Body dysmorphic disorder et chirurgie esthétique : réévaluation de 24 sujets ayant un défaut minime de l’apparence 5 ans après leur demande de chirurgie esthétique

Abstract

To evaluate the effect of cosmetic surgery in patients with a minimal defect in appearance, with and without body dysmorphic disorder (BDD), 5 years after their request for plastic surgery. Thirty patients requesting cosmetic surgery with a minimal defect in appearance, 12 diagnosed with BDD and 18 not, were contacted 5 years later for a telephone interview about their cosmetic surgery, their satisfaction with it, BDD diagnosis, handicap, and psychiatric comorbidity. Of the 30 patients, we were able to re-evaluate 24 subjects (80%), 10 with BDD and 14 without. Seven BDD subjects had undergone cosmetic surgery compared with 8 without BDD. Patient satisfaction with the intervention was high in both groups. Nevertheless at follow-up, 6 of the 7 BDD patients who had surgery still had a BDD diagnosis and showed higher levels of handicap and psychiatric comorbidity than their non-BDD counterparts. Moreover, 3 non-BDD patients had developed BDD at follow-up. The high level of satisfaction with their surgery expressed by BDD patients was surprising and in contrast to the literature. It may explain, together with the patients' strong insistence, why plastic surgeons do not fully agree with psychiatrists on the contraindication of plastic surgery for BDD patients. Nevertheless in our study, most of the BDD patients were still diagnosed with BDD 5 years after surgery, with a significant handicap. The BDD diagnosis at follow-up in patients initially without BDD might be related to the presence of sub-threshold symptoms at the initial evaluation. This prospective study confirms that cosmetic surgery is not effective against BDD despite patients' reported satisfaction. Cosmetic surgery had no significant effects on BDD diagnosis, handicap or psychiatric comorbidity in BDD patients 5 years after surgery. Furthermore, BDD appeared at follow-up in some subjects not initially diagnosed. Patients' reported satisfaction with surgery may help explain why some plastic surgeons do not consider BDD a complete contraindication to cosmetic surgery.