BDD diagnostic tools

While many BDD screening tools exist, sources advise selecting an approach that best fits one's practice and personality. The following list summarizes a few:

Accordingly, she says such tools are not realistic for busy dermatology practices.

Instead, she says, "The best way to screen these patients is to read some of the psychodermatologic literature. Anyone who is thinking of getting involved seriously with cosmetic procedures should perhaps be more acquainted with BDD, depression and monosymptomatic delusional disorders."

In addition to plastic surgeons and dermatologists, she says, "We are busy with maxillofacial surgeons, gynecologists and many other somatic doctors who want to identify which patients have BDD."

David Veale, M.D., a psychiatrist, says that, while such criteria can successfully identify BDD in dermatologic and psychiatric clinics, they haven't been tested in cosmetic surgery clinics.

Richard Fried, M.D.,Ph.D., adds, "There is consensus by the DSM regarding what the diagnostic criteria are. But they're not necessarily applicable to the cosmetic realm."

"The longer the list," Dr. Fried says, "the more unpleasable the patient."

In this area, Dr. Fried says, "Try to get them to be specific. I can't do a procedure based on the statement 'My skin looks crummy.'"

Subsequent steps include targeting one or two problems, envisioning what treatment will accomplish ("My wife won't leave me," for example) and proactively setting an appointment if appropriate.

Overall, Dr. Fried says that with an abundance of diagnostic tools available, "I'm not sure that which one you use is necessarily as important as whether you consider asking some appropriate questions," if not on paper, then at some point during the encounter.

The average physician may avoid written surveys for fear of scaring patients off, he adds.

Accordingly, Dr. Fried says, "One may want to have one's medical assistant ask a few well-placed questions," perhaps noting unusual answers on the patient's chart to save time and copying costs.

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