Preoperative Screening for Body Dysmorphic Disorder in Facial Plastic Surgery: Protocol Development and Validation

Body Dysmorphic Disorder (BDD) is characterized by recurrent thoughts related to one or more perceived defects in physical appearance, which are either nonexistent or minimal to others, leading to emotional distress and impairments in social, occupational, and emotional functioning. The prevalence of BDD among individuals seeking plastic surgery is significantly higher than in the general population. It is therefore essential for plastic surgeons to identify individuals at greater risk for BDD. Several questionnaires are available for this purpose, typically administered by mental health professionals, with the Yale-Brown Obsessive-Compulsive Scale Modified for Body Dysmorphic Disorder (BDD-YBOCS) regarded as the gold standard. This study aimed to develop and validate a questionnaire designed for easy use by the attending physician, using the Brazilian Portuguese-translated BDD-YBOCS as a validation instrument.

This prospective cross-sectional study enrolled adults seeking primary or secondary facial plastic surgery at Hospital Paranaense of Otorhinolaryngology (January 2022-July 2024). Participants completed two questionnaires: a PILOT instrument developed from validated BDD tools and the BDD-YBOCS administered by a psychologist. Total scores were calculated, and thresholds defined to classify BDD probability.

A total of 149 patients participated in the study, responding to both the PILOT questionnaire and the BDD-YBOCS. There was a strong correlation between the scores of the PILOT questionnaire and the BDD-YBOCS, with a Spearman's correlation coefficient of 0.79 (p < 0.001). The PILOT questionnaire demonstrated a sensitivity of 88.6% and a specificity of 77.2%. Internal consistency was excellent, with a Cronbach's alpha estimated at 0.91.

The PILOT questionnaire was validated successfully, proving to be a practical and reliable tool for use by attending physicians in identifying the possible presence or signs of BDD.

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