Considering that the article “Should Plastic Surgeons Operate on Patients Diagnosed with Body Dysmorphic Disorder?” is a “letter of intent,” the questions raised in our original letter were aimed at engaging scholars and experts in a discussion of issues related to body dysmorphic disorder, a phenomenon that has been observed in many cultures and during different historical periods.1 Although this seems to be a recent phenomenon, it was first described by Enrico Morselli in 1886.2 Clinical observations of patients with this profile have opened new perspectives and possibilities for research on body dysmorphic disorder in cosmetic surgery. Body dysmorphic disorder is a psychiatric condition related to body image and associated with cosmetic surgery, which indicates the existence of an interface between this surgical specialty and psychiatry. This highlights the importance of a comprehensive assessment of candidates for cosmetic surgery to identify patients with body dysmorphic disorder.
Paolo G. Morselli, a contemporary researcher, agrees with the view and arguments presented in our original letter, and highlights the importance of this interface when investigating dysmorphopathies.3 Thus, the importance of psychological screening of patients seeking cosmetic surgery; the patient-doctor relationship; and the association between motivation, expectations, and level of patient satisfaction was reiterated. There is no doubt that the analysis of these variables will allow the prediction of patient satisfaction with cosmetic surgery outcomes.4 The concept of “dysmorphopathy” defined by Morselli3 as a more comprehensive term to refer to all conditions of psychological distress related to body image and the classification of dysmorphopathies created for plastic surgery patients may simplify the concept of body image in body dysmorphic disorder.3
Changes in perception of body image are common in many mental disorders. Body dysmorphic disorder can be seen as an extreme on a continuum of the normal body image concerns that may cause impairment of global functioning, dramatically affecting the quality of life of the individual.5 Thus, body image in body dysmorphic disorder has specific characteristics that need to be identified for the precise diagnosis of this heterogeneous condition frequently associated with comorbidities.
In fact, our clinical experience has shown that body dysmorphic disorder is not an exclusion criterion for cosmetic surgery, provided that the symptoms are mild. Thus, cosmetic surgery may be considered a treatment option for some body dysmorphic disorder patients. Further prospective studies are necessary to improve the decision-making of plastic surgeons and psychiatrists regarding the risks and benefits of cosmetic surgery for body dysmorphic disorder patients.
The authors have no financial interest to declare in relation to the content of this communication. No outside funding was received.
Maria José Azevedo de Brito, Ph.D.
Division of Plastic Surgery
Fábio Xerfan Nahas, M.D., Ph.D.
Lydia Masako Ferreira, M.D., Ph.D.
Division of Plastic Surgery
Department of Surgery
Universidade Federal de São Paulo
São Paulo, Brazil
1. de Brito MJ, Nahas FX, Ferreira LM. Should plastic surgeons operate on patients diagnosed with body dysmorphic disorder? Plast Reconstr Surg.. 2012;129:406e–407e
2. Morselli E, Jerome L. Dysmorphophobia and taphephobia: Two hitherto undescribed forms of insanity with fixed ideas. Hist Psychiatry. 2001;12:103–107
3. Morselli PG, Boriani F. Should plastic surgeons operate on patients diagnosed with body dysmorphic disorders? Plast Reconstr Surg.. 2012;130:620e–622e
4. de Brito MJ, Nahas FX, Barbosa MV, et al. Abdominoplasty and its effect on body image, self-esteem, and mental health. Ann Plast Surg.. 2010;65:5–10
5. Lambrou C, Veale D, Wilson G. Appearance concerns comparisons among persons with body dysmorphic disorder and nonclinical controls with and without aesthetic training. Body Image. 2012;9:86–92