Copyright © 2015 American Society of Plastic Surgeons. Unauthorized reproduction of this article is prohibited. www.PRSJournal.com 462 B ody dysmorphic disorder is a relatively com- mon and often severe psychiatric disorder that is possibly underdiagnosed and under- reported. 1,2 According to the Diagnostic and Statisti- cal Manual of Mental Disorders (Fifth Edition), body dysmorphic disorder is characterized by a preoccu- pation with one or more perceived defects or laws in physical appearance that are not observable or appear slight to others, and repetitive behav- iors (e.g., mirror checking, excessive grooming, skin picking, reassurance seeking) or mental acts (e.g., comparing his or her appearance with that of others) in response to appearance concerns. It causes clinically signiicant distress or impairment in important areas of functioning, and its symp- toms are not better explained by normal concerns with physical appearance or by concerns with body fat or weight in individuals meeting diagnos- tic criteria for eating disorders. Body dysmorphic disorder symptoms may be associated with mus- cle dysmorphia, and body dysmorphic disorder Disclosure: The authors have no financial interest to declare in relation to the content of this article. A “Hot Topic Video” by Editor-in-Chief Rod J. Rohrich, M.D., accompanies this article. Go to PRSJournal.com and click on “Plastic Sur- gery Hot Topics” in the “Videos” tab to watch.” On the iPad, tap on the Hot Topics icon. Copyright © 2016 by the American Society of Plastic Surgeons DOI: 10.1097/01.prs.0000475753.33215.8f Maria José Azevedo de Brito, Ph.D. Fábio Xerfan Nahas, M.D., Ph.D. Táki Athanássios Cordás, M.D., Ph.D. Hermano Tavares, M.D., Ph.D. Lydia Masako Ferreira, M.D., Ph.D. São Paulo and Pouso Alegre, Brazil Background: Body dysmorphic disorder may negatively affect self-perception of body shape and lead patients to seek cosmetic surgery. This study estimates the level of body dissatisfaction and prevalence of body dysmorphic disorder symptoms in candidates for three plastic surgical procedures. Methods: Three hundred patients of both sexes divided into three groups (abdominoplasty, n = 90; rhinoplasty, n = 151; and rhytidectomy, n = 59) were classiied as having (n = 51, n = 79, and n = 25, respectively) or not having (n = 39, n = 72, and n = 34, respectively) body dysmorphic disorder symptoms, based on the Body Dysmorphic Disorder Examination, which was administered preoperatively. Results: Prevalence rates of body dysmorphic disorder symptoms in the abdominoplasty, rhinoplasty, and rhytidectomy groups were 57, 52, and 42 percent, respectively. Signiicant between-group differences were observed regarding age (p < 0.001), body mass index (p = 0.001), and onset of body dysmorphic disorder symptoms (p < 0.001). Within-group differences in body dysmorphic disorder severity were observed in the abdominoplasty (p < 0.001), rhinoplasty (p < 0.001), and rhytidectomy (p = 0.005) groups. Body dysmorphic disorder severity was signiicantly associated with degree of body dissatisfac- tion (mean Body Dysmorphic Disorder Examination total scores; p < 0.001), avoidance behaviors (p < 0.001), sexual abuse (p = 0.026), suicidal ideation (p < 0.001), and suicide attempt (p = 0.012). Conclusions: Abdominoplasty candidates showed the highest prevalence; rhyt- idectomy candidates exhibited the highest percentage of severe cases, and rhi- noplasty candidates had the lowest percentage of severe cases. (Plast. Reconstr. Surg. 137: 462, 2016.) From the Graduate Program in Translational Surgery and the Division of Plastic Surgery, Federal University of São Paulo; the Department of Psychiatry, University of São Paulo; and the College of Health Science, Sapucaí Valley University. Received for publicaton February 23, 2015; accepted September 17, 2015. Body Dysmorphic Disorder in Patients Seeking Abdominoplasty, Rhinoplasty, and Rhytidectomy COSMETIC