Does body dysmorphic disorder have implications for bariatric surgery?

Body dysmorphic disorder (BDD) is a condition in which an individual perceives an area of their body to be fundamentally flawed. Individuals may notice small imperceptible blemishes that become the epicenter for obsessional repetitive ritualistic behaviors that can force them to spend many hours in front of mirrors examining and reexamining the same area. Any area of the body may become the perceived area of attention, but in general the most frequently reported areas are hair, face, breasts, stomach, and thighs. These problem areas may be explored for up to 8 hours/day. There is a strong association with obsessive compulsive disorder, and BDD is found in 37% of those with the condition, with a lifetime prevalence of 83%. Even though the Diagnostic and Statistical Manual of Mental Disorders has no specific diagnostic category for BDD within an obese population, evidence has shown that many individuals seeking weight loss surgery report a number of psychological and physiological reasons. Body image dissatisfaction is a major contributing factor in the motivation to elect for surgical intervention. The events that occur after bariatric surgery with regards to BDD, body image, and quality-of-life (QoL) have remained largely unexplored. However, studies suggest that the antecedents to BDD, including anxiety and depression, are reported to be much improved following bariatric surgery. Individuals who have dramatic and relatively sudden weight loss following bariatric surgery often have postoperative skin folds. The skin folds can become a source of frustration and anxiety, and can even prevent further weight loss. It is suggested that the individual’s new body image may become a source of deep frustration, shame, and even humiliation.