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Body Dysmorphic Disorder: Suggestions for Detection and Treatment in a Surgical Dermatology Practice

BACKGROUND Body dysmorphic disorder is a relatively common condition in patients seeking elective surgery. Little has been written, however, in the dermatologic surgery literature about body dysmorphic disorder, where proper recognition and management of this disorder is needed during this time of increased demand for aesthetic dermatologic surgery. OBJECTIVE The objective was to review the prevalence, demographics, clinical features, treatment approaches, and referral suggestions for patients with body dysmorphic disorder in an attempt to facilitate care of such patients in a general dermatologic surgical practice. METHODS We reviewed the dermatologic, cosmetic surgical, and psychiatric literature regarding body dysmorphic disorder and related disorders. RESULTS Body dysmorphic disorder is observed in 6% to 15% of dermatologic and cosmetic surgery patients and in 2% of the general population. Surgical treatment of patients with body dysmorphic disorder typically leads to no change or worsening of symptoms in the majority of patients. The use of screening questionnaires and observation for hallmark features are helpful for clinicians in managing patients with body dysmorphic disorder. Psychiatric referral is desirable, because cognitive behavioral therapy and pharmacologic intervention with selective serotonin reuptake inhibitors are often efficacious. CONCLUSIONS Body dysmorphic disorder is often underdiagnosed and suboptimal management is common. Effective treatment consists of behavioral and pharmacologic intervention. Use of the Dufresne Body Dysmorphic Disorder Questionnaire appears to be useful as a screening tool in an outpatient setting, and awareness of clinical features of body dysmorphic disorder in the dermatologic surgical setting may spare patients significant morbidity while allowing surgical dermatologists to manage their patients and practices more effectively.