Resident Physician University of North Carolina at Chapel Hill Chapel Hill, North Carolina
Educational Objective: At the conclusion of this presentation, the participants should be able to identify key features of facial dysmorphic disorder, understand its prevalence and identify key elements that should trigger referral to a mental health professional.
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.
Study Design: This was a prospective, single center, cross-sectional case control study using semi structured interviews and symptom assessments at a university based craniofacial center.
Methods: Patients without CL/P undergoing non-cosmetic facial surgery were recruited as controls (n=20). CL/P patients (n=30). Body Dysmorphic Disorder-Yale Brown Obsessive Compulsive Scale (BBD-YBOCS) scores were collected from control and CL/P patients to assess FDD severity. Interviews were coded using thematic analysis to identify key elements central to CL/P patients.
Results: Demographic factors such as age, biological sex and ethnicity had no significant impact on FDD symptom scores. CL/P patients were more likely to have significant FDD symptoms (BDD-YBOCS > 16) than a non-CL/P patient (OR 11.6, CI95 1.4-99.3), and had a mean difference in FDD symptoms scores of 10.04 (p < 0.0001; CI95 5.5-14.6). CL/P patients seen by a mental health provider in the past three months had 3-fold lower overall FDD symptom scores (OR 0.081; CI95 0.0085-0.77).
Conclusions: CL/P adults 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.