Body Image Disturbance and Obsessive-Compulsive Disorder Symptoms Improve After Orthognathic Surgery

Astrid Häberle; Hamzah Alkofahi; Jia Qiao; Debra L Safer; Paul A Mittermiller; Roseanne Menorca; Amber W Trickey; Sabine Girod

doi:10.1016/j.joms.2020.07.021

Body Image Disturbance and Obsessive-Compulsive Disorder Symptoms Improve After Orthognathic Surgery

J Oral Maxillofac Surg. 2020 Nov;78(11):2054-2060. doi: 10.1016/j.joms.2020.07.021. Epub 2020 Jul 23.

Authors

Astrid Häberle¹, Hamzah Alkofahi², Jia Qiao³, Debra L Safer⁴, Paul A Mittermiller⁵, Roseanne Menorca¹, Amber W Trickey⁶, Sabine Girod⁷

Affiliations

¹ Research Assistant, Department of Surgery, Stanford University, Stanford, CA.
² Oral and Maxillofacial Surgeon, Visiting Scholar, Department of Surgery, Stanford University, Stanford, CA.
³ Plastic Surgeon, Visiting Scholar, Department of Surgery, Stanford University, Stanford, CA.
⁴ Associate Professor of Psychiatry, Department of Psychiatry, Stanford University, Stanford, CA.
⁵ Resident, Department of Surgery, Stanford University, Stanford, CA.
⁶ Biostatistician, S-SPIRE Center, Department of Surgery, Stanford School of Medicine, Stanford, CA.
⁷ Professor of Surgery (Emerita), Department of Surgery, Stanford University, Stanford, CA; S-SPIRE Center, Department of Surgery, Stanford School of Medicine, Stanford, CA. Electronic address: sgirod@stanford.edu.

PMID: 32810443
DOI: 10.1016/j.joms.2020.07.021

Abstract

Purpose: Although body image disturbance (BID), anxiety, depression, and obsessive-compulsive disorder (OCD) are the most common comorbid psychological conditions among patients presenting for orthognathic surgery (OS), little is known about whether psychological symptoms relate to facial deformity or how symptoms change after OS. To fill these knowledge gaps, this study investigated preoperative and postoperative psychological symptoms and preoperative baseline facial deformity in patients who underwent OS.

Patients and methods: This study included 49 patients who underwent OS by a single surgeon between 2011 and 2018. The patients completed validated psychological tests to assess symptoms of anxiety (Beck Anxiety Inventory), depression (Patient Health Questionnaire-9), BID (BID Questionnaire, BIDQ), and OCD (Florida Obsessive-Compulsive Inventory). In addition, we measured severity of preoperative facial deformity with the Facial Aesthetic Index (FAI). We compared preoperative and postoperative symptoms using univariate nonparametric Wilcoxon signed rank tests. We tested associations between the 4 types of preoperative psychological symptoms and baseline Facial Aesthetic Index category using Spearman's rank correlations.

Results: Postoperatively, both BIDQ scores (median 2 to 1.2, P < .001) and Florida Obsessive-Compulsive Inventory scores (median number of OCD symptoms 1 to 0, P < .001) decreased, whereas anxiety and depression symptoms showed no change (P > .45). Preoperative BIDQ was significantly associated with the severity of the facial deformity (ρ = 0.32, P = .025; median BIDQ: mild FAI = 1.0, severe FAI = 2.1).

Conclusions: Our results show that patients with more severe facial deformity have a higher BID preoperatively and that both BID and OCD improve after OS. Interestingly, anxiety and depression symptoms did not change after OS.

MeSH terms

Anxiety
Body Image
Humans
Obsessive-Compulsive Disorder*
Orthognathic Surgery*
Orthognathic Surgical Procedures*