Body image and personality disorders in cosmetic surgery settings

Objectives: Psychiatric disorders characterized by body image disorder (BID) such as body dysmorphic disorder, are relatively common in cosmetic surgery settings and several authors suggested the need for a preoperative clinical evaluation of Axis I and Axis II comorbidity. Study 1 investigated the prevalence of Personality Disorders (PDs) and Study 2 investigated the comorbidity between BID and PDs in patients seeking cosmetic surgery. Methods: Sixty two patients (study 1) scheduled for aesthetic rhinoplasty (62,9% F; Mage = 34.47 ± 10.69 ys) and 80 patients (study 2) scheduled for profile, breast and body contouring cosmetic surgery from two Italian hospitals (91% F; Mage = 32.68 ± 3.63) completed the Body Uneasiness Test (BUT) and the Personality Diagnostic Questionnaire - 4+ (PDQ-4+) with the exception of the items relating to two appendix PDs. Results: 19.6% and 17.5% of subjects (study 1 and 2, respectively), had at least 1 PD. In both studies, cluster B and C PDs are the most prevalent. In particular, the five most prevalent PDs were: obsessive-compulsive, avoidant, narcissistic, borderline and histrionic PD. In study 2, using the BUT cut-off score as a marker of clinical significance, 43.8% of subjects had a BID and all PD patients showed comorbidity with BID. Conclusion: Our study supports the evidence that PDs and BIDs are common in cosmetic surgery settings, as well as the importance of preoperative clinical evaluation of these disorders.