Background: Dissatisfaction with appearance is most pronounced in rhinoplasty patients compared to candidates for other aesthetic procedures. We aimed to test and introduce the Body Image Concern Inventory (BICI) as a self-report screening tool for identifying body dysmorphic disorder (BDD) among patients seeking rhinoplasty.
Methods: The surgeon completed a two-point defect severity scale in which a score of 1 represented no defect or one defect and a score of 2 represented more than one defect. Each of the 117 subjects with a score of 1 answered a questionnaire that was designed to obtain demographic data and completed the Persian version of the BICI. The psychiatrist, considering the patient's demographic data and blind to the BICI score, interviewed him/her using a semistructured diagnostic tool for BDD based on DSM-IV.
Results: The validity of the Persian version of the BICI was calculated at 85%. The reliability of the Persian BICI items was tested and Cronbach's alpha was 0.90. The results of ROC analysis for the ideal cutoff point of the Persian BICI, based on the Youden index method and optimum sensitivity and specificity, revealed that the ideal cutoff point for positive or negative criterion of that questionnaire's result may be the total score of 42 (sensitivity, 93.5%; specificity, 80.8%) The diagnostic accuracy of the Persian BICI in comparison with the gold standard (psychiatric interview), according to the area under the ROC curve (AUC), was 91.4% (95% CI = 86-97%, P < 0.0001). The agreement of the results of the Persian BICI questionnaire with the psychiatric interview for diagnosis of BDD, according to kappa index, was 61.7% (P < 0.001), and the odds ratio (OR) of being diagnosed with BDD in a psychiatric interview for those with overall scores ≥42 for the Persian BICI was 47.7 (95% CI = 43-52).
Conclusion: The results of the present study emphasize the high rate of BDD (12.2%) in subjects seeking rhinoplasty. The BICI appears to be an internally consistent and valid brief multiple-choice instrument for assessing dysmorphic concern. To our knowledge, this is the first time that this measure has ever been used for identifying BDD patients in a rhinoplasty setting; it is also the first time that ROC analysis has been used for calculating and analyzing the results of BICI. Our study suggests that rhinoplasty surgeons could rely on the scores of the BICI to identify subjects with probable BDD among their consultants with no or one slight defect.