Body Dysmorphic Disorder and Comorbidity Among Orthognathic Surgery Patients Purpose

Purpose.  Orthognathic surgery (OS) is a functional surgery that can result in dramatic changes in facial appearance for patients with maxillo-mandibular deformities.  Several studies have examined OS patients’ motivation for surgery in terms of aesthetic objectives, but only one study has looked at the prevalence of Body Dysmorphic Disorder (BDD) in the OS population. While this study found the prevalence of BDD in the OS population to be 10%, it did not examine BDD’s co-occurrence with anxiety, depression, and obsessive-compulsive disorder (OCD). BDD is an extremely distressing disorder involving preoccupation with an imagined or exaggerated deformity. In this study, we investigated the presence of BDD and its comorbidity with anxiety, depression, and OCD in patients undergoing OS.

Methods & Materials.We recruited 89 patients from the outpatient Oral & Maxillofacial Surgery Clinic at Stanford University who requested OS. The incidence of BDD, depression, anxiety, and OCD in this population was assessed, preoperatively using the following self-report measures:  Body Image Dissatisfaction Questionnaire (BIDQ), Patient Health Questionnaire - 9(PHQ-9), Beck Anxiety Inventory (BAI), and Florida Obsessive-Compulsive Inventory (FOCI). 

Results.  Of the patients, 12% (n=10) screened positive for BDD.  Using Fisher’s exact test, there was no significance between gender, race, age or marital status for patients screening positive or negative for BDD. Depressive symptoms were reported by 38 % (n=33), with severities ranging from minimal symptoms (23%), Major Depression - mild (8%), Major Depression - moderately-severe (6%), and Major Depression – severe (1%).  In terms of anxiety, 8%, 7%, and 3% of the sample reported mild, moderate, and severe anxiety respectively.  Twenty-seven percent of patients endorsed the presence of OCD symptoms.  Spearman correlations revealed significant correlations between the BIDQ and the BAI (p=.0001), and the BIDQ and PHQ (p=.006).

Conclusion.  This is one of the first studies to estimate the prevalence of BDD within the OS population and the first to examine the comorbidity of BDD with depression, anxiety, and OCD symptomology.  Because studies examining cosmetic and dermatologic populations have shown poor outcome satisfaction among BDD patients, it is important to draw attention to the significant number of patients with BDD who present for OS surgery.  Theoretically, depression, OCD, and anxiety have considerable overlap with BDD and co-occurrence may be representative of greater severity of psychological distress.  OS populations should be routinely screened for BDD, and other psychological distress, to allow for the reassessment of patients’ expectations regarding the benefit of surgery.