key: cord-0917243-zl7zczr0 authors: Pourani, Mohammad Reza; Ghalamkarpour, Fariba title: Perceived impact of COVID‐19 pandemic on body dysmorphic disorder and anxiety among population seeking cosmetic procedures date: 2022-02-18 journal: J Cosmet Dermatol DOI: 10.1111/jocd.14833 sha: a97f4d2b32ace44c7ac05b4488da5a0886220644 doc_id: 917243 cord_uid: zl7zczr0 INTRODUCTION: COVID‐19‐related anxiety and preventative actions like the widespread shutdown of beauty‐related services emerged as a stressful condition for BDD patients seeking expert opinions. MATERIAL AND METHODS: We conducted a cross‐sectional investigation to assess anxiety symptoms (by CDAS) and BDD (via BDD‐YBOCS questionnaire) in patients referred to the esthetic clinic. RESULTS: A total of 120 individuals (106 females and 14 males; mean age: 45.53 ± 11.84) were evaluated. 13.3% of subjects were diagnosed with BDD; 79.2%, 17.5%, and 3.3% of them perceived none or mild, moderate, and severe symptoms of anxiety, respectively. CONCLUSION: Anxiety was not connected with BDD in our investigation. Further evaluation of other psychiatric disorders associated with anxiety and BDD was recommended. Patients with complaints related to BDD experienced symptoms of anxiety and depression. In this pandemic, anxiety connected with the COVID-19 era and the closure of dermatologic clinics might incommode BDD patients seeking expert opinions. 5 In this study, we investigated the level of anxiety and BDD in individuals searching for esthetic procedures. We designed a cross-sectional study to evaluate symptoms of anxiety and BDD in patients referred to our clinic for esthetic procedures. The study was conducted using the Corona Disease Anxiety Scale (CDAS) and Body Dysmorphic Disorder Modification of the Y-BOCS (BDD-YBOCS) [adult version] questionnaire for the assessment of anxiety and BDD, respectively, which was validated in Persian. 6 The breakpoint of the BDD-YBOCS scale is at least 20 score for the diagnosis of BDD. Patients referred to our clinic for esthetic actions filled the questionnaires from October 12, 2020, to December 6, 2020. Descriptive statistics were considered for the overall sample, and the analysis was performed with the SPSS software version 25. A total of 120 eligible subjects were assessed in this study (106 females and 14 males, mean age: 45.53 ± 11.84). In our studied population, 13.3% of individuals were diagnosed with BDD. The baseline demographic data regarding the presence of symptoms of BDD are presented in Table 1 . In this pandemic, 79.2%, 17.5%, and 3.3% of individuals perceived none or mild, moderate, and severe symptoms of anxiety, respectively. Younger individuals had symptoms of BDD significantly more than elderly patients. In the COIVD-19 era, anxiety symptoms were correlated with the level of education in our population (Table 2) . Also, younger patients experienced higher levels of anxiety in the COVID-119 pandemic. Furthermore, BDD was not associated with a level of COVID-19 pandemic-related anxiety. Furthermore, the incidence of BDD did not change pre-COVVID-19 era and after the first COVID-19 lockdown. 10 In this study, we did not evaluate the level of anxiety and number of BDD patients before the COVID-19; furthermore, a comparison of these conditions was not possible. Widespread closure of medical cosmetic procedures caused a deprivation of esthetic consults and visits for regular cosmetic procedure users. 1 Theoretically, up to 10% of BDD patients search for esthetic procedures, whereas 2% of individuals with eating disorders seek cosmetic procedures. 5 Physicians usually underestimate the diagnosis of BDD in patients seeking cosmetic procedures leading to numerous unnecessary treatment modalities for changing patients' appearance and dissatisfaction. 11 Potentially, halt of esthetic procedures could aggravate concern of BDD patients regarding thinking of imperfection physical beauty and appearance. 5 In another study, 15.2% of individuals reported symptoms of anxiety and body dissatisfaction, which were indicative of BDD during the COVID-19 pandemic. 12 BDD was associated with willingness to have plastic surgery despite understanding its related risk during the pandemic; Further, 36.6% of BDD patients were inclined to undergo plastic surgery compared to 6.6% of individuals without BDD. 13 In our investigation, the prevalence of BDD was 13.3% in the COVID-19 era. Furthermore, the presence of BDD in individuals was not correlated with the level of anxiety related to COVID-19. However, 20.8% of participants reported moderate-to-severe anxiety levels associated with the COVID-19 pandemic. The prevalence of BDD have been investigated in Iranian studies, and its prevalence was 4.5%, 33.3%, and 56% among college students, patients referring to dermatology clinic, and rhinoplastic surgery applicants, respectively. 14, 15 The main limitation of this study was the limited sample size and the questionnaire-based and crosssectional design of the study. Despite using the CDAS questionnaire, anxiety among BDD patients could affect the evaluation of COVID-19-related anxiety in the study. These data correspond with our results, and we recommend evaluating the association of BDD with other psychiatric disorders such as eating disorders and depression. In the COVID-19 era, about 20% and 13% of individuals reported moderate-to-severe anxiety and symptoms of BDD, respectively, similar to previous studies in the pre-COVID-19 pandemic. However, in this study, anxiety was not associated with BDD. For further investigations, we recommend assessing the association of other psychiatric disorders with anxiety and BDD. anxiety, body dysmorphic disorder, coronavirus 2019, COVID-19, psychology The authors declare no conflict of interest. University of Medical Science confirmed this cross-sectional study. The data that support the findings of this study are available from the corresponding author upon reasonable request. The COVID-19 pandemic: psychological and behavioral responses to the shutdown of the beauty industry Predicting COVID-19-related anxiety: the role of obsessive-compulsive symptom dimensions, anxiety sensitivity, and body vigilance Video chatting and appearance satisfaction during COVID-19: appearance comparisons and self-objectification as moderators Selfies-living in the era of filtered photographs Assessing body dysmorphic disorder and eating disorders in cosmetic procedure populations Validity of the Yale-Brown obsessive compulsive scale modified for Body Dysmorphic Disorder (BDD) in students of the University of Isfahan Assessment of the Impact of COVID-19 pandemic on population-level interest in skincare: evidence from a google trends-based Infodemiology study Perceived impact of Covid-19 across different mental disorders: a study on disorderspecific symptoms, psychosocial stress and behavior Coronavirus pandemic (COVID-19) in Spain Changes in body dysmorphic disorder, eating disorder, and exercise addiction symptomology during the COVID-19 pandemic: a longitudinal study of 319 health club users A practical guide to managing body dysmorphic disorder in the cosmetic surgery setting Exercise addiction, body dysmorphic disorder, and use of enhancement drugs during the COVID-19 pandemic confinement period: a transcultural study The public's awareness and willingness to undergo plastic surgery procedures during the COVID-19 pandemic Prevalence of body dysmorphic disorder among a group of college students in Shiraz Levels of Body Dysmorphic Disorder (BDD) incidence in individuals seeking rhino plastic surgery Perceived impact of COVID-19 pandemic on body dysmorphic disorder and anxiety among population seeking cosmetic procedures