๐ ็ธฝ็ฎ้ ๏ฝ ๐ ่ฑๆๅๆ๏ผๆฌ็ฏ๏ผ ๏ฝ ๐ ๅฎๆด็ฟป่ญฏ ๏ฝ โญ ็ฒพ่ฏ็ญ่จ
Body Dysmorphic Patients
Body Dysmorphic Patients
Body dysmorphic disorder (BDD) is the most common psychiatric condition seen in patients seeking cosmetic procedures.12 The Diagnostic and Statistical Manual of Mental Disorders 5 (DSM-5) defines BDD as โdistress due to a perceived physical anomaly.โ18 In a literature review, it was estimated that 6% to 15% of patients presenting for treatment in a surgical dermatology practice suffer from body dysmorphia.19 Another article noted that BDD occurs in 2.4% of the U.S. population and makes up 2% to 7% of patients in cosmetic surgery practices and 9% to 15% in dermatology practices.20 Although cosmetic practices generally see more female than male patients, body dysmorphia is equally common in both men and women in outpatient mental health settings.19,20 Any area of the body may be the focus of concern, though the most common BDD complaints involve the skin (such as scarring), hair, and nose.20 Because these patient concerns are โperceivedโ rather than real, it is not surprising that few patients are satisfied with any treatment: one study reported 75% of body
dysmorphic patients being dissatisfied with their results.21
The easiest way to screen for BDD during the consultation is to have the patient point out concerns while looking in a mirror. Confirm that you see what the patient sees. Unfortunately, some patients have a more subtle presentation of BDD. The issue may not become apparent until follow-up to a procedure while reviewing before and after photos. Whenever it becomes clear that a patient is not able to see what the physician and staff see, it is time to discontinue additional treatment. Tell the patient that unfortunately you are not seeing what she sees and, as such, you are unable to change it. Suggest that another aesthetic physician may serve her better. An official discharge from the practice is usually not necessary, just your empathetic acknowledgment that you wish you could help but you cannot, though check with your malpractice carrier regarding the advisability of discharging the patient from the practice.20