The results of this study in an Iranian cohort are consistent with previous research in Western societies which found that body dysmorphic disorder and mental problems were more prevalent in candidates for rhinoplastic surgery. Scores in both DCQ and GHQ were significantly higher among people who were candidate for rhinoplastic surgery than the control group. The study group also scored higher in all sub-scales of GHQ but the somatization subscale. Although one would expect these subscores to be higher in the study group, the absence of this might be because people who had physical complaints were excluded.
Social function of people in the study group was found to be impaired more than in the control group. This finding is consistent with previous studies 14
and can be due to time-consuming involvement of patients with their appearance and time spent on applying cosmetics to correct the assumed defect 14
However, it can also be due to their lowered social selfesteem because of a negative self-image. Although the higher GHQ scores can be related to the effects of a negative self-image due to dissatisfaction with appearance, one can also suggest that a negative attitude toward appearance can be the physical expression of unconscious emotional problems, that at the same time produce some levels of depression and anxiety.
An important difference of our study with others is that most of the cases in our study were women. This is because women in Iran seek cosmetic plastic surgery more often than men, in contrast to other countries.
Like previous studies, the results of this study show the importance of mental health assessment of patients who seek plastic surgical treatments. As it is already shown, people with body dysmorphic disorder request more plastic surgical treatments than other people. However, the rate of dissatisfaction after surgery is significantly higher in these individuals. They also sue their surgeons more than others due to this dissatisfaction.
Body dysmorphic disorder can be treated with psychotherapy, medication, or both. Cognitive behavioural therapy (CBT) and selective serotonin reuptake inhibitors (SSRIs) are effective in treating body dysmorphic disorder, and their combination is more effective than either alone 15
One limit of this study is the lack of any structured psychiatric assessment by instruments such as the SCID. We did not make diagnoses according to DSM-IV criteria or make use of DSM-IV-derived diagnostic tools, which limits our findings. Additionally, the level of dissatisfaction of patients undergoing rhinoplastic surgery was not assessed using specific instruments. Patients with known severe neurologic or psychiatric disorders such as epilepsy or psychosis were also excluded, and groups were not matched according to the size and shape of nose. Furthermore, no assessment of DCQ after surgery was made, which should be considered in future studies. Moreover, individuals with apparently malformed nose (from cosmetic view) were not included in the case group which limits the study results. Lastly, patients were not checked to fulfil the first criteria of body dysmorphic disorder, but were only verified to have no apparent nose malformation (cosmetically).