Researchers report in a new study that giving patients a self-administered screening as part of their routine intake is a feasible and effective way to identify patients with body dysmorphic disorder (BDD).
A team of Johns Hopkins University School of Medicine researchers set out to validate and assess the feasibility of the Body Dysmorphic Disorder Questionnaire (BDDQ) developed by Katherine Phillips, M.D., director of the BDD Program at Rhode Island Hospital, for use in a facial plastic and reconstructive surgery clinic.
Dr. Phillips is chief of outpatient services, director of the Body Dysmorphic Disorder and Body Image Program at Butler Hospital, and assistant professor of psychiatry and human behavior at Brown University School of Medicine in Providence, RI.
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In the study, Jacob Dey, B.S., Masaru Ishii, M.D., Maria Phillis, J.D., Patrick Byrne, M.D., Kofi Boahene, M.D., and Lisa Ishii, M.D., looked at implementing a standardized process of identifying BDD patients and assessing the comorbidities of BDD, depression and anxiety among patients in a busy practice. Their study population included 234 consecutive patients at the clinic who were 18 years and older, from March 3 to June 30, 2014. They used the BDDQ and validated their findings with the criterion-standard BDD Structured Clinical Interview for DSM-IV and a defect severity scale.
Within the study population, researchers found that more than 13 percent of cosmetic surgery patients and 1.8 percent of reconstructive surgery patients presented with validated BDD. “We found the BDDQ to be an accurate (91.7%), sensitive (100%), and specific (90.3%) screening instrument for BDD,” they report.
According to their findings, patients suffering from the disorder were concerned with areas often addressed by cosmetic surgeons. The nose was the most common concern among patients (58 percent) with BDD. Twenty-eight percent were concerned with their skin. Among the three remaining BDD patients, concerns were hair, chin and ears. Depression and anxiety scores were also higher in BDD patients than in those who were found to not have the disorder.
Based on their results, the authors stress the importance of implementing a systematic process for identifying cosmetic patients with BDD and believe the BDDQ is “a feasible and effective way to identify patients with BDD.”
Using the BDDQ in Practice
The screening is easy to incorporate into daily practice, according to the study’s senior author Lisa E. Ishii, M.D., M.H.S., associate professor, facial plastic and reconstructive surgery at Johns Hopkins School of Medicine. According to Dr. Ishii, aesthetic practitioners should have each patient complete the survey before or after their visit.
“We have the patients complete it on a tablet prior to seeing the physician. If any patient screens positive, that is flagged to the nurse, so everyone is aware before the visit. For patients who screen positive, further diagnostic questions are asked,” explains Dr. Ishii.
The screening process, which is self-administered by the patient, takes only minutes and becomes part of routine intake, according to Dr. Ishii.
Download the BDDQ
The BDDQ is available for clinicians, researchers and individual patients who wonder if they may have BDD. The questionnaire, which takes 1 to 5 minutes to administer, is designed as a screening tool only. BDDQ results help to indicate which patients should undergo further diagnosis with the BDD Diagnostic Module. Both adolescent and adult versions of the BDDQ are available to download:
Katharine A. Phillips, M.D. The Broken Mirror: Understanding and Treating Body Dysmorphic Disorder. Revised and Expanded Edition. New York: Oxford University Press, 2005.