RESUMO
Body dysmorphic disorder (BDD) has been considered the most relevant neuropsychiatric condition to cosmetic treatments. Patients' ideal expectations often exceed what is expected to be achieved in reality by plastic surgery, signaling the presence of BDD. It is fundamental to detect BDD symptoms during screening for cosmetic surgery. A secondary concern with physical appearance may be one of the most important parameters to be detected during patient assessment, as it may interfere with overall patient satisfaction following treatment. A good doctor-patient relationship is essential for detecting this psychopathology. Mild-to-moderate BDD is not an exclusion criterion for cosmetic surgery, but specific treatment planning and a multidisciplinary approach are required. Recent studies have presented preliminary evidence for the effectiveness of cosmetic procedures in reducing BDD symptoms and providing patient satisfaction with treatment results. The use of validated instruments at pre- and postoperative assessments to systematically evaluate the patient's level of distress with the physical appearance and patient satisfaction with treatment results will provide important information for the development of more sensitive validated tools for detection of severe levels of BDD symptoms to help plastic surgeons in the selection of patients in a more effective and practical manner.Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
Assuntos
Transtornos Dismórficos Corporais/cirurgia , Transtorno Obsessivo-Compulsivo , Rinoplastia , Cirurgia Plástica , Humanos , Relações Médico-Paciente , Prevalência , Inquéritos e QuestionáriosRESUMO
BACKGROUND: Rhinoplasty is one of the most sought-after procedures in plastic surgery by individuals with body dysmorphic disorder (BDD). The identification of BDD symptoms is a challenge for plastic surgeons. The purpose of this study was to use a specific instrument for detection of BDD symptoms as a screening tool in rhinoplasty candidates and estimate the prevalence and severity of BDD symptoms in this population. METHODS: Eighty patients of both sexes seeking rhinoplasty were consecutively recruited at a plastic surgery outpatient clinic of a university hospital from February 2014 to March 2015. In a clinical interview, 50 of them showed an excessive preoccupation with physical appearance associated with clinically significant subjective distress and were, therefore, selected to participate in the study. All participants were assessed using the Brazilian-Portuguese versions of the Yale-Brown Obsessive Compulsive Scale modified for BDD (BDD-YBOCS) and the Body Dysmorphic Symptoms Scale (BDSS), which can be applied by plastic surgeons, who are laypersons in psychology/psychiatry. RESULTS: Twenty-four (48%, 24/50) candidates had BDD symptoms, and 27 (54%, 27/50) showed moderate to severe appearance-related obsessive-compulsive symptoms. A strong correlation was found between the BDSS and BDD-YBOCS scores (r = 0.841, P < 0.001), and a strong agreement was observed between the BDSS cutoff point and body dysmorphic disorder symptom status (kappa = 0.822). CONCLUSIONS: A high prevalence of BDD and moderate to severe appearance-related obsessive-compulsive symptoms was found among aesthetic rhinoplasty candidates. The BDSS may be used as a screening tool for BDD symptoms in plastic surgery patients. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
Assuntos
Transtornos Dismórficos Corporais/epidemiologia , Imagem Corporal/psicologia , Transtorno Obsessivo-Compulsivo/epidemiologia , Psicometria/métodos , Rinoplastia/métodos , Adulto , Distribuição por Idade , Transtornos Dismórficos Corporais/diagnóstico , Brasil/epidemiologia , Estudos de Coortes , Comorbidade , Feminino , Hospitais Universitários , Humanos , Masculino , Pessoa de Meia-Idade , Transtorno Obsessivo-Compulsivo/diagnóstico , Seleção de Pacientes , Prevalência , Estudos Retrospectivos , Rinoplastia/psicologia , Rinoplastia/estatística & dados numéricos , Distribuição por SexoRESUMO
OBJECTIVE: To identify changes in body image in patients with surgical wound dehiscence. DESIGN AND SETTING: This cross-sectional, descriptive, analytical study was conducted in a university hospital and nursing care center in Brazil. PATIENTS AND INTERVENTION: Sixty-one adult surgical patients of both genders from different inpatient wards or receiving outpatient care were selected. Forty-one participants had surgical wound dehiscence, and 20 had achieved complete wound healing (controls). MAIN OUTCOME MEASURE: The Body Dysmorphic Disorder Examination (BDDE), Body Investment Scale (BIS), and a questionnaire assessing clinical and sociodemographic characteristics of patients were used for data collection. MAIN RESULTS: Surgical wound dehiscence defects were 0.5 to 30 cm in length, located on the arms, legs, and chest. They were significantly associated with being white (P = .048), number of children (P = .024), and presence of comorbid conditions (P = .01). Overall, men reported higher BIS scores (positive feelings about the body) than women (P = .035). Patients with wound dehiscence had higher BDDE scores (negative body image) than controls (P = .013). The BDDE scores were associated with presence of surgical wound dehiscence (P = .013), number of children (P = .009), and wound length (P = .02). There were significant correlations between BIS scores in men with wound dehiscence (P = .042), number of children (P < .001), and BDDE scores (P < .001) and between BDDE scores and number of children (P = .031), wound length (P = .028), and BIS scores (P < .001). CONCLUSION: Surgical wound dehiscence had a negative impact on body image.
Assuntos
Imagem Corporal/psicologia , Qualidade de Vida , Deiscência da Ferida Operatória/psicologia , Inquéritos e Questionários , Fatores Etários , Assistência Ambulatorial , Brasil , Distribuição de Qui-Quadrado , Estudos Transversais , Feminino , Hospitais Universitários , Humanos , Masculino , Medição de Risco , Fatores Sexuais , Fatores Socioeconômicos , Estatísticas não Paramétricas , Deiscência da Ferida Operatória/diagnóstico , Deiscência da Ferida Operatória/terapiaRESUMO
BACKGROUND: Body image dissatisfaction is one of the major factors that motivate patients to undergo plastic surgery. However, few studies have associated body satisfaction with reduction mammaplasty. OBJECTIVES: The aim of this study was to evaluate the impact of breast hypertrophy and reduction mammaplasty on body image. METHODS: Breast hypertrophy patients, with reduction mammaplasty already scheduled between June 2013 and December 2015 (mammaplasty group, MG), were prospectively evaluated through the body dysmorphic disorder examination (BDDE), body investment scale (BIS), and breast evaluation questionnaire (BEQ55) tools. Women with normal-sized breasts were also evaluated as study controls (normal-sized breast group, NSBG). All the participants were interviewed at the initial assessment and after six months. Data were analyzed before and after six months. RESULTS: Each group consisted of 103 women. The MG group had a significant improvement in BDDE, BIS, and BEQ55 scores six months postoperatively (P ≤ 0.001 for the three instruments), whereas the NSBG group showed no alteration in results over time (P = 0.876; P = 0.442; and P = 0.184, respectively). In the intergroup comparison it was observed that the MG group began to invest more in the body, similarly to the NSBG group, and surpassed the level of satisfaction and body image that the women of the NSBG group had after the surgery. CONCLUSIONS: Reduction mammaplasty promoted improvement in body image of women with breast hypertrophy.
Assuntos
Imagem Corporal/psicologia , Mama/anormalidades , Hipertrofia/cirurgia , Mamoplastia/métodos , Satisfação do Paciente , Adulto , Mama/cirurgia , Feminino , Humanos , Hipertrofia/psicologia , Mamoplastia/psicologia , Pessoa de Meia-Idade , Qualidade de Vida , Resultado do Tratamento , Adulto JovemAssuntos
Abdominoplastia , Genitália Feminina , Psicometria , Qualidade de Vida , Autoimagem , Adulto , Tamanho Corporal , Brasil , Feminino , Humanos , Estudos Retrospectivos , Inquéritos e QuestionáriosRESUMO
OBJECTIVE: To evaluate self-esteem and body image in patients with venous leg ulcers (VLUs). DESIGN: A multicenter, prospective, descriptive, analytical, clinical study. SETTINGS: A nursing care and education center of a university hospital, a health center, and an outpatient wound care clinic in Brazil. PATIENTS: Fifty-nine consecutive adult patients with VLUs and Doppler ankle-brachial index ranging from 0.8 to 1.0 were recruited for the study. Exclusion criteria were mixed ulcers, arterial ulcers, and diabetic foot ulcers. MAIN OUTCOME MEASURES: A questionnaire assessing sociodemographic and clinical characteristics of patients, the Brazilian version of the Body Investment Scale, and the Rosenberg Self-esteem (RSE)/UNIFESP-EPM (São Paulo da Universidade Federal de São Paulo-Escola Paulista de Medicina) scale were administered to all patients. MAIN RESULTS: Most participants were women, aged between 60 and 70 years, and smokers; 33 (56%) were divorced, widowed, or single, and 26 (44%) were married. The patients had the ulcer for a mean of 5.42 years. Exudate and foul odor were present in most cases. Twenty-one ulcers (36%) measured 29 cm or less in surface area, and 17 (29%) ulcers measured between 30 and 49 cm (mean, 3.39 cm). The mean RSE score was 22.66, indicating low self-esteem. The mean Body Investment Scale total score was 27.49, and the scores on the body image and body touch subscales were also low, indicating negative feelings about the body. CONCLUSION: Patients with VLUs had low self-esteem and negative feelings about their bodies.
Assuntos
Imagem Corporal/psicologia , Autoimagem , Úlcera Varicosa/diagnóstico , Úlcera Varicosa/psicologia , Adulto , Fatores Etários , Idoso , Assistência Ambulatorial , Brasil , Distribuição de Qui-Quadrado , Doença Crônica , Estudos de Coortes , Feminino , Hospitais Universitários , Humanos , Úlcera da Perna/diagnóstico , Úlcera da Perna/psicologia , Úlcera da Perna/terapia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Medição de Risco , Índice de Gravidade de Doença , Fatores Sexuais , Fatores Socioeconômicos , Inquéritos e Questionários , Úlcera Varicosa/terapiaRESUMO
AIM: To translate into Brazilian Portuguese and cross-culturally adapt the Neonatal/Infant Braden Q Risk Assessment Scale (Neonatal/Infant Braden Q Scale), and test the psychometric properties, reproducibility and validity of the instrument. There is a lack of studies on the development of pressure ulcers in children, especially in neonates. METHODS: Thirty professionals participated in the cross-cultural adaptation of the Brazilian-Portuguese version of the scale. Fifty neonates of both sexes were assessed between July 2013 and June 2014. Reliability and reproducibility were tested in 20 neonates and construct validity was measured by correlating the Neonatal/Infant Braden Q Scale with the Braden Q Risk Assessment Scale (Braden Q Scale). Discriminant validity was assessed by comparing the scores of neonates with and without ulcers. RESULTS: The scale showed inter-rater reliability (ICC = 0.98; P < 0.001) and intra-rater reliability (ICC = 0.79; P < 0.001). A strong correlation was found between the Neonatal/Infant Braden Q Scale and Braden Q Scale (r = 0.96; P < 0.001). CONCLUSION: The cross-culturally adapted Brazilian version of the Neonatal/Infant Braden Q Scale is a reliable instrument, showing face, content and construct validity.
Assuntos
Úlcera por Pressão/etiologia , Medição de Risco/métodos , Medição de Risco/normas , Comparação Transcultural , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , PsicometriaAssuntos
Transtorno Depressivo/epidemiologia , Cirurgia Plástica/psicologia , Cirurgia Plástica/estatística & dados numéricos , Inquéritos e Questionários , Adolescente , Comportamento do Adolescente , Fatores Etários , Procedimentos Cirúrgicos Ambulatórios/estatística & dados numéricos , Brasil , Criança , Comportamento Infantil , Estudos Transversais , Transtorno Depressivo/diagnóstico , Feminino , Humanos , Masculino , Programas de Rastreamento/métodos , Psicometria/métodos , Reprodutibilidade dos Testes , Medição de Risco , Fatores SexuaisRESUMO
BACKGROUND: Body dysmorphic disorder may negatively affect self-perception of body shape and lead patients to seek cosmetic surgery. This study estimates the level of body dissatisfaction and prevalence of body dysmorphic disorder symptoms in candidates for three plastic surgical procedures. METHODS: Three hundred patients of both sexes divided into three groups (abdominoplasty, n = 90; rhinoplasty, n =151; and rhytidectomy, n =59) were classified as having (n =51, n =79, and n =25, respectively) or not having (n =39, n =72, and n =34, respectively) body dysmorphic disorder symptoms, based on the Body Dysmorphic Disorder Examination, which was administered preoperatively. RESULTS: Prevalence rates of body dysmorphic disorder symptoms in the abdominoplasty, rhinoplasty, and rhytidectomy groups were 57, 52, and 42 percent, respectively. Significant between-group differences were observed regarding age (p < 0.001), body mass index (p = 0.001), and onset of body dysmorphic disorder symptoms (p < 0.001). Within-group differences in body dysmorphic disorder severity were observed in the abdominoplasty (p < 0.001), rhinoplasty (p < 0.001), and rhytidectomy (p = 0.005) groups. Body dysmorphic disorder severity was significantly associated with degree of body dissatisfaction (mean Body Dysmorphic Disorder Examination total scores; p < 0.001), avoidance behaviors (p< 0.001), sexual abuse (p = 0.026), suicidal ideation (p < 0.001), and suicide attempt (p = 0.012). CONCLUSIONS: Abdominoplasty candidates showed the highest prevalence; rhytidectomy candidates exhibited the highest percentage of severe cases, and rhinoplasty candidates had the lowest percentage of severe cases.