Author’s Disclosure Block: David Jordan, none

Abstract Body
Purpose: Body Dysmorphic Disorder (BDD) is a psychiatric disturbance with a high incidence in aesthetic clinical settings. Early recognition may avoid unnecessary elective procedures with ethical and medicolegal consequences. The Purpose: of this paper is to describe the dysmorphic Concern Questionnaire (DCQ), its usefulness for the assessment of dysmorphic concerns, and how the author uses it in clinical practice. Study Design: Retrospective case series and Systematic review. Methods: The author gave the DCQ questionnaire to all consecutive cosmetic patients seeking blepharoplasty over the past 5 years. After each clinical encounter, the author evaluated the likelihood the patient had mild, moderate or severe dysmorphic concerns, and whether they were a god, or poor risk for surgery. Results: While BDD screening enables the recognition of at-risk individuals, further study is required to confirm the best screening tool for general aesthetic clinical practice. The Dysmorphic Concern Questionnaire (DCQ) is a sensitive, specific and validated screening tool that can be carried quickly and without any complicated interpretation or analysis by an expert in psychological testing. The author reviews how he uses it clinically. Conclusions: Body Dysmorphic disorder (BDD) is a relatively common condition across facial plastic and oculoplastic surgery practice settings. It often remains unrecognized as surgeons have a poor ability to screen for patients with BDD when compared to validated screening instruments such as the Dysmorphic Concern Questionnaire (DCQ). Negative body beliefs where the individual spends a great deal of time worrying about perceived flaws in their appearance (dysmorphic concerns) is the hallmark of BDD. Although the existence of dysmorphic concerns does not necessarily imply a diagnosis of BDD, a high score on the DCQ (>9) is suggestive, and is also associated greater postoperative pain scores, greater complication rates and higher reoperation rates. Routine implementation of validated BDD screening instruments (e.g., DCQ) may improve patient care, as well as patient and physician safety.