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Identification and Management of Mental Health Issues by Dermatologic Surgeons: A Survey of American Society for Dermatologic Surgery Members

Sarwer, David B. PhD*,†,‡,§; Spitzer, Jacqueline C. MSEd*; Sobanko, Joseph F. MD§,‖; Beer, Kenneth R. MD, FAAD‖,¶

doi: 10.1097/DSS.0000000000000279
Original Article

BACKGROUND Dermatologists have long been interested in mental health issues of their patients. Some psychosocial distress likely motivates the pursuit of cosmetic dermatologic treatments. However, a percentage of patients seeking treatment suffer from significant psychopathology, such as body dysmorphic disorder (BDD), which may contraindicate treatment.

OBJECTIVE To assess dermatologic surgeons' strategies for identification and management of mental health issues among patients seeking cosmetic procedures.

MATERIALS AND METHODS A survey was sent to 2,855 practicing members of the American Society for Dermatologic Surgery by e-mail.

RESULTS Two hundred sixty members completed the survey (9.1%). Approximately, 60% of respondents indicated that they ask new patients about psychiatric treatment history, and 92% reported that they have declined to provide a cosmetic treatment because of concerns about mental health status. Most (94%) indicated that they were aware of BDD, and 62% indicated that they refused to treat a patient believed to have BDD. Respondents estimated that 13% of new patients had BDD and 63% considered BDD to be a contraindication to treatment.

CONCLUSION Approximately 60% of dermatologic surgeons inquire about the mental health issues of their cosmetic patients. Most are aware of BDD, but less than two-thirds consider it a contraindication to treatment.

*Department of Psychiatry, Center for Weight and Eating Disorders, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania;

Division of Plastic Surgery, Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania;

Children's Hospital of Philadelphia, Philadelphia, Pennsylvania;

§Edwin and Fannie Gray Hall Center for Human Appearance, University of Pennsylvania, Philadelphia, Pennsylvania;

Department of Dermatology, Hospital of University of Pennsylvania, Philadelphia, Pennsylvania;

Kenneth Beer, MD PA, General, Surgical and Esthetic Dermatology, West Palm Beach, Florida

Address correspondence and reprint requests to: David B. Sarwer, PhD, 3535 Market Street, Suite 3108, Philadelphia, PA 19104, or e-mail: dsarwer@mail.med.upenn.edu

D. B. Sarwer has consulting relationships with BAROnova, EnteroMedics, and Kythera. K. R. Beer is a consultant and investigator for Allergan, Valeant, Anterios and a shareholder in Theraplex LLC and Anterios. The remaining authors have indicated no significant interest with commercial supporters.

© 2015 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. All rights reserved.
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