Today’s cast will focus on the all-important topic of patient selection, with a specific focus on body dysmorphic disorder. As we know, not every patient who seeks a consultation with a plastic surgeon is physically or emotionally suited to undergo an operation than can result in a significant change in his or her appearance.

According to the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, (DSM-V) the following criteria define the diagnosis of body dysmorphic disorder (BDD):

• Preoccupation with one or more perceived defects or flaws in physical appearance that are not observable or appear slight to others.
• At some point during the course of the disorder, the individual has performed repetitive behaviors (e.g., mirror checking, excessive grooming, skin picking, reassurance seeking) or mental acts (e.g., comparing his or her appearance with that of others) in response to the appearance concerns.
• The preoccupation causes clinically significant distress and impairment in daily function.
• An eating disorder may be seen with body dysmorphia, but is not pivotal to its diagnosis.

A diagnostic criterion describing repetitive behaviors or mental acts in response to preoccupations with perceived defects or flaws in physical appearance has been added since the DSM-IV-TR, consistent with data indicating the prevalence and importance of this symptom.

And while there are no hard and fast rules helping guide us in terms of patient selection, there are some “red flags” that we can look out for during an initial consultation:

• Patient who continually related the need for a change in their appearance to something said to them by a sig. other or family member
• Patients who verbalize that their mother or father or other family member was/is critical of a certain body feature
• Excessive worry over a minor deformity
• Obsession with general appearance

Prior history of cosmetic surgery (rhinoplasty in this case) is not part of the diagnostic criteria for body dysmorphic disorder.

Diagnosis of BDD may be more accurately made if plastic surgeons and psychiatrists were to work together.

Beneficence: actions that promote the well-being of others. In the medical context, this means taking actions that serve the best interests of patients and their families.

Non- Maleficence: embodied by the phrase, “first, do no harm,” and is part of the Hippocratic oath.

Autonomy: The principle of autonomy views the rights of an individual to self-determination. This is rooted in society’s respect for individuals’ ability to make informed decisions about personal matters with freedom.The definition of autonomy is the ability of an individual to make a rational, un-influenced decision.

Sources:
ACAPS inservice exams 2015-2019
Constantian, M. B. (2009). Rhinoplasty: craft and magic. Thieme.