Previous studies indicated that there many a relationship between mental health and seeking rhinoplasty [16]. Despite that most people request cosmetic surgery to feel better psychologically, yet for some subjects, this process may not give the expected results [8].
Some studies in this field revealed dissatisfaction with the physical appearance after surgery and showed that serious problems occurred for both the patient and the surgeon [17, 18].
Thus, seekers for rhinoplasty should be evaluated thoroughly for their motives and psychological disabilities prior to surgery to avoid the possible negative consequences [19, 20].
This preliminary study that we thought (for the best of our knowledge) that it is the first Egyptian study in this field, we examined a sample of rhinoplasty seekers to estimate the rate and profile of psychiatric morbidity among them.
The results of the current research indicate that DSM-IV Axis I and Axis II psychiatric morbidity comprised almost 50% of seekers for rhinoplasty. These results are consistent with some previous studies [4, 21].
In a cross-sectional study done by Alavi and co-investigators [18], two psychiatrists interviewed 306 patients seeking rhinoplasty who were referred from cosmetic surgery clinics. They used the DSM IV-TR criteria, and it was found that 126 (41%) of patients had an associated Axis I psychiatric disorders. A higher rate (75%) was recorded by Morselli and Maltz [17], and the difference could be attributed to different sociocultural contexts using different assessment tools of limited studies looking at the details of the psychopathology aspects. In contrast, Zojaji and his colleagues [22] found no significant personality disorders among subjects requesting rhinoplasty; this was the most frequent diagnostic category in our subjects. 15.2% labeled the diagnosis of mixed personality disorder, 6.8% borderline personality disorder, and 3.4% histrionic personality disorders. We are in partial agreement with the findings of Moore and Jefferson [23] who recorded that borderline, compulsive narcissistic and passive-aggressive personality disorders were encountered in their study among rhinoplasty seekers.
According to Ambro and Wright [2], the borderline patient is best identified prior to surgery and should be avoided, and also patients with a narcissistic personality, histrionic, or compulsive personality are poor operative candidates.
The prevalence of BDD is about 1% in the general population; however, it is 6 to 16 times more prevalent in esthetic surgical patients [24, 25].
Anxiety disorders including OCD were the second common Axis I diagnosis encountered in our sample (5%) followed by depression (3.4%). Almost similar findings were found by Alavi and his coworkers in the Iranian population [18].
Kisely and his colleagues [26] found that body dysmorphic disorder (BDD) is common among subjects who desired rhinoplasty; patients with this disorder often have dissatisfaction of their appearance from imagining a sense of being misshaped and thus they have needless cosmetic surgery [27].
Similarly, the most common Axis I diagnosis in the current study is the body dysmorphic (BDD) disorder (10.2%) while a lower rate (7%) was recorded by Sarwer and Crerand [28], on and the other hand, higher rates (24.5%, 32.5%, and 33%) were found by other investigators [18, 29, 30]. Differences could be attributed to different methods of assessment and diagnosis.
Mood disorders are not considered as a contraindication to cosmetic surgery; however, those patients should receive antidepressants and psychotherapy before undergoing this intervention [2].
The interest in cosmetic surgery such as rhinoplasty has been related to a number of sociodemographic variables. 81.4% of our subjects interested in rhinoplasty are women, and also 70% of them were having psychiatric morbidity. We are in concordance with previous studies in Iran that women who seek rhinoplasty outnumber men [18, 19].
In another culture, it was found that male patients seeking cosmetic surgery have been described to be more psychologically unstable. This point should be explored in socio-cultural perspective in future studies [31].
When we attempted to study some demographic variables related to the pattern of psychiatric morbidity in patients requesting rhinoplasty, we found that female patients suffered more frequently from either Axis II disorder (70%) (P = 0.03) or comorbid Axis I and II disorders. Single patients significantly seek cosmetic surgery more than married or divorced subjects (P = 0.02). Forty percent of those with Axis II disorder had a significant past history of cosmetic surgery (P = 0.01).
Body image as measured by the Multidimensional Body Self-Relation Questionnaire (MBSRQ) is compared to the reference population; the study group obtained significantly lower scores in appearance evaluation, fitness, and health evaluation. Previous investigators used the same tools stated that appearance orientation and appearance evaluation subscales are negative predictors for the interest in requesting the operation [32, 33]. Moreover, changes in self-evaluative body image are clearly associated with cognitive distortions or biases in information processing and with increased vulnerability to dysmorphic body image states [34].