Some Nose-Job Patients May Have Mental Illness

Some Nose-Job Patients May Have Mental Illness
By TARA PARKER-POPE

Many people who complain about the size or shape of their noses show signs of mental illness, a new study suggests.

About one in three people seeking rhinoplasty — commonly called a nose job — have signs of body dysmorphic disorder, a mental health condition in which a person has an unnatural preoccupation with slight or imagined defects in appearance.

The findings are based on a study of 266 patients evaluated by plastic surgeons in Belgium over a 16-month period. The patients made appointments to discuss a rhinoplasty procedure and were given a questionnaire to assess their symptoms of body dysmorphic disorder. Among those seeking the procedure for medical reasons — to correct a breathing problem, for example — only 2 percent of patients exhibited symptoms of the disorder. But among patients seeking to change their noses for cosmetic reasons, 43 percent showed signs of the disorder, expressing an unreasonable preoccupation and distress about their bodies despite having noses that were relatively normal. Over all, 33 percent of patients in the study showed symptoms of the disorder.

The study, published in the August issue of Plastic and Reconstructive Surgery, shows a surprisingly high rate of body dysmorphic disorder among nose-job patients. Previous studies have shown that about 10 percent of patients seeking plastic surgery suffer from the condition.

Doctors say it is important to note that a person who is highly distressed about his or her appearance because of a very prominent or misshapen nose isn’t necessarily showing signs of body dysmorphic disorder.

“We know body image dissatisfaction falls on a continuum, and there has to be some degree of dissatisfaction that leads us to see a plastic surgeon in the first place,” said David B. Sarwer, associate professor of psychology at the Center for Human Appearance at the Perelman School of Medicine at the University of Pennsylvania. “It’s when it begins to interfere with daily functioning. Patients with more severe B.D.D. struggle to maintain social relationships and have difficulty getting to work or staying employed.”

Dr. Sarwer, who wrote a discussion article accompanying the study, said that while it is normal to be dissatisfied with one’s appearance, most people don’t let minor facial or body flaws disrupt their lives.

“Almost all of us will get up in the morning and look in the mirror and see something in our appearance we may not like or wish looked different,’’ said Dr. Sarwer. “But for patients with B.D.D., that thought never leaves their mind. They are chronically thinking about their nose, checking in the mirror or a reflective surface, or they avoid situations where people can see their profile. You can see that is a distraction and can make it hard to focus on jobs or studies or family.’’

In the recent study, the researchers found no relationship between the level of body dysmorphic disorder and the level of abnormality in the nose. In many cases, patients showing signs of the disorder often were complaining about noses that most people would consider to be normal.

Doctors said more study was needed to follow up on the Belgian study to determine whether people seeking nose jobs have higher rates of body dysmorphic disorder than those seeking breast enhancement, face-lifts or other forms of cosmetic enhancement.

Dr. Phillip Haeck, a Seattle plastic surgeon and president of the American Society of Plastic Surgeons, said the organization advises doctors not to proceed with surgery for patients who exhibit signs of the disorder.

“The biggest mistake is to offer to operate on them, because the chances that they will be satisfied afterward, no matter how good the shape of the nose may be, are very low,” said Dr. Haeck.

Dr. Haeck said he has encountered patients in his practice who clearly exhibit signs of body dysmorphic disorder, but it is often difficult to convince them to seek therapy.

“Often patients who have this can’t stop looking at themselves,’’ said Dr. Haeck. “When I’ve encountered cases like this, I’ve found it difficult to make eye contact. They tend to stand in the mirror in the examination room and look at themselves throughout the exam.”