The Consequences of operating on Patients with BDD

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All surgeons have had or will have the unfortunate experience of operating on patients who become profoundly dissatisfied with the surgical outcome even when objectively the result is satisfactory. It is likely that many of these patients were not diagnosed with BDD prior to them becoming unwittingly operated on. A minor problem such as wound healing, scar, numbness or persistent bruising can trigger profound dissatisfaction or the BDD "attack," No amount of encouragement or support will mitigate their disappointment and these people become the total focus of you and your staff's working and out-of-office time often at the expense of other patients in the practice. The stress levels of the treating surgeon and his/her

Dysmorphic Concern Questionnaire
Fig. 18.3. A satisfied cosmetic surgery patient has an improved body image and self-esteem

Table 18.1. Body dysmorphic disorder questionnaire

Body Dysmorphic Disorder Questionnaire (BDDQ)


This questionnaire assesses concerns about physical appearance. Please read each question carefully and circle the answer that best describes your experience. Also write in answers where indicated.

1. Are you very concerned about the appearance of some part(s) of your body that you consider especially unattractive?

If yes: Do these concerns preoccupy you? That is, you think about them a lot and wish you could think about them less?

If yes: What are they?

Examples of areas of concern include: your skin (e.g., acne, scars, wrinkles, paleness, redness); hair (e.g., hair loss or thinning); the shape or size of your nose, mouth, jaw, lips, stomach, hips, etc.; or defects of your hands, genitals, breasts, or any other body part.

If yes: What specifically bothers you about the appearance of these body part(s)? (Explain in detail):

(Note: If you answered "No" to either of the above questions, you are finished with this questionnaire. Otherwise please continue).

2. Is you main concern with your appearance that you aren't thin enough or that you might become too fat?

2/Body Dysmorphic Disorder Questionnaire (BDDQ)

3. What effect has your preoccupation with your appearance had on your life?

  • Has your defect(s) caused you a lot of distress, torment or pain?
  • Has it significantly interfered with your social life? If yes: How?

- Has your defect(s) significantly interfered with your (e.g., as a homemaker)?

- Are there things you avoid because of your defect(s)? If yes: What are they?

work, your job, or your ability to function in your role

  • Yes □ No
  • Yes □ No
  1. How much time do you spend thinking about your defect(s) per day on average? (circle one)
  2. Less than 1 h a day b) 1-3 h a day c) More than 3 h a day staff are increased dramatically. This worsens if the dissatisfied patient begins to threaten the physician with violence. Unchecked, the BDD patient often proceeds to litigation. Bodily harm and even murder of a surgeon are possible but an unlikely sequence. The following three cases , two patients I operated unwittingly on and another I reviewed for a colleague, demonstrate the diverse but disturbing sequelae of operating on patients with BDD.

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