All published articles of this journal are available on ScienceDirect.
Prevalence of Body Dysmorphic Disorder (BDD) among Orthodontic Patients Compared to Community Population in Eastern Mediterranean Region
Abstract
Background and Objectives
Many orthodontists may recognize that some of their clinic's patients may have one or more abnormal physical or psychological conditions, such as Body Dysmorphic Disorder (BDD). The aims of this study were to screen and identify the prevalence of BDD among orthodontic patients using the COPS-BDD questionnaire. Additionally, the study aimed to compare the prevalence of BDD between orthodontic patients and the normal population (community group) in the Eastern Mediterranean region.
Material and Methods
Two groups of participants aged between 18-25 years old were recruited: a) Community group consisting of dental clinic visitors for operative procedures (n=503 participants), and b) Orthodontic patients' group comprising individuals seeking orthodontic treatment at orthodontic offices (n=500 participants).
Results
According to questionnaire guidelines, 7.36% and 11.2% of participants from the community group and orthodontic patients' group, respectively, were likely to have BDD with higher probability. Meanwhile, 16.7% and 12.4% of participants from these groups were still likely to have BDD but with lower probability. Females scored higher than males in both groups. In both groups, BDD was more common among females, with younger individuals showing higher likelihood of BDD. No significant differences in the mean scores of BDD subjects were observed when comparing the study groups. While there were no significant variations in the prevalence of BDD between both groups, the scores of questionnaire items suggested that subjects in the orthodontic patients' group received significantly higher scores than those in the community group, indicating a greater tendency to have BDD.
Conclusion
Body Dysmorphic Disorder (BDD) is a notable psychological condition that should be carefully investigated and addressed by orthodontists. It is recommended that BDD be routinely considered as part of the decision-making process in orthodontic offices.
1. INTRODUCTION
Nowadays, it is evident that there is a noticeable increase in patients seeking orthodontic treatment to enhance their physical attractiveness and quality of life. Every orthodontist may recognize that many of their clinic's patients could have one or more abnormal physical or psychological conditions, such as Body Dysmorphic Disorder (BDD) [1-4].
Historically, Morselli, in 1886, was the first to describe BDD as dysmorphophobia [1]. BDD was initially included in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-III) in 1987, referred to as 'dysmorphophobia' [5, 6].
1.1. Etiology
The age of onset of Body Dysmorphic Disorder (BDD) typically occurs during adolescence [7-9], although it can also start in childhood. The exact cause varies from individual to individual but may be attributed to a combination of biological, psychological, and environmental factors from their past or present experiences [10]. Additionally, abuse and neglect can also contribute to the development of BDD [5].
The causes of Body Dysmorphic Disorder (BDD) are multifaceted and not completely understood. Several risk factors are suggested for the onset of the disorder. These include:
- Biological/Genetic:
- Chemical imbalance in the brain.
- Genetic predisposition
- Abnormalities in the brain region.
- Visual processing
- Obsessive compulsive disorder
- Generalized anxiety disorder.
- Psychological:
- Teasing or criticism
- Parenting style
- Other life experiences: such as neglect, physical and/or sexual trauma, in security or rejection.
- Enviromental:
- Media: media pressure like glamour models and the implied necessity of esthetic beauty.
- Personality: Various personality traits have been suggested as potential contributing factors [9-11].
1.2. Common Symptoms & Compulsive Behavior associated with BDD
1.2.1. Common Symptoms of BDD
The primary cognitive feature of BDD is an excessive preoccupation with appearance and the belief that the imagined defect reflects a personal inadequacy. Individuals with BDD may go to great lengths to avoid exposing their perceived defect in public and often shun social interactions, fearing ridicule and believing that the defect signifies a personal shortcoming. In severe cases, this avoidance behavior can lead individuals to become housebound or even contemplate suicide [9, 12-15].- The primary symptoms of BDD can be categorized as follows [5]:
- Obsessive thoughts about perceived appearance flaws.
- Symptoms of major depressive disorder.
- Delusional thoughts and beliefs related to appearance.
- Withdrawal from social and family interactions, social phobia, loneliness, and self-imposed isolation.
- Suicidal thoughts.
- Anxiety and potential panic attacks.
- Chronic low self-esteem.
- Feeling self-conscious in social settings and experiencing strong feelings of shame.
- Inability to work or an inability to focus at work due to preoccupation with appearance.
1.2.2. Common Compulsive Behaviors of BDD
- Checking mirrors compulsively, glancing at reflective surfaces, or avoiding looking at one's own reflection or photos may lead to removing mirrors from the home.
- Trying to hide the perceived defect by using cosmetic camouflage, wearing loose clothing, maintaining specific body postures, or wearing hats.
- Engaging in distraction techniques to shift focus away from the perceived flaw, such as wearing flamboyant clothing or excessive jewelry.
- Excessive grooming behaviors like skin picking, hair combing, eyebrow plucking, shaving, etc.
- Compulsive touching of the skin, particularly to assess or feel the imagined defect.
- Extreme dieting or exercise, focusing heavily on external appearance.
1.3. Prevalence
Despite the studies and reports on the prevalence of Body Dysmorphic Disorder (BDD) among the general population or dental clinic patients, the exact ratios remain uncertain due to the gray area and diagnostic challenges [16]. Underdiagnosis and under-representation are likely as patients often keep their symptoms “secretive” [5].
According to national population-based surveys, the prevalence ratios of Body Dysmorphic Disorder (BDD) were 2.4% in the United States, 1.7-1.8% in Germany, and 2.3% in Australia [5]. Most studies indicate that BDD occurs in both sexes, although reports of sex bias vary. Initially, Phillips quoted a ratio of 1.3:1, female to male, but in later papers, the ratio is suggested to be approximately 1:1 [15].
Higher prevalence of Body Dysmorphic Disorder (BDD) in females is often observed in studies involving self-referrals, emphasis on body shape or weight, and less severe cases of BDD [17]. In a study conducted by Crerand et al. on non-psychiatric medical treatment, it was discovered that 71% of individuals with BDD sought such treatment, and 64% of them actually received it [18].
1.4. Implications for Orthodontics
Applying the diagnostic criteria for Body Dysmorphic Disorder (BDD) to patients seeking orthodontic treatment can present challenges. These criteria, focusing on individuals preoccupied with minor or perceived flaws in appearance, may overlap with those seeking aesthetic improvements. Many individuals opt for aesthetic procedures to enhance or correct minor imperfections in what is deemed as 'normal' features. Therefore, in the context of orthodontic patients, additional diagnostic criteria that evaluate the extent of functional impairment in daily activities may be more pertinent. It is crucial to thoroughly evaluate the specific feature of concern [19]. Patients who make multiple requests for orthodontic treatment or seek consultations from multiple providers (referred to as 'doctor-shopping'), whether before or after treatment, should raise suspicions of Body Dysmorphic Disorder (BDD) [20, 21]. It is essential to gather a detailed patient history and ensure clear and realistic communication of the patient's expectations. While there isn't a single question that can definitively diagnose Body Dysmorphic Disorder (BDD), diagnosis usually involves a combination of patient interviews, medical history review, and observation of consistent behavioral patterns [22-24].
Identifying patients who may have Body Dysmorphic Disorder (BDD) is crucial for facilitating access to the necessary treatment. It is recommended that individuals suspected of having BDD be referred to a psychiatrist or clinical psychologist for an accurate diagnosis and appropriate management, although this may pose challenges [23]. A study examining orthodontists in the UK regarding their opinions on referring orthognathic patients to a liaison psychiatrist or clinical psychologist offers insights into this matter [25]. The study showed that more than half of the orthodontists surveyed did not refer any patients for a psychiatric or psychological consultation, even though they believed it would be beneficial [25]. Reasons cited for not referring included not having anyone to refer to or fearing a negative reaction from the patient [25]. Currently, there are no published studies that have explored patients' responses to mental health referrals. This presents an opportunity for future research in this area. Orthodontists could benefit from additional education on local resources and training in effective communication skills to better convey the importance of further assessment and treatment for patients suspected of having Body Dysmorphic Disorder (BDD) [16]. This could enhance the overall care provided to patients with potential mental health concerns, such as Body Dysmorphic Disorder.
1.5. Cosmetic Procedure Screening Questionnaire (COPS) for Body Dysmorphic Disorder
Guidelines suggest screening patients for Body Dysmorphic Disorder (BDD) before undergoing cosmetic surgery to pinpoint those who may benefit from additional psychological evaluation [26]. The questionnaire for this purpose was developed by David Veale, Nell Ellison, Tom Werner, Rupa Dodhia, Marc Serfaty, and Alex Clarke [26]. The Cosmetic Procedure Screening Questionnaire (COPS) has been described as a tool that (a) is concise, available for free download, and capable of detecting individuals with Body Dysmorphic Disorder (BDD), (b) may forecast dissatisfaction with a cosmetic procedure or the absence of improvement or even worsening of BDD symptoms, and (c) could be responsive to changes following an intervention [8-10].
The Cosmetic Procedure Screening Questionnaire (COPS) requests information on the specific feature(s) that the individual perceives as unattractive, details about the cosmetic procedures they are considering, and includes diagnostic criteria for Body Dysmorphic Disorder (BDD). The final version of the COPS questionnaire consists of 9 items, with each item scored from 0 (least impaired) to 8 (most impaired). The scale and a comprehensive version of the paper are accessible for download at http://www.iop.kcl.ac.uk/cadatquestionnaire. The score on the Cosmetic Procedure Screening Questionnaire (COPS) is calculated by adding up the scores from Items 2 to 10. Items 2, 3, and 5 are reverse-scored. The total score ranges from 0 to 72, where a higher score indicates higher levels of impairment [26, 27].
1.6. Aims of Study
The aims of this study were:
- 1- To screen and identify the prevalence of Body Dysmorphic Disorder (BDD) among orthodontic patients.
- 2- To compare the prevalence of BDD between orthodontic patients and the general population (community group) in the Eastern Mediterranean region.
- 3- To compare the prevalence of BDD between males and females.
2. MATERIAL AND METHODS
2.1. Sample
This study was approved by the Ethics Committee of Tishreen University (Ethical Permission No 11733 on 22-12-2022). This study was conducted in accordance with the Declaration of Helsinki for human studies in 2013. This study was conducted from January 2023 to January 2024. The sample size was determined according to the G power software, which a 95% confidence level, the size of the total population. The required sample size according to the 95% confidence level, was 900 participants.
2.1.1. The Inclusion Criteria
- The participants had to be over 18 years of age.
- Willing to participate in the study.
- Fill out the questionnaire.
2.1.2. The Exclusion Criteria
Patients with physical deformities, craniofacial syndromes, cleft lip and/or palate, and skeletal malocclusion require orthognathic surgery.
All new subjects who met the inclusion criteria were given a version of the COPS-BDD questionnaire, which has been verified to have reliable validity and reproducibility according to Philips et al. [28].
2.2. The Questionnaire
The questionnaire comprised 9 questions, with the diagnosis based on the patient's total score. Each question had 9 possible answers, scored between 0 and 8. The total score provides an initial diagnosis, with higher scores indicating more distress and interference in life, increasing the likelihood of a diagnosis of Body Dysmorphic Disorder (BDD).
According to the guidelines of the questionnaire [29, 30], the scores were categorized as follows:
- If the patient scored 40 or more, it is recommended that they seek an assessment, as they are likely to have Body Dysmorphic Disorder (BDD).
- If the score falls between 30 and 40, the individual may still have BDD and could benefit from an assessment.
- If the score is below 30, it is unlikely that the individual has BDD.
2.3. Groups
Two groups of participants were recruited for the study:
2.4. Statistical Analyses
The data was analyzed using the Statistical Package for Social Sciences (SPSS) version 18 for Windows (SPSS, Inc., Chicago, IL, USA).
The following analyses were used:
- Descriptive statistics, including the mean and standard deviations.
- Unpaired Student’s t-test to compare means between groups, subgroups, and questionnaire items.
The statistical significance was considered to be p ≤ 0.05.
3. RESULTS
In this study, a total of 1003 of the 1200 questionnaires distributed to patients were completed (Table 1) provides a descriptive statistic for both groups, including the number of subjects, gender distribution, and percentage, age range, and mean age.
| Group | Number | Gender No. | Gender Percentage | Age Range | Mean Age |
|---|---|---|---|---|---|
| Community | 503 | M:229 | 45.5% | 18-25 | 21.38 |
| F:274 | 54.5% | 20.14 | |||
| Orthodontic patients | 500 | M: 238 | 47.6% | 18-25 | 20.12 |
| F:262 | 52.4% | 20.08 |
3.1. Internal Consistency
The reliability analysis showed an internal consistency of Cronbach's α = 0.92, indicating a high level of internal consistency for the questionnaire used in the study.
3.2. Test-retest Reliability
In the study, 75 participants from the community group repeated the COPS-BDD questionnaire after 1 week. The questionnaire demonstrated good test-retest reliability with a correlation coefficient of 0.9 (p < 0.01).
Table 2 presents the distribution of subjects in each group by gender and psychological status based on the questionnaire criteria categorizations (more likely to have BDD, likely to have BDD, unlikely to have BDD).
In the community group consisting of 503 patients (229 male and 274 female), it was found that:
| - | Subgroup (Gender) | Number | Mean Score | SD |
|---|---|---|---|---|
| Community Group | Total | 503 | 19.56 | 13.97 |
| Male | 229 | 17.16 | 11.80 | |
| Female | 274 | 21.56 | 15.27 | |
| Orthodontic patients Group | Total | 500 | 20.22 | 15.12 |
| Male | 238 | 17.29 | 12.57 | |
| Female | 262 | 22.88 | 16.66 |
- 37 patients (7.36%), including 8 men and 29 women, were diagnosed with a high possibility of Body Dysmorphic Disorder (BDD) as they scored 40 or more.
- 84 patients (16.7%), with 34 men and 50 women, were diagnosed as likely to have BDD as their scores fell between 30 and 40.
- 382 patients (75.95%), comprising 187 men and 195 women, were diagnosed as not having BDD as their scores were below 30.
In the orthodontic patients' group, which consisted of 500 patients (238 male and 262 female):
- 56 patients (11.2%), including 13 males and 43 females, were diagnosed with a high possibility of Body Dysmorphic Disorder (BDD) as their scores were 40 or more.
- 62 patients (12.4%), with 26 men and 36 women, were diagnosed as likely to have BDD based on scores falling between 30 and 40.
- 382 patients (76.4%), comprising 199 men and 183 women, were diagnosed as not having BDD as their scores were below 30.
In comparing the mean scores of the COPS-BDD questionnaire between the study groups, it was observed that the orthodontic patients' group subjects obtained slightly higher scores than the community group subjects, although this difference was not statistically significant. However, when comparing these scores between males and females within each group, significant differences were found between the genders, with females scoring higher. This significant gender difference was evident in both the community and orthodontic patients' groups, as indicated in Tables 3-4 (p ≤ 0.001).
In Table 5, a comparison of the questionnaire items individually (1-9) between the orthodontic patients and community groups was conducted. It was evident that the orthodontic patients' group subjects obtained significantly higher scores than the community group subjects for all items except item No. 9. Interestingly, for item No. 9, it was found that orthodontic patients' group subjects showed a greater tendency toward Body Dysmorphic Disorder (BDD) compared to the community group subjects, despite the total mean score not reflecting this difference significantly (as indicated in (Table 3).
| Group | Gender | Inference | N | Mean of Score | SD | Percentage from Total Group Subjects (males+ Females) | Percentage from Gender Subgroup |
|---|---|---|---|---|---|---|---|
| Community group N(503) | All participants | More likely to have BDD | 37 | 50.32 | 8.59 | 7.36% | |
| Likely to have BDD | 84 | 34.23 | 3.07 | 16.7% | |||
| No BDD | 382 | 13.35 | 8.38 | 75.94% | |||
| Male N(229) | More likely to have BDD | 8 | 44.63 | 4.24 | 1.59% | 3.49% | |
| Likely to have BDD | 34 | 33.62 | 2.82 | 6.76% | 14.85% | ||
| No BDD | 187 | 12.99 | 8.33 | 37.18% | 81.66% | ||
| Female N(274) | More likely to have BDD | 29 | 51.9 | 8.82 | 5.76% | 10.58% | |
| Likely to have BDD | 50 | 34.64 | 3.17 | 9.94% | 18.25% | ||
| No BDD | 195 | 13.69 | 8.4 | 38.77% | 71.17% | ||
| Orthodontic patients group N(500) | All participants | More likely to have BDD | 56 | 51.29 | 8.79 | 11.2% | |
| Likely to have BDD | 62 | 33.34 | 2.71 | 12.4% | |||
| No BDD | 382 | 13.52 | 8.51 | 76.4% | |||
| Male N(238) | More likely to have BDD | 13 | 46.92 | 6.09 | 2.6% | 5.46% | |
| Likely to have BDD | 26 | 33 | 2.75 | 5.2% | 10.92% | ||
| No BDD | 199 | 13.31 | 8.95 | 39.8% | 83.61% | ||
| Female N(262) | More likely to have BDD | 43 | 52.6 | 9.03 | 8.6% | 16.41% | |
| Likely to have BDD | 36 | 33.58 | 2.66 | 7.2% | 13.74% | ||
| No BDD | 183 | 13.79 | 8 | 36.6% | 52.67% |
| Group | Number | Mean of score | SD | t value | Sig. p value |
|---|---|---|---|---|---|
| Community Group | 503 | 19.56 | 13.97 | 0.718 | 0.473 Ns |
| Orthodontic patients group | 500 | 20.22 | 15.12 |
| Group | Gender | Number | Mean of Score | SD | t value | Sig. p value | - |
|---|---|---|---|---|---|---|---|
| Community Group | Male | 229 | 17.16 | 11.80 | -3.561 | 0.000*** | |
| Female | 274 | 21.56 | 15.27 | ||||
| Orthodontic patients group | Male | 238 | 17.29 | 12.57 | -4.202 | 0.000*** | |
| Female | 262 | 22.88 | 16.66 |
| Inference | Group | Number | Mean Score | SD | T | p-value |
|---|---|---|---|---|---|---|
| No BDD | Community Group | 382 | 13.35 | 8.38 | 0.311 | 0.756 Ns |
| Orthodontic patients group | 382 | 13.54 | 8.51 | |||
| Likely to have BDD | Community Group | 84 | 34.23 | 3.07 | -1.819 | 0.071 Ns |
| Orthodontic patients group | 62 | 33.34 | 2.71 | |||
| More likely to have BDD | Community Group | 37 | 50.32 | 8.59 | 0.526 | 0.6 Ns |
| Orthodontic patients group | 56 | 51.29 | 8.79 |
4. DISCUSSION
Since patients with Body Dysmorphic Disorder (BDD) often lack insight into the psychiatric nature of their condition and tend to prefer non-psychiatric treatments, they may not disclose prior psychological consultations [4]. Therefore, it is important for orthodontists to be mindful of the prevalence of such psychological cases to make informed decisions and treatment plans.
This study aimed to compare the prevalence of BDD among patients who seek orthodontics treatment and other community individuals, taking into account gender in order to study the effect of this psychological condition on making patients make the decision to visit orthodontic clinics as a branch of cosmetic practice.
The study showed that about 7.36% and 11.2% of a community group and orthodontic patient group respectively, are “more likely to have BDD”, and it’s recommended that they seek assessment (Table 6).
Whereas 16.7% of a community group and 12.4% of orthodontic patients group were diagnosed to “may still have BDD” and may still benefit from assessment.
On the other hand, the subjects’ percentages who were diagnosed as “unlikely to have BDD” according to their scores in the questionnaire were 75.95% and 76.4% for the community group and orthodontic patient group, respectively.
This study showed a significant difference in scores between males and females; however, the females got higher scores and had a higher tendency to have BDD than males.
In one study, the prevalence of Body Dysmorphic Disorder (BDD) has been estimated to be 1-2% in the general population of the United States. However, BDD is more common among patients seeking cosmetic treatments, with reported diagnoses in around 7.5% of an orthodontic patient sample in London, which included 40 patients [17]. Another study on an Iranian sample found that 5.5% of orthodontic patients screened positive for BDD [4]. Veale et al. conducted a systematic review that showed that BDD had different estimated weighted prevalence in different settings. For example, whilst the weighted prevalence of BDD in adults in the community was estimated to be 1.9%, the figure for adult psychiatric inpatients was much higher at 7.4%. Interestingly and more importantly for orthodontists, they found that the weighted prevalence was 5.2% in orthodontics/cosmetic dentistry settings, with prevalence ranging from 4.2% to 7.5% [10].
In our study, no significant differences were noted between males, females, and all subjects when comparing them separately for both groups according to scores and psychological status, which means that our sample conducted from orthodontic clinics had no significant difference from a community group. However, when comparing the questionnaire total score means of males and females (number X questionnaire score) for every individual group, the study showed that the prevalence of BDD was higher among females in both groups, and females in general have a higher tendency to get higher scores for both groups. The same result was found in the study of Veale D et al., with the estimated weighted prevalence of 7.9% among women and 2.5% among men [10]. According to the same study, there was a sex ratio of 1.27 for women to men in the community [10] (Table 7).
In our study, we observed a gender preference towards females [4, 32], which aligns with some previous findings and differs from others [1, 31-33].
The comparison of the questionnaire’s items between both groups showed significant differences in scores of all questions except (question number 9) with higher scores for the orthodontic patient’s group, which can play a role in making subjects of this group more aware of their appearance, although there were no significant differences in total score means between both groups according to psychological status.
| Group | inference | Gender | Number | Mean Score | SD | T | p-value |
|---|---|---|---|---|---|---|---|
| Orthodontic Patients Group | No BDD | Male | 199 | 13.31 | 8.95 | -0.551 | 0.582 Ns |
| Female | 183 | 13.79 | 8 | ||||
| Likely to have BDD | Male | 26 | 33 | 2.75 | -0.835 | 0.407 Ns | |
| Female | 36 | 33.58 | 2.66 | ||||
| More likely to have BDD | Male | 13 | 46.92 | 6.09 | -2.121 | 0.014* | |
| Female | 43 | 52.6 | 9.03 | ||||
| Community | No BDD | Male | 187 | 12.99 | 8.33 | -0.818 | 0.414 Ns |
| Female | 195 | 13.69 | 8.4 | ||||
| Likely to have BDD | Male | 34 | 33.62 | 2.82 | -1.512 | 0.134 Ns | |
| Female | 50 | 34.64 | 3.17 | ||||
| More likely to have BDD | Male | 8 | 44.63 | 4.24 | -2.244 | 0.031* | |
| Female | 29 | 51.9 | 8.82 |
| Gender | Inference | Group | Number | Mean Score | SD | T | p-value |
|---|---|---|---|---|---|---|---|
| Male | No BDD | Orthodontic | 199 | 13.31 | 8.95 | 0.363 | 0.717 Ns |
| Community | 187 | 12.99 | 8.33 | ||||
| Likely to have BDD | Orthodontic | 26 | 33 | 2.75 | -0.853 | 0.397 Ns | |
| Community | 34 | 33.62 | 2.82 | ||||
| More likely to have BDD | Orthodontic | 13 | 46.92 | 6.09 | 0.93 | 0.364 Ns | |
| Community | 8 | 44.63 | 4.24 | ||||
| Total | Orthodontic | 238 | 17.29 | 12.57 | 0.115 | 0.908 Ns | |
| Community | 229 | 17.16 | 11.8 | ||||
| Female | No BDD | Orthodontic | 183 | 13.79 | 8 | 0.118 | 0.906 Ns |
| Community | 195 | 13.69 | 8.4 | ||||
| Likely to have BDD | Orthodontic | 36 | 33.58 | 2.66 | -1.634 | 0.106 Ns | |
| Community | 50 | 34.64 | 3.17 | ||||
| More likely to have BDD | Orthodontic | 43 | 52.6 | 9.03 | 0.326 | 0.746 Ns | |
| Community | 29 | 51.9 | 8.82 | ||||
| Total | Orthodontic | 262 | 22.88 | 16.66 | 0.957 | 0.339 Ns | |
| Community | 274 | 21.56 | 15.27 |
| Variable |
Community Group |
Orthodontic Patients Group |
Difference between Groups |
|
|---|---|---|---|---|
| - | M (SD) | M (SD) | t value | Sig. p value |
|
1. Avoid looking at my feature(s) |
3.5368 (0.2796 | 4.1160 (0.4613 | -24.061 | 0.000** |
|
2. Frequency of checking feature(s) |
3.4513 (0.4049 | 5.3700 (0.5681 | -61.617 | 0.000** |
|
3. How ugly, unattractive or ’not right’ feature(s) are |
3.2624 (0.3132 | 4.9380 (0.4553 | -67.933 | 0.000** |
|
4. Distress caused by feature(s) |
2.3738 (0.2743 | 4.2040 (0.4601 | -76.573 | 0.000** |
|
5. Avoid situations or activities because of feature(s) |
3.0795 (0.2454 | 4.8000 (0.5200 | -67.072 | 0.000** |
|
6. Preoccupation with feature(s) |
2.3400 (0.2799 | 3.9960 (0.2962 | -91.009 | 0.000** |
|
7. Interference with relationship/dating |
2.4274 (0.2868 | 3.0840 (0.3087 | -34.896 | 0.000** |
|
8. Interference with relationship |
2.9165 (0.3406 | 3.4200 (0.2961 | -24.979 | 0.000** |
|
9. Inability to work/study due to feature(s) |
2.9423 (0.3234 | 2.9400 (0.2638 | 0.`126 | 0.900 Ns |
| Group | Inference | Mean Age (years) |
|---|---|---|
| Community group | More likely to have BDD | 20.2 |
| Likely to have BDD | 20.8 | |
| NO BDD | 21.3 | |
| Orthodontic patient group | More likely to have BDD | 19.6 |
| Likely to have BDD | 20.1 | |
| NO BDD | 20.8 |
In both groups, the subjects with BDD were younger than other subjects, which accords with earlier findings of Sathyanarayana et al. (1) Yassaei et al. [4], Vulink et al. [33], and Philips et al. [32] in which BDD was more prevalent in the younger age group, and was in contrary to the findings of Uzun et al. [34] (Tables 8-10).
CONCLUSION
We expect that the decreased level of awareness about the role of orthodontic treatment in improving Health Related Quality of Life – functionally, not only esthetically – played a significant role in changing society's point of view to orthodontics as a therapeutic procedure, not just cosmetic one, which resulted in more patients seeking this treatment with higher recognition to treat malocclusion pathological condition not just to improve their smile. However, it is recommended to investigate and reveal such BDD cases by using COPS- BDD questionnaire as a routine step in diagnosis and decision-making procedures in order to take into account the requirements of these patients individually, which need special deals.
AUTHORS’ CONTRIBUTION
The author confirms sole responsibility for the following: study conception and design, data collection, analysis and interpretation of results, and manuscript preparation.
ETHICS APPROVAL AND CONSENT TO PARTICIPATE
This study was approved by the Ethics Committee of Tishreen University (Ethical Permission No 11733 on 22-12-2022).
HUMAN AND ANIMAL RIGHTS
All human research procedures followed were in accordance with the ethical standards of the committee responsible for human experimentation (institutional and national), and with the Helsinki Declaration of 1975, as revised in 2013.
