Psychopathology and body dissatisfaction in prospective plastic surgery patients: the SMILE experience

Objectives According to the Diagnostic and Statistical Manual of Mental Disorder IV (DSM-IV), Body Dysmorphic Disorder (BDD) is defined as an excessive concern with an imagined or slight defect in physical appearance. Body dysmorphic disorder (BDD) is estimated to affect 1-2% of the general population. Almost 6-15% of subjects suffering from body dissatisfaction (BD) undergo plastic surgery (PS) without any psychological benefits. Castle and Morkell have shown that approximately 6%-15% BDD patients require plastic surgery (PS) operations. This treatment, however, frequently results in no change or worsening of body dissatisfaction symptoms. The aim of the present study was to investigate the presence of BD and psychiatric symptoms in a sample of prospective PS patients. Methods Between November 2009 and April 2010, 56 patients (M = 12; F = 44) referred to the Plastic Surgery Unit of L'Aquila were enrolled. All patients were asked to complete a self-administered anonymous questionnaire for socio-demographic data collection, the Symptom Check List 90 (SCL-90) for psychopathological evaluation and the Body Uneasiness Test (BUT) to evaluate body dissatisfaction. Results 33.92% of the study participants showed positive BUT results. Individuals with a body dissatisfaction (GSI >= 1.2) had significantly higher scores on all SCL-90 subscales. SCL-90 scores showed the prevalence of the following subscales: "depression" (mean = 9.70, ds +/- 10.1), "somatisation" (mean = 9.41, ds +/- 8.1), "obsessiveness-compulsiveness" (mean = 8.25, ds +/- 7.4), and "anxiety" (mean = 8.02, ds +/- 7.5). Next, the total sample (N = 56) was divided into two groups according to type of surgical intervention: reconstructive surgery (N = 24; 42.6%) and aesthetic surgery (N = 32; 57.4%) and also further divided in a BD group (GSI = 1.2) and no BD group (GSI < 1.2) to analyze psychopathological differences. Conclusions Our results, in agreement with international literature, seem to confirm the presence of considerable body dissatisfaction among patients requesting PS interventions, as well as their comorbidity with other psychiatric symptoms. In most North American countries, prospective PS patients receive preoperative psychiatric assessment. This procedure is not common in Europe. The present study seems to confirm the importance of a psychiatric screening of this patient group in order to identify early a body dissatisfaction and a diagnosis of BDD to assess suitability for surgery. In conclusion, our findings show the importance of active collaboration between Psychiatry and Plastic Surgery to avoid global health impairment and thus improve patient quality of life.