencing the detection of BDD symptoms in study populations. Despite efforts to assess study quality using the STROBE checklist, variations in reporting standards remain.

5. Conclusions

Our meta-analysis revealed a significant prevalence of BDD in plastic and reconstructive surgery, estimated at 18.6% across 65 studies and 17,000 patients. While no clear increasing trend in BDD prevalence over time was identified, further research is warranted to explore evolving trends in body image perceptions. Overall, our study emphasizes the importance of proactive interventions and collaborative efforts to improve patient care and outcomes. The findings underscore the need for standardized screening protocols and multidisciplinary care approaches to address the complex challenges posed by BDD.

Author Contributions

Conceptualization, J.D.K. and J.E.J.; methodology, J.D.K. and J.E.J.; software, J.D.K. and J.E.J.; validation, J.D.K. and J.E.J.; formal analysis, J.D.K. and J.E.J.; investigation, J.D.K. and J.E.J.; resources, J.D.K. and J.E.J.; data curation, J.D.K. and J.E.J.; writing—original draft preparation, J.D.K. and J.E.J.; writing—review and editing, J.D.K. and J.E.J.; visualization, J.D.K. and J.E.J.; supervision, J.D.K. and J.E.J.; project administration, J.D.K. and J.E.J. All authors have read and agreed to the published version of the manuscript.

Institutional Review Board Statement

Not applicable.

Informed Consent Statement

Not applicable.

Data Availability Statement

All data are available upon reasonable request from the corresponding author.

Conflicts of Interest

Author Jeffrey E. Janis receives royalties from Thieme and Springer Publishing. All other authors declare no financial or other relationships that may lead to a conflict of interest.

Funding Statement

This research received no external funding.

Footnotes

Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content.

References

  • 1.Bjornsson A.S., Didie E.R., Phillips K.A. Body dysmorphic disorder. Dialogues Clin. Neurosci. 2010;12:221–232. doi: 10.31887/DCNS.2010.12.2/abjornsson. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 2.Berrios G.E., Kan C.S. A conceptual and quantitative analysis of 178 historical cases of dysmorphophobia. Acta Psychiatr. Scand. 1996;94:1–7. doi: 10.1111/j.1600-0447.1996.tb09817.x. [DOI] [PubMed] [Google Scholar]
  • 3.Morselli E. Sulla dismorfofobia e sulla tafefobia. Boll. Accad. Sci. Med. Genova. 1886;6:100. [Google Scholar]
  • 4.Koran L.M., Abujaoude E., Large M.D., Serpe R.T. The prevalence of body dysmorphic disorder in the United States adult population. CNS Spectr. 2008;13:316–322. doi: 10.1017/S1092852900016436. [DOI] [PubMed] [Google Scholar]
  • 5.Otto M.W., Wilhelm S., Cohen L.S., Harlow B.L. Prevalence of body dysmorphic disorder in a community sample of women. Am. J. Psychiatry. 2001;158:2061–2063. doi: 10.1176/appi.ajp.158.12.2061. [DOI] [PubMed] [Google Scholar]
  • 6.Rief W., Buhlmann U., Wilhelm S., Borkenhagen A., Brähler E. The prevalence of body dysmorphic disorder: A population-based survey. Psychol. Med. 2006;36:877–885. doi: 10.1017/S0033291706007264. [DOI] [PubMed] [Google Scholar]
  • 7.Schulte J., Schulz C., Wilhelm S., Buhlmann U. Treatment utilization and treatment barriers in individuals with body dysmorphic disorder. BMC Psychiatry. 2020;20:69. doi: 10.1186/s12888-020-02489-0. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 8.Feusner J.D., Neziroglu F., Wilhelm S., Mancusi L., Bohon C. What Causes BDD: Research Findings and a Proposed Model. Psychiatr. Ann. 2010;40:349–355. doi: 10.3928/00485713-20100701-08. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 9.Higgins S., Wysong A. Cosmetic Surgery and Body Dysmorphic Disorder–An Update. Int. J. Womens Dermatol. 2018;4:43–48. doi: 10.1016/j.ijwd.2017.09.007. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 10.Phillips K.A. The Presentation of Body Dysmorphic Disorder in Medical Settings. Prim. Psychiatry. 2006;13:51–59. [PMC free article] [PubMed] [Google Scholar]
  • 11.Bouman T.K., Mulkens S., van der Lei B. Cosmetic Professionals’ Awareness of Body Dysmorphic Disorder. Plast. Reconstr. Surg. 2017;139:336–342. doi: 10.1097/PRS.0000000000002962. [DOI] [PubMed] [Google Scholar]
  • 12.Lee K., Guy A., Dale J., Wolke D. Adolescent Desire for Cosmetic Surgery: Associations with Bullying and Psychological Functioning. Plast. Reconstr. Surg. 2017;139:1109–1118. doi: 10.1097/PRS.0000000000003252. [DOI] [PubMed] [Google Scholar]
  • 13.Hostiuc S., Isailă O.M., Rusu M.C., Negoi I. Ethical Challenges Regarding Cosmetic Surgery in Patients with Body Dysmorphic Disorder. Healthcare. 2022;10:1345. doi: 10.3390/healthcare10071345. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 14.Ribeiro R.V.E. Prevalence of Body Dysmorphic Disorder in Plastic Surgery and Dermatology Patients: A Systematic Review with Meta-Analysis. Aesthetic Plast. Surg. 2017;41:964–970. doi: 10.1007/s00266-017-0869-0. [DOI] [PubMed] [Google Scholar]
  • 15.Salari N., Kazeminia M., Heydari M., Darvishi N., Ghasemi H., Shohaimi S., Mohammadi M. Body dysmorphic disorder in individuals requesting cosmetic surgery: A systematic review and meta-analysis. J. Plast. Reconstr. Aesthet. Surg. 2022;75:2325–2336. doi: 10.1016/j.bjps.2022.04.098. [DOI] [PubMed] [Google Scholar]
  • 16.Nabavizadeh S.S., Naseri R., Sadeghi E., Afshari A., Dehdari Ebrahimi N., Sadeghi A. Prevalence of body dysmorphic disorder in rhinoplasty candidates: A systematic review and meta-analysis. Health Sci. Rep. 2023;6:e1495. doi: 10.1002/hsr2.1495. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 17.Cuschieri S. The STROBE guidelines. Saudi J. Anaesth. 2019;13((Suppl. S1)):S31–S34. doi: 10.4103/sja.SJA_543_18. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 18.Aghsaghloo V., Meibodi S.S., Nasirmohtaram S., Habibi A.F., Zare R., Isanazar A., Ashraf A. Comparison of the Prevalence of Body Dysmorphic Disorder in Rhinoplasty Patients and its Influence on its Surgical Outcomes. Indian J. Otolaryngol. Head Neck Surg. 2024;76:1549–1553. doi: 10.1007/s12070-023-04355-3. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 19.Akinboro A.O., Adelufosi A.O., Onayemi O., Asaolu S.O. Body dysmorphic disorder in patients attending a dermatology clinic in Nigeria: Sociodemographic and clinical correlates. An. Bras. Dermatol. 2019;94:422–428. doi: 10.1590/abd1806-4841.20197919. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 20.Al Shuhayb B.S., Bukhamsin S., Albaqshi A.A., Omer Mohamed F. The Prevalence and Clinical Features of Body Dysmorphic Disorder Among Dermatology Patients in the Eastern Province of Saudi Arabia. Cureus. 2023;15:e42474. doi: 10.7759/cureus.42474. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 21.Alavi M., Kalafi Y., Dehbozorgi G.R., Javadpour A. Body dysmorphic disorder and other psychiatric morbidity in aesthetic rhinoplasty candidates. J. Plast. Reconstr. Aesthet. Surg. 2011;64:738–741. doi: 10.1016/j.bjps.2010.09.019. [DOI] [PubMed] [Google Scholar]
  • 22.Aldukhi S., Almukhadeb E. Prevalence of Body Dysmorphic Disorder among Dermatology and Plastic Surgery Patients in Saudi Arabia and its Association with Cosmetic Procedures. Bahrain Med. Bull. 2021;43:1. [Google Scholar]
  • 23.Almuhanna N. Prevalence of Body Dysmorphic Disorder Among Saudi Female Patients Seeking Cosmetic Procedures. Eur. Psychiatry. 2022;65:S294–S295. doi: 10.1192/j.eurpsy.2022.751. [DOI] [Google Scholar]
  • 24.Altamura C., Paluello M.M., Mundo E., Medda S., Mannu P. Clinical and subclinical body dysmorphic disorder. Eur. Arch. Psychiatry Clin. Neurosci. 2001;251:105–108. doi: 10.1007/s004060170042. [DOI] [PubMed] [Google Scholar]
  • 25.Aouizerate B., Pujol H., Grabot D., Faytout M., Suire K., Braud C., Auriacombe M., Martin D., Baudet J., Tignol J. Body dysmorphic disorder in a sample of cosmetic surgery applicants. Eur. Psychiatry. 2003;18:365–368. doi: 10.1016/j.eurpsy.2003.02.001. [DOI] [PubMed] [Google Scholar]
  • 26.Bahlol F.A., Hashim M.T., Abdul Khaleq M.A., Marzook A.A. Prevalence of Body Dysmorphic Disorder among Attendances Seeking Facial Cosmetic Procedures in Baghdad. Pol. Merkur. Lekarski. 2023;51:511–520. doi: 10.36740/Merkur202305110. [DOI] [PubMed] [Google Scholar]
  • 27.Baykal B., Erdim I., Ozbay I., Oghan F., Oncu F., Erdogdu Z., Kayhan F.T. Evaluation of Relationship Between Body Dysmorphic Disorder and Self-Esteem in Rhinoplasty Candidates. J. Craniofac. Surg. 2015;26:2339–2341. doi: 10.1097/SCS.0000000000002082. [DOI] [PubMed] [Google Scholar]
  • 28.Bellino S., Zizza M., Paradiso E., Rivarossa A., Fulcheri M., Bogetto F. Dysmorphic concern symptoms and personality disorders: A clinical investigation in patients seeking cosmetic surgery. Psychiatry Res. 2006;144:73–78. doi: 10.1016/j.psychres.2005.06.010. [DOI] [PubMed] [Google Scholar]
  • 29.Bowe W.P., Leyden J.J., Crerand C.E., Sarwer D.B., Margolis D.J. Body dysmorphic disorder symptoms among patients with acne vulgaris. J. Am. Acad. Dermatol. 2007;57:222–230. doi: 10.1016/j.jaad.2007.03.030. [DOI] [PubMed] [Google Scholar]
  • 30.Brohede S., Wyon Y., Wingren G., Wijma B., Wijma K. Body dysmorphic disorder in female Swedish dermatology patients. Int. J. Dermatol. 2017;56:1387–1394. doi: 10.1111/ijd.13739. [DOI] [PubMed] [Google Scholar]
  • 31.Callaghan G.M., Lopez A., Wong L., Northcross J., Anderson K.R. Predicting consideration of cosmetic surgery in a college population: A continuum of body image disturbance and the importance of coping strategies. Body Image. 2011;8:267–274. doi: 10.1016/j.bodyim.2011.04.002. [DOI] [PubMed] [Google Scholar]
  • 32.Castle D.J., Molton M., Hoffman K., Preston N.J., Phillips K.A. Correlates of dysmorphic concern in people seeking cosmetic enhancement. Aust. N. Z. J. Psychiatry. 2004;38:439–444. doi: 10.1080/j.1440-1614.2004.01381.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 33.Cerea S., Lovetere G., Bottesi G., Sica C., Ghisi M. The relationship between body dysmorphic disorder symptoms and ‘not just right’ experiences in a sample of individuals seeking cosmetic surgery and aesthetic medicine procedures. Clin. Psychol. Psychother. 2022;29:1034–1049. doi: 10.1002/cpp.2683. [DOI] [PubMed] [Google Scholar]
  • 34.Collins B., Gonzalez D., Gaudilliere D.K., Shrestha P., Girod S. Body dysmorphic disorder and psychological distress in orthognathic surgery patients. J. Oral. Maxillofac. Surg. 2014;72:1553–1558. doi: 10.1016/j.joms.2014.01.011. [DOI] [PubMed] [Google Scholar]
  • 35.Conrado L.A., Hounie A.G., Diniz J.B., Fossaluza V., Torres A.R., Miguel E.C., Rivitti E.A. Body dysmorphic disorder among dermatologic patients: Prevalence and clinical features. J. Am. Acad. Dermatol. 2010;63:235–243. doi: 10.1016/j.jaad.2009.09.017. [DOI] [PubMed] [Google Scholar]
  • 36.Crerand C., Sarwer D., Magee L., Rossen L., Lowe M., Bartlett S., Becker D., Glat P., LaRossa D., Low D., et al. Rate of Body Dysmorphic Disorder Among Patients Seeking Facial Plastic Surgery. Psychiatr. Ann. 2004;34:958–965. doi: 10.3928/0048-5713-20041201-19. [DOI] [Google Scholar]
  • 37.de Brito M.J.A., Nahas F.X., Cordás T.A., Tavares H., Ferreira L.M. Body Dysmorphic Disorder in Patients Seeking Abdominoplasty, Rhinoplasty, and Rhytidectomy. Plast. Reconstr. Surg. 2016;137:462–471. doi: 10.1097/01.prs.0000475753.33215.8f. [DOI] [PubMed] [Google Scholar]
  • 38.Brito M.J., Nahas F.X., Cordás T.A., Gama M.G., Sucupira E.R., Ramos T.D., Felix G.E.A., Ferreira L.M. Prevalence of Body Dysmorphic Disorder Symptoms and Body Weight Concerns in Patients Seeking Abdominoplasty. Aesthet. Surg. J. 2016;36:324–332. doi: 10.1093/asj/sjv213. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 39.de Souza T.S.C., Patrial M.T.C.R., Meneguetti A.F.C., de Souza M.S.C., Meneguetti M.E., Rossato V.F. Body Dysmorphic Disorder in Rhinoplasty Candidates: Prevalence and Functional Correlations. Aesthetic. Plast. Surg. 2021;45:641–648. doi: 10.1007/s00266-020-01930-9. [DOI] [PubMed] [Google Scholar]
  • 40.Dey J.K., Ishii M., Phillis M., Byrne P.J., Boahene K.D., Ishii L.E. 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;17:137–143. doi: 10.1001/jamafacial.2014.1492. [DOI] [PubMed] [Google Scholar]
  • 41.Dobosz M., Rogowska P., Sokołowska E., Szczerkowska-Dobosz A. Motivations, demography, and clinical features of body dysmorphic disorder among people seeking cosmetic treatments: A study of 199 patients. J. Cosmet. Dermatol. 2022;21:4646–4650. doi: 10.1111/jocd.14890. [DOI] [PubMed] [Google Scholar]
  • 42.Ghazizadeh Hashemi S.A., Edalatnoor B., Edalatnoor B., Niksun O. Investigating the Level of Body Image Concern among the Applicants for Rhinoplasty before and after Surgery. Int. J. Pediatr. 2017;5:5789–5796. [Google Scholar]
  • 43.Hayashi K., Miyachi H., Nakakita N., Akimoto M., Aoyagi K., Miyaoka H., Uchinuma E. Importance of a psychiatric approach in cosmetic surgery. Aesthet. Surg. J. 2007;27:396–401. doi: 10.1016/j.asj.2007.05.010. [DOI] [PubMed] [Google Scholar]
  • 44.Hohenberger R., Endres P., Salzmann I., Plinkert P.K., Wallner F., Baumann I., Alt J., Riedel F., Lippert B.M., Bulut O.C. Quality of Life and Screening on Body Dysmorphic Disorder, Depression, Anxiety in Septorhinoplasty. Laryngoscope. 2024;134:2187–2193. doi: 10.1002/lary.31212. [DOI] [PubMed] [Google Scholar]
  • 45.Hsu C., Ali Juma H., Goh C.L. Prevalence of body dysmorphic features in patients undergoing cosmetic procedures at the National Skin Centre, Singapore. Dermatology. 2009;219:295–298. doi: 10.1159/000228329. [DOI] [PubMed] [Google Scholar]
  • 46.Ishigooka J., Iwao M., Suzuki M., Fukuyama Y., Murasaki M., Miura S. Demographic features of patients seeking cosmetic surgery. Psychiatry Clin. Neurosci. 1998;52:283–287. doi: 10.1046/j.1440-1819.1998.00388.x. [DOI] [PubMed] [Google Scholar]
  • 47.Jeremy G. Prevalence of Body Dysmorphic Disorder and Impact on Subjective Outcome amongst Singaporean Rhinoplasty Patients. Anaplastology. 2015;4:1000140. [Google Scholar]
  • 48.Joseph A.W., Ishii L., Joseph S.S., Smith J.I., Su P., Bater K., Byrne P., Boahene K., Papel I., Kontis T., et al. Prevalence of Body Dysmorphic Disorder and Surgeon Diagnostic Accuracy in Facial Plastic and Oculoplastic Surgery Clinics. JAMA Facial. Plast. Surg. 2017;19:269–274. doi: 10.1001/jamafacial.2016.1535. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 49.Joseph J., Randhawa P., Hannan S.A., Long J., Goh S., O’Shea N., Saleh H., Hansen E., Veale D., Andrews P. Body dysmorphic disorder in patients undergoing septorhinoplasty surgery: Should we be performing routine screening? Clin. Otolaryngol. 2017;42:508–513. doi: 10.1111/coa.12752. [DOI] [PubMed] [Google Scholar]
  • 50.Dogruk Kacar S., Ozuguz P., Bagcioglu E., Coskun K.S., Uzel Tas H., Polat S., Karaca S. The frequency of body dysmorphic disorder in dermatology and cosmetic dermatology clinics: A study from Turkey. Clin. Exp. Dermatol. 2014;39:433–438. doi: 10.1111/ced.12304. [DOI] [PubMed] [Google Scholar]
  • 51.Kashan D.L., Horan M.P., Wenzinger E., Kashan R.S., Baur D.A., Zins J.E., Quereshy F.A. Identification of Body Dysmorphic Disorder in Patients Seeking Corrective Procedures From Oral and Maxillofacial Surgeons. J. Craniofac. Surg. 2021;32:970–973. doi: 10.1097/SCS.0000000000007370. [DOI] [PubMed] [Google Scholar]
  • 52.Lai C., Lee S., Yeh Y., Chen C. Body dysmorphic disorder in patients with cosmetic surgery. Kaohsiung J. Med. Sci. 2010;26:478–482. doi: 10.1016/S1607-551X(10)70075-9. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 53.Metcalfe D.B., Duggal C.S., Gabriel A., Nahabedian M.Y., Carlson G.W., Losken A. Prevalence of Body Dysmorphic Disorder Among Patients Seeking Breast Reconstruction. Aesthet. Surg. J. 2014;34:733–737. doi: 10.1177/1090820X14531775. [DOI] [PubMed] [Google Scholar]
  • 54.Moroco A.E., Daher G.S., O’Connell Ferster A.P., Lighthall J.G. Prevalence of Body Dysmorphic Disorder in an Otolaryngology-Head and Neck Surgery Clinic. Ann. Otol. Rhinol. Laryngol. 2023;132:783–789. doi: 10.1177/00034894221118772. [DOI] [PubMed] [Google Scholar]
  • 55.Mortada H., Seraj H., Bokhari A. Screening for body dysmorphic disorder among patients pursuing cosmetic surgeries in Saudi Arabia. Saudi. Med. J. 2020;41:1111–1120. doi: 10.15537/smj.2020.10.25380. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 56.Mr F., Tabrizi A.G., Bafghi A.F., Sa N., Makhdoom A. Body dysmorphic disorder in aesthetic rhinoplasty candidates. Pak. J. Med. Sci. 2013;29:197–200. doi: 10.12669/pjms.291.2733. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 57.Murshidi R., Hammouri M., Al-Ani A., Kitaneh R., Al-Soleiti M., Al Ta’ani Z., Sweis S., Halasa Z., Fashho E., Arafah M., et al. Investigating the prevalence of body dysmorphic disorder among Jordanian adults with dermatologic and cosmetic concerns: A case-control study. Sci. Rep. 2024;14:5993. doi: 10.1038/s41598-024-56315-8. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 58.Omar A., Eid M., Ali R. Psychiatric morbidity among Egyptian patients seeking rhinoplasty. Middle East Curr. Psychiatry. 2019;26:8. doi: 10.1186/s43045-019-0008-5. [DOI] [Google Scholar]
  • 59.Pavan C., Vindigni V., Semenzin M., Mazzoleni F., Gardiolo M., Simonato P., Marini M. Personality, temperament and clinical scales in an Italian Plastic Surgery setting: What about body dysmorphic disorder? Int. J. Psychiatry Clin. Pract. 2006;10:91–96. doi: 10.1080/13651500500487677. [DOI] [PubMed] [Google Scholar]
  • 60.Phillips K., Dufresne R., Wilkel C., Vittorio C. Rate of body dysmorphic disorder in dermatology patients. J. Am. Acad. Dermatol. 2000;42:436–441. doi: 10.1016/S0190-9622(00)90215-9. [DOI] [PubMed] [Google Scholar]
  • 61.Picavet V.A., Prokopakis E.P., Gabriëls L., Jorissen M., Hellings P.W. High prevalence of body dysmorphic disorder symptoms in patients seeking rhinoplasty. Plast. Reconstr. Surg. 2011;128:509–517. doi: 10.1097/PRS.0b013e31821b631f. [DOI] [PubMed] [Google Scholar]
  • 62.Pikoos T.D., Rossell S.L., Tzimas N., Buzwell S. Is the needle as risky as the knife? The prevalence and risks of body dysmorphic disorder in women undertaking minor cosmetic procedures. Aust. N. Z. J. Psychiatry. 2021;55:1191–1201. doi: 10.1177/0004867421998753. [DOI] [PubMed] [Google Scholar]
  • 63.Rabaioli L., Oppermann P.O., Pilati N.P., Klein C.F.G., Bernardi B.L., Migliavacca R., Lavinsky-Wolff M. Evaluation of postoperative satisfaction with rhinoseptoplasty in patients with symptoms of body dysmorphic disorder. Braz. J. Otorhinolaryngol. 2022;88:539–545. doi: 10.1016/j.bjorl.2020.07.013. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 64.Ramos T.D., de Brito M.J.A., Suzuki V.Y., Sabino Neto M., Ferreira L.M. High Prevalence of Body Dysmorphic Disorder and Moderate to Severe Appearance-Related Obsessive-Compulsive Symptoms Among Rhinoplasty Candidates. Aesthetic Plast. Surg. 2019;43:1000–1005. doi: 10.1007/s00266-018-1300-1. [DOI] [PubMed] [Google Scholar]
  • 65.Saeed K., Khan F.A., Khan I., Farid A. Psychology Behind Aesthetic Rhinoplasty-Introducing the term “SIFON”. J. Craniofac. Surg. 2021;32:2152–2154. doi: 10.1097/SCS.0000000000007496. [DOI] [PubMed] [Google Scholar]
  • 66.Sahraian A., Janipour M., Tarjan A., Zareizadeh Z., Habibi P., Babaei A. Body Dysmorphic and Narcissistic Personality Disorder in Cosmetic Rhinoplasty Candidates. Aesthetic Plast. Surg. 2022;46:332–337. doi: 10.1007/s00266-021-02603-x. [DOI] [PubMed] [Google Scholar]
  • 67.Sarwer D.B., Wadden T.A., Pertschuk M.J., Whitaker L.A. Body image dissatisfaction and body dysmorphic disorder in 100 cosmetic surgery patients. Plast. Reconstr. Surg. 1998;101:1644–1649. doi: 10.1097/00006534-199805000-00035. [DOI] [PubMed] [Google Scholar]
  • 68.Shandilya M., Bourke S., Shandilya A. Facial Plastic Surgery. Thieme Medical Publishers, Inc.; New York, NY, USA: 2024. Surgical Rhinoplasty in Mild Forms of Body Dysmorphic Disorder: Safety, Protocols, and Long-Term Outcomes. [DOI] [PubMed] [Google Scholar]
  • 69.Stevens S.M., Markatia Z.A., Ameli K., Bayaraa E., Lee W.W. Prevalence of Body Dysmorphic Disorder in Orbital Plastic Surgery and Its Relationship with the Use of Social Media. Aesthetic Plast. Surg. 2023;47:2447–2452. doi: 10.1007/s00266-023-03483-z. [DOI] [PubMed] [Google Scholar]
  • 70.Taziki S., Saghafi S., Zahmatkesh N., Alishahi V., Roshandel G. Body Dysmorphic Disorder, Self-esteem and Depression in Cosmetic Rhinoplasty. Eur. Psychiatry. 2015;3:466. doi: 10.1016/S0924-9338(15)30369-2. [DOI] [Google Scholar]
  • 71.Thanveer F., Khunger N. Screening for Body Dysmorphic Disorder in a Dermatology Outpatient Setting at a Tertiary Care Centre. J. Cutan. Aesthet. Surg. 2016;9:188–191. doi: 10.4103/0974-2077.191649. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 72.Uzun O., Başoğlu C., Akar A., Canseve A., Ozşahin A., Cetin M., Ebrinç S. Body dysmorphic disorder in patients with acne. Compr. Psychiatry. 2003;44:415–419. doi: 10.1016/S0010-440X(03)00102-0. [DOI] [PubMed] [Google Scholar]
  • 73.Veale D., De Haro L., Lambrou C. Cosmetic rhinoplasty in body dysmorphic disorder. Br. J. Plast. Surg. 2003;56:546–551. doi: 10.1016/S0007-1226(03)00209-1. [DOI] [PubMed] [Google Scholar]
  • 74.Vindigni V., Pavan C., Semenzin M. The importance of recognizing body dysmorphic disorder in cosmetic surgery patients: Do our patients need a preoperative psychiatric evaluation? Eur. J. Plast. Surg. 2002;25:305–308. [Google Scholar]
  • 75.Vulink N., Sigurdsson V., Kon M., Bruijnzeel-Koomen C., Westenberg H., Denys D. Body dysmorphic disorder in 3–8% of patients in outpatient dermatology and plastic surgery clinics. Ned. Tijdschr. Geneeskd. 2006;150:97–100. [PubMed] [Google Scholar]
  • 76.Wang Q., Cao C., Guo R., Li X., Lu L., Wang W., Li S. Avoiding Psychological Pitfalls in Aesthetic Medical Procedures. Aesthetic Plast. Surg. 2016;40:954–961. doi: 10.1007/s00266-016-0715-9. [DOI] [PubMed] [Google Scholar]
  • 77.Wei E.X., Kimura K.S., Abdelhamid A.S., Abany A.E., Losorelli S., Green A., Kandathil C.K., Most S.P. Prevalence and Characteristics Associated with Positive Body Dysmorphic Disorder Screening Among Patients Presenting for Cosmetic Facial Plastic Surgery. Facial. Plast. Surg. Aesthet. Med. 2023;26:262–269. doi: 10.1089/fpsam.2023.0212. [DOI] [PubMed] [Google Scholar]
  • 78.Wei E.X., Green A., Kandathil C.K., Most S.P. Increased Prevalence of Positive Body Dysmorphic Disorder Screening Among Rhinoplasty Consultations During the COVID-19 Era. Facial. Plast. Surg. Aesthet. Med. 2023 doi: 10.1089/fpsam.2023.0262. ahead of print . [DOI] [PubMed] [Google Scholar]
  • 79.Woolley A.J., Perry J.D. Body dysmorphic disorder: Prevalence and outcomes in an oculofacial plastic surgery practice. Am. J. Ophthalmol. 2015;159:1058–1064.e1051. doi: 10.1016/j.ajo.2015.02.014. [DOI] [PubMed] [Google Scholar]
  • 80.Yu Z., Zhang Z., Wang X., Song D., Yan Q., Sun Y., Xiong X., Meng X., Li W., Yi Z. Psychological evaluation of Asian female patients with rhinoplasty. J. Plast. Reconstr. Aesthet. Surg. 2024;88:112–118. doi: 10.1016/j.bjps.2023.10.127. [DOI] [PubMed] [Google Scholar]
  • 81.Yurtsever I., Matusiak Ł., Szepietowski J.C. To Inject or to Reject? The Body Image Perception among Aesthetic Dermatology Patients. J. Clin. Med. 2022;12:172. doi: 10.3390/jcm12010172. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 82.Lee A.D., Hale E.W., Mundra L., Le E., Kaoutzanis C., Mathes D.W. The heart of it all: Body dysmorphic disorder in cosmetic surgery. J. Plast. Reconstr. Aesthet. Surg. 2023;87:442–448. doi: 10.1016/j.bjps.2023.10.068. [DOI] [PubMed] [Google Scholar]
  • 83.ASPS Statistics. [(accessed on 2 May 2024)]. Available online: www.plasticsurgery.org.
  • 84.Schut C., Dalgard F.J., Bewley A., Evers A.W.M., Gieler U., Lien L., Sampogna F., Ständer S., Tomás-Aragonés L., Vulink N., et al. Body dysmorphia in common skin diseases: Results of an observational, cross-sectional multicentre study among dermatological outpatients in 17 European countries. Br. J. Dermatol. 2022;187:115–125. doi: 10.1111/bjd.21021. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 85.Furnham A., Levitas J. Factors that motivate people to undergo cosmetic surgery. Can. J. Plast. Surg. 2012;20:e47–e50. doi: 10.1177/229255031202000406. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 86.Constantian M. Recovering from Body Dysmorphic Disorder-Full Interview-Dr Mark B Constantian. 2021. [(accessed on 10 May 2024)]. Available online: https://www.youtube.com/watch?v=mmX_zGhHnbk.
  • 87.Jiotsa B., Naccache B., Duval M., Rocher B., Grall-Bronnec M. Social Media Use and Body Image Disorders: Association between Frequency of Comparing One’s Own Physical Appearance to That of People Being Followed on Social Media and Body Dissatisfaction and Drive for Thinness. Int. J. Environ. Res. Public Health. 2021;18:2880. doi: 10.3390/ijerph18062880. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 88.Fletcher L. Development of a multiphasic, cryptic screening protocol for body dysmorphic disorder in cosmetic dermatology. J. Cosmet. Dermatol. 2021;20:1254–1262. doi: 10.1111/jocd.13885. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 89.Pereira I.N., Chattopadhyay R., Fitzpatrick S., Nguyen S., Hassan H. Evidence-based review: Screening body dysmorphic disorder in aesthetic clinical settings. J. Cosmet. Dermatol. 2023;22:1951–1966. doi: 10.1111/jocd.15685. [DOI] [PubMed] [Google Scholar]
  • 90.Thomson D.R., Thomson N.E.V., Southwick G. Screening for Body Dysmorphic Disorder in Plastic Surgery Patients. Aesthetic. Plast. Surg. 2024. [DOI] [PubMed]
  • 91.Shivakumar S., Jafferany M., Sood S., Sushruth V. Cosmetic Presentations and Challenges of Body Dysmorphic Disorder and Its Collaborative Management. J. Cutan Aesthet. Surg. 2021;14:20–25. doi: 10.4103/JCAS.JCAS_180_20. [DOI] [PMC free article] [PubMed] [Google Scholar]

Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Data Availability Statement

All data are available upon reasonable request from the corresponding author.

Articles from Healthcare are provided here courtesy of Multidisciplinary Digital Publishing Institute (MDPI)

RESOURCES