Body Dysmorphic Disorder in Adult Patients With an Orofacial Cleft: An Unseen Psychological Burden.

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Tytuł:: Body Dysmorphic Disorder in Adult Patients With an Orofacial Cleft: An Unseen Psychological Burden.
Autorzy:: Stepp WH; Department of Otolaryngology, University of North Carolina, School of Medicine, Chapel Hill, North Carolina, U.S.A.
Stein EJ; Department of Otolaryngology, University of North Carolina, School of Medicine, Chapel Hill, North Carolina, U.S.A.
Canfarotta MW; Department of Otolaryngology, University of North Carolina, School of Medicine, Chapel Hill, North Carolina, U.S.A.
Wood J; University of North Carolina Craniofacial Center, University of North Carolina, School of Dentistry, Chapel Hill, North Carolina, U.S.A.; Department of Surgery, University of North Carolina, School of Medicine, Chapel Hill, North Carolina, U.S.A.
Vandoros E; Department of Otolaryngology, University of North Carolina, School of Medicine, Chapel Hill, North Carolina, U.S.A.
Stein M; University of North Carolina Craniofacial Center, University of North Carolina, School of Dentistry, Chapel Hill, North Carolina, U.S.A.
Daniel R; University of North Carolina Craniofacial Center, University of North Carolina, School of Dentistry, Chapel Hill, North Carolina, U.S.A.; Department of Oral and Maxillofacial Surgery, University of North Carolina, School of Dentistry, Chapel Hill, North Carolina, U.S.A.
Shockley WW; Department of Otolaryngology, University of North Carolina, School of Medicine, Chapel Hill, North Carolina, U.S.A.
Clark JM; Department of Otolaryngology, University of North Carolina, School of Medicine, Chapel Hill, North Carolina, U.S.A.
Drake AF; Department of Otolaryngology, University of North Carolina, School of Medicine, Chapel Hill, North Carolina, U.S.A.; University of North Carolina Craniofacial Center, University of North Carolina, School of Dentistry, Chapel Hill, North Carolina, U.S.A.
Źródło:: The Laryngoscope [Laryngoscope] 2023 Apr; Vol. 133 (4), pp. 818-821. Date of Electronic Publication: 2022 Sep 02.
Typ publikacji:: Journal Article; Research Support, Non-U.S. Gov't; Research Support, N.I.H., Extramural
Język:: English
Imprint Name(s):: Publication: <2009- >: Philadelphia, PA : Wiley-Blackwell
Original Publication: St. Louis, Mo. : [s.n., 1896-
MeSH Terms:: Body Dysmorphic Disorders*
Cleft Lip*/complications
Cleft Lip*/surgery
Cleft Palate*/complications
Cleft Palate*/surgery
Humans ; Adult ; Cross-Sectional Studies ; Case-Control Studies ; Prospective Studies
References:: IPDTOC. Prevalence at birth of cleft lip with or without cleft palate: data from the International Perinatal Database of Typical Oral Clefts. Cleft Palate Craniofac J. 2011;48(1):66-81.
Meyer R. In: Stepp W, ed. Orofacial Cleft Prevalence 2009-2013; North Carolina Department of Health 2016.
Stock NM, Feragen KB, Rumsey N. "It doesn't all just stop at 18": psychological adjustment and support needs of adults born with cleft lip and/or palate. Cleft Palate Craniofac J. 2015;52:543-554.
Stock NM, Rumsey N. Starting a family: the experience of parents with cleft lip and/or palate. Cleft Palate Craniofac J. 2015;52:425-436.
Hamlet C, Harcourt D. Older adults' experiences of living with cleft lip and palate: a qualitative study exploring aging and appearance. Cleft Palate Craniofac J. 2015;52:e32-e40.
Oosterkamp BC, Dijkstra PU, Remmelink HJ, et al. Satisfaction with treatment outcome in bilateral cleft lip and palate patients. Int J Oral Maxillofac Surg. 2007;36:890-895.
Collett BR, Speltz ML. A developmental approach to mental health for children and adolescents with orofacial clefts. Orthod Craniofac Res. 2007;10:138-148.
Kapp-Simon KA, McGuire DE. Observed social interaction patterns in adolescents with and without craniofacial conditions. Cleft Palate Craniofac J. 1997;34:380-384.
Ramstad T, Ottem E, Shaw WC. Psychosocial adjustment in Norwegian adults who had undergone standardised treatment of complete cleft lip and palate. I. Education, employment and marriage. Scand J Plast Reconstr Surg Hand Surg. 1995;29:251-257.
Sinko K, Jagsch R, Prechtl V, Watzinger F, Hollmann K, Baumann A. Evaluation of esthetic, functional, and quality-of-life outcome in adult cleft lip and palate patients. Cleft Palate Craniofac J. 2005;42:355-361.
Phillips KA, Hollander E, Rasmussen SA, Aronowitz BR, DeCaria C, Goodman WK. A severity rating scale for body dysmorphic disorder: development, reliability, and validity of a modified version of the Yale-Brown Obsessive Compulsive Scale. Psychopharmacol Bull. 1997;33:17-22.
Altamura C, Paluello MM, Mundo E, Medda S, Mannu P. Clinical and subclinical body dysmorphic disorder. Eur Arch Psychiatry Clin Neurosci. 2001;251:105-108.
Sandy J, Williams A, Mildinhall S, et al. The Clinical Standards Advisory Group (CSAG) cleft lip and palate study. Br J Orthod. 1998;25:21-30.
Ramstad T, Ottem E, Shaw WC. Psychosocial adjustment in Norwegian adults who had undergone standardised treatment of complete cleft lip and palate. II. Self-reported problems and concerns with appearance. Scand J Plast Reconstr Surg Hand Surg. 1995;29:329-336.
Grant Information:: United States AI NIAID NIH HHS; 5T32DC005360 United States DE NIDCR NIH HHS; NIHT32-GM008719 United States GM NIGMS NIH HHS
Contributed Indexing:: Keywords: access to care; adults with cleft lip; body dysmorphic disorder; cleft palate; facial dysmorphia; social relationships; transition to adult care
Entry Date(s):: Date Created: 20220902 Date Completed: 20230316 Latest Revision: 20230523
Update Code:: 20240105
DOI:: 10.1002/lary.30378
PMID:: 36054769
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Objectives: Facial dysmorphic disorder (FDD), a variant of body dysmorphic disorder, occurs when individuals are preoccupied with perceived defects in their facial appearance. Cleft lip and/or palate (CL/P) requires many clinical interventions and has significant psychological impacts on a patient's perception of appearance. This study identified psychological burdens related to living as an adult with CL/P and characterizes the degree of FDD symptoms in an adult craniofacial population.
Methods: This was a prospective, single-center, cross-sectional case-control study using semi-structured interviews and symptom assessments at a university-based craniofacial center. Patients without CL/P undergoing non-cosmetic facial surgery were recruited as controls (n = 20). Patients with an orofacial cleft (n = 30) were recruited from medical and dental providers at the University of North Carolina. Body Dysmorphic Disorder-Yale Brown Obsessive Compulsive Scale (BBD-YBOCS) scores were collected from a control population and patients with CL/P to assess FDD severity.
Results: Demographic factors such age, biological sex, and ethnicity had no significant impact on FDD symptom scores. Patient with CL/P were more likely to have significant FDD symptoms (BDD-YBOCS greater than 16) than patients without CL/P (OR 10.5, CI 95 2.7-41.1), and had a mean difference in FDD symptoms scores of 10.04 (p < 0.0001; CI 95 5.5-14.6). Patients with CL/P seen by a mental health provider in the past 3 months had 3-fold lower overall FDD symptom scores (OR 0.081; CI 95 0.0085-0.77).
Conclusions: Adults with CL/P would benefit from treatment for cleft-specific needs and psychological support as they face unique stressors related to their appearance, including an increase in FDD-associated symptoms. This study emphasizes the importance of recognizing psychological symptoms and providing ongoing multidisciplinary care to adults with CL/P.
Level of Evidence: 3; Individual case-control study Laryngoscope, 133:818-821, 2023.
(© 2022 The American Laryngological, Rhinological and Otological Society, Inc.)

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