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Importance of psychological screening for nonsurgical procedures may be underappreciated

Article-Importance of psychological screening for nonsurgical procedures may be underappreciated

Key iconKey Points

  • Formal psychological screening for patients requesting nonsurgical rejuvenation is not common
  • Recent pilot study evaluated probability of body dysmorphic disorder in patients seeking nonsurgical aesthetic medical procedures

Dr. Dzwierzynski
Just as it is for those interested in surgical cosmetic procedures, assessment for psychopathology should be a part of the pretreatment evaluation for patients seeking nonsurgical cosmetic rejuvenation, said William W. Dzwierzynski, M.D., at the 91st annual meeting of the American Association of Plastic Surgeons.

His comment was based on the findings of a pilot study including 35 patients seeking nonsurgical aesthetic medical procedures that found that appreciable proportions of this population suffered psychologic distress, low quality of life and a moderate to high probability of body dysmorphic disorder (BDD).

"Plastic surgeons are taught to routinely look for psychological issues in patients seeking cosmetic surgery, and particularly to identify BDD that occurs at an increased prevalence in this group and may be considered a relative contraindication for surgery. However, formal psychological screening is typically not done in patients requesting nonsurgical rejuvenation, based on the premise it may be less important for procedures that produce appearance changes that are generally modest and temporary," says Dr. Dzwierzynski, professor of plastic surgery, Medical College of Wisconsin, Milwaukee.

"Our findings on the psychosocial profiles of patients requesting nonsurgical cosmetic enhancements suggest that surgeons may be remiss in omitting an evaluation for psychopathology in this population. Although further study is needed to determine the impact of nonsurgical cosmetic procedures in patients with pre-existing psychopathology, we believe undertaking a brief screening to identify psychosocial issues preoperatively is justified and prudent."

STUDY DETAILS The patients enrolled in the study were predominantly female (91 percent) and ranged in age from 32 to 66 years (mean 46). The procedures they underwent included botulinum toxin injection, filler injections, dermabrasion, chemical peels and laser resurfacing. About one-fourth of the patients had previous cosmetic surgery.

The psychosocial evaluation was composed of a battery of three validated questionnaires that were administered by a licensed psychologist, Elizabeth Stern, Psy.D., professor of psychology, Milwaukee Area Technical College. They included the Body Dysmorphic Disorder Questionnaire (BDDQ), which screens for BDD based on DSM-IV criteria; the Brief Symptom Inventory (BSI), which measures nine common areas of psychopathology; and the Quality of Life Inventory (QOLI), which assesses importance and satisfaction across 16 domains.

Comparisons of mean scores on the various questionnaires to the respective normative control groups showed that the study population had a significantly higher QOLI score and a similar Global Symptom Index score for the BSI. However, on the QOLI, the score for five patients (14 percent) fell into the "very low" category, and the BSI score was significantly elevated, indicating significant psychological distress, for three (9.4 percent) patients.

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