Screening
Screening for BDD is highly recommended in both psychiatric and cosmetic treatment settings.[64] BDD is common in both settings.[7]
BDD is associated with poor functioning, poor quality of life, and high rates of suicidality.[32] However, it is often missed as the presenting condition.[64]
It is also important to screen for BDD in cosmetic/aesthetic treatment settings (for example, surgical, dermatological, dental settings), not only because BDD is common in these settings but also because cosmetic procedures are usually sought by patients with BDD but are virtually never helpful for BDD concerns.[35][52] Providing cosmetic treatment for BDD, especially surgery, can result in legal action and even violence against the provider, despite an objectively acceptable treatment outcome.[36]
Committee opinions from the American College of Obstetricians and Gynecologists state that individuals younger than 18 who request breast or labia surgery should be screened for BDD, and that individuals (women) should be assessed, if indicated, for BDD.[65][66] One rhinoplasty practice guideline from the American Academy of Otolaryngology states that presurgical diagnosis is imperative for patient safety and satisfaction, in part due to the potential for suicide or for legal or physical threats or action toward the surgeon.[67][68]
Use of appropriate, validated screening tools can enhance recognition of BDD.[64] When such screening measures are used, confirm the BDD diagnosis by clinician interview or use of one of the previously mentioned diagnostic instruments for BDD. Clinicians need to confirm, for example, that perceived appearance flaws are actually minimal or non-existent, that distress or impairment are clinically significant, and that concerns with body fat or weight are not better explained by an eating disorder.
Body Dysmorphic Disorder Questionnaire (BDDQ)
The Body Dysmorphic Disorder Questionnaire (BDDQ) screens for BDD. It is a 1- to 4-item self-report screening questionnaire that maps to the diagnostic criteria for BDD. It has good psychometric properties (sensitivity, specificity, accuracy) in psychiatry, facial plastic and reconstructive surgery, and dermatology settings.[53]
Body Dysmorphic Disorder Questionnaire - Dermatology Version (BDDQ-Dermatology Version)
The Body Dysmorphic Disorder Questionnaire - Dermatology Version (BDDQ-Dermatology Version) is virtually identical to the BDDQ except for a few minor wording differences and use of 5-point Likert scales (none, mild, moderate, severe, extreme) rather than dichotomised yes/no questions as on the BDDQ.[54]
Dysmorphic Concern Questionnaire (DCQ)
The Dysmorphic Concern Questionnaire (DCQ) is a self-report screening questionnaire that has good psychometric properties in psychiatric settings, although not all items reflect BDD symptoms.[55]
Cosmetic Procedure Screening Questionnaire (COPS)
The Cosmetic Procedure Screening Questionnaire (COPS) is a 9-item self-report screening questionnaire with good psychometric properties (reliability, validity, sensitivity) in a cosmetic surgery setting.[56]
When any of these screening measures are used, confirm the BDD diagnosis by clinician interview or use of one of the previously mentioned diagnostic instruments for BDD. Clinicians need to confirm, for example, that perceived appearance flaws are actually minimal or non-existent, that distress or impairment are clinically significant, and that concerns with body fat or weight are not better explained by an eating disorder.
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