CRANIOMAXILLOFACIAL DEFORMITIES/COSMETIC SURGERY Body Dysmorphic Disorder and Psychological Distress in Orthognathic Surgery Patients Brooke Collins, MS, * Daisy Gonzalez,y Dyani Kalea Gaudilliere, DMD, MPH,z Puja Shrestha, DDS,x and Sabine Girod, MD, PhD, DDSk Purpose: Body dysmorphic disorder (BDD) is a distressing condition involving preoccupation with an imagined or exaggerated deformity. The purpose of our study was to investigate the presence of BDD and its comorbidity with anxiety, depression, and obsessive-compulsive disorder (OCD) in patients undergoing orthognathic surgery (OS). Materials and Methods: The present prospective study included 99 patients from the outpatient oral and maxillofacial surgery clinic at Stanford University who requested OS. The incidence of BDD, depres- sion, anxiety, and OCD was assessed preoperatively using validated self-report measures. To determine the prevalence of Axis I psychological symptoms among patients, the descriptive and bivariate statistics were computed. P < .05 was considered significant. Results: In our sample, 13 patients (13%) screened positive for BDD. We did not find any significant cor- relations between the presence of BDD and gender, race, age, or marital status. Depressive symptoms were reported by 42% of the patients, OCD symptoms by 29%, and mild, moderate, and severe anxiety by 14%, 5%, and 4%, respectively. Using Spearman correlations, we found significant correlations between BDD and anxiety, depression, and OCD (P < .01). Conclusions: The results of the present study suggest that the rates of BDD, depression, anxiety, and OCD are high in patients undergoing OS. Furthermore, we found a strong correlation between BDD and anxiety, OCD, and depression in these patients. Future studies are necessary to determine the postop- erative changes in these psychological disorders and whether these changes are affected by having positive BDD screening results at baseline. Ó 2014 American Association of Oral and Maxillofacial Surgeons J Oral Maxillofac Surg -:1-6, 2014 Orthognathic surgery (OS), also known as corrective jaw surgery, is considered functional surgery for the treatment of maxillomandibular dysfunction. Howev- er, the dramatic resolution of the maxillomandibular deformity also yields an esthetic value. Some studies have reported that 52 to 74% of patients will list facial appearance as their motivation for OS, 1,2 and several studies have suggested that OS patients and cosmetic surgery patients will have similar psychological motivations. 3 After surgery, satisfaction with the outcome has been grossly favorable, with reports of satisfaction as great as 92% 4-6 and reports of an increased quality of life. 7 For the few patients (<10%) who are dissatisfied with the surgical outcome, overarching psychological distress might be the culprit, rather than an *Graduate Student, Palo Alto University, Palo Alto, CA. yUndergraduate Student, Stanford University, Stanford, CA. zClinician Instructor, Oral Medicine and Maxillofacial Surgery, Stanford University School of Medicine, Stanford, CA. xVisiting Scientist, Oral Medicine and Maxillofacial Surgery, Stanford University School of Medicine, Stanford, CA. kChief, Oral Medicine and Maxillofacial Surgery, Stanford University School of Medicine, Stanford, CA. This research was presented and received a Best Paper Award at the American Association of Oral and Maxillofacial Surgeons Annual Meeting 2013. Address correspondence and reprint requests to Dr Girod: Department of Oral Medicine and Maxillofacial Surgery, Stanford University School of Medicine, 770 Welch Road, Suite 400, Stanford, CA 94305; e-mail: sgirod@stanford.edu Received December 17 2013 Accepted January 14 2014 Ó 2014 American Association of Oral and Maxillofacial Surgeons 0278-2391/14/00103-7$36.00/0 http://dx.doi.org/10.1016/j.joms.2014.01.011 1