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Body Dysmorphic Disorder in
Hair loss Patients &
Benefit After Hair Transplant
Dr Rajesh Rajput aka Rajendrasingh,
M.S., M...
Patient Selection
Age – 21 to 50 yrs, 100 male patients
Random volunteers – 19 refused to
enroll after reading the quest...
Body Dysmorphic Disorder, BDD is defined as an excessive concern
about a marginal defect in appearance, psychologically a...
Table 1 - Patient’s Personal Evaluation of the Deformity discussed with the Surgeon’s Plan
Criteria Score 0 Score 1 Score ...
Yale–Brown Obsessive Compulsive Scale
Identification of one or more Obsessive behaviors -
1.Looking frequently into the m...
Table 2: Yale – Brown Obsessive Scale – Score of 10 & above Indicates BDD
Obsession Score 0 Score 1 Score 2 Score 3 Score ...
Figure 1
Evaluation of Residual Traits in 16% with
Severe Score
Still wanted to look in the mirror several times a day
sometimes t...
Evaluation of Work, College, Social and
Family Life
• Cannot concentrate due to thoughts about hair loss
• Frequent distra...
Table 3 Sheehan Disability Scale – for Social Life
Criteria No
Disturb
-ance
Mild - Continue
routine but
concerned
Moderat...
Figure 2
88% had Improved Work,
Family, Social life but 12%
Scored Severe
Evaluation of Residual Traits in 12% with
Severe Score
Never make up for some opportunities that were missed
Could not g...
Evaluation of Personal Feelings & Emotions
raised due to hair loss
Self -conscious of appearance and worried about the
re...
Table 4 Derriford Personal Appearance Short Scale - Modified
0 Did not apply to me at all 1 Applied to me to some
degree, ...
Table 4 Derriford Personal Appearance Short Scale – Modified - Continued
Criteria Score
0
Never
1
Sometimes
2
Considerable...
Table 4 Derriford Personal Appearance Short Scale – Modified - Continued
Criteria Score
0
Never
1
Sometimes
2
Considerable...
Figure 3
Evaluation of Residual Traits in 61% with
Severe to Extreme Score
Still need to use hair filler and camouflage
Will alwa...
Conclusion
We need be more sensitive to apparently minor changes in hair loss patients
Patient’s Personal perception of ...
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Body Dysmorphic Disorder in Hair loss Patients

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Body Dysmorphic Disorder, BDD is defined as an excessive concern about a marginal defect in appearance, psychologically affecting work, personal & social life.

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Body Dysmorphic Disorder in Hair loss Patients

  1. 1. Body Dysmorphic Disorder in Hair loss Patients & Benefit After Hair Transplant Dr Rajesh Rajput aka Rajendrasingh, M.S., M.Ch., Plastic Surgeon, Mumbai. drrajeshrajput@gmail.com www.hairlossindia.com, +91-9821308411
  2. 2. Patient Selection Age – 21 to 50 yrs, 100 male patients Random volunteers – 19 refused to enroll after reading the questionnaire Hair loss Grade I – Grade V Grade VI & VII were excluded Re-evaluation for improvement 8months after Hair Transplant
  3. 3. Body Dysmorphic Disorder, BDD is defined as an excessive concern about a marginal defect in appearance, psychologically affecting work, personal & social life. BDD Suspects – 1. Patients who want lower hairline & more density despite the number of sittings it may take 2.Patients wearing a hair piece at early grades of baldness 3.Patients wearing a cap continuously 4.Patients unwilling to remove cap or hair piece even for clinical evaluation or refusing photographs 5.Patients remain isolated from family and social events Started by recording the patient’s expectations & surgeons plans Later found systems for evaluation of obsessive behavior, impact on work, family, social life & personal perception of appearance Planned this study to evaluate effects of obsessive behavior and compare any changes or benefit after hair transplant
  4. 4. Table 1 - Patient’s Personal Evaluation of the Deformity discussed with the Surgeon’s Plan Criteria Score 0 Score 1 Score 2 Score 3 Level of the hairline Good as it is Acceptable with marginal correction Correction as per doctors Guidelines Unusual expectations or own ideas Shape of the hairline Good as it is Acceptable with marginal correction Correction as per doctors Guidelines Unusual expectations or own ideas Temporal receding To match the hairline Acceptable with marginal correction Correction as per doctors Guidelines Unusual expectations or own ideas Thinning and Scalp show Average correction to look better Correction in directly visible areas Correction as per doctors Guidelines Very high Density all over Baldness in one or more areas Average correction to look better Correction in directly visible areas Correction as per doctors Guidelines Very high Density all over Mild – 0 to 5, Moderate – 6 to 8, Severe – 9 to 11, Extreme – 12 to 15 Severity judged by the patient did not match clinical grade of Hair loss. Patients perception of deformity was much higher than surgeon’s evaluation of the deformity.
  5. 5. Yale–Brown Obsessive Compulsive Scale Identification of one or more Obsessive behaviors - 1.Looking frequently into the mirror, 2.Spending time to set the hair 3.Adjust slightest disturbance in their hair, 4.Wearing cap all the time at home & work, 5.Using hair concealers and topping up during the day, 6.Refusing dance, games etc. where hair may get undone, 7.Spending time with selected friends & family members, 8.Avoiding photographs and social events, 9.Spending time looking for newer hair loss remedies, Scale evaluates time spent on obsession and the effect on work, family, social and day to day life Same scale was used to record improvement with therapy Part of the scale for compulsive actions was not used
  6. 6. Table 2: Yale – Brown Obsessive Scale – Score of 10 & above Indicates BDD Obsession Score 0 Score 1 Score 2 Score 3 Score 4 Time spent on Obsession 0 hours 0 – 1 hours 1 – 3 hour 3 – 8 hours >> 8 hours Interference from Obsession None Mild Definite manageable Substantial impairment Incapacitating Distress from Obsession None Mild Moderate manageable Severe Constant and Disabling Resistance to the Obsession Always Resist Often resists Sometimes can resist Only try to resist Cannot resist Control over the Obsession Complet e control Much control Little control Some control No Control Mild – 0 to 5, Moderate – 6 to 9, Severe – 10 to 14, Extreme – 15 to 20 Score above 10 indicates BDD
  7. 7. Figure 1
  8. 8. Evaluation of Residual Traits in 16% with Severe Score Still wanted to look in the mirror several times a day sometimes taking break from their work Wanted to first go to the washroom and set hair right before entering the party, meeting or social event Wanted to comb the hair between a dance or after dance Would have photographs only at a particular angle where the hair looked the best
  9. 9. Evaluation of Work, College, Social and Family Life • Cannot concentrate due to thoughts about hair loss • Frequent distraction or need breaks from work or studies • Inability to complete assignments • Hair loss is affecting friendship & acceptance by peers • Reduced participation in social events • Keep company of select few family members • Do not like any talk or discussion about their hair loss
  10. 10. Table 3 Sheehan Disability Scale – for Social Life Criteria No Disturb -ance Mild - Continue routine but concerned Moderate – worry makes routine incomplete Severe – worry stops or reduces routine activity Extreme – cannot carry on routine life Score 0 1 2 3 4 5 6 7 8 9 10 Work or School Social Life Family / Home Mild – 0 to 9, Moderate – 10 to 18, Severe – 19 to 27, Extreme – 27 to 30
  11. 11. Figure 2 88% had Improved Work, Family, Social life but 12% Scored Severe
  12. 12. Evaluation of Residual Traits in 12% with Severe Score Never make up for some opportunities that were missed Could not get the kind of friends that others had Brothers and sisters who are better looking enjoy more affection among family members Colleagues with more hair are preferred for important job assignments Ridiculed by bald friends for having a hair transplant done
  13. 13. Evaluation of Personal Feelings & Emotions raised due to hair loss Self -conscious of appearance and worried about the reactions and comments by others Reduced Confidence or Poor Self Esteem Nervousness, distress, depression, irritability, Feel rejected, hurt, misjudged, unworthy, Unable to give the best in life, underachieved, Lack of initiative, feeling low, Difficult to relax, always thinking about hair loss
  14. 14. Table 4 Derriford Personal Appearance Short Scale - Modified 0 Did not apply to me at all 1 Applied to me to some degree, or some of the time 2Applied to me to a considerable degree 3 Applied to me very much, or most of the time Criteria Score 0 Never 1 Sometimes 2 Considerable 3 Always 1 Feeling loss of Confidence 2 Distress at Reflection 3 Irritable at Home 4 Feel Hurt, Feel Rejected 5 Self Conscious of appearance 6 Distress at Pubs Restaurants or Social events
  15. 15. Table 4 Derriford Personal Appearance Short Scale – Modified - Continued Criteria Score 0 Never 1 Sometimes 2 Considerable 3 Always 7 Misjudged due to appearance 8 Feel incomplete masculine or feminine 9 Felt I wasn't worth much as a person 10 Adjust the hair if it flies or gets disturbed 11 Adopt Concealing Gestures 12 Difficult to work up the initiative to do things 13 Tended to over-react getting upset by quite trivial situations 14 Found others preferred over me for important assignments
  16. 16. Table 4 Derriford Personal Appearance Short Scale – Modified - Continued Criteria Score 0 Never 1 Sometimes 2 Considerable 3 Always 15 Felt sad and depressed sometimes 16 Found myself getting impatient when I was delayed in any way (eg, lifts, traffic lights, being kept waiting) 17 Could have done better with proper looks 18 Felt that I had nothing to look forward to 19 Found it difficult to relax 20 Felt nervous in situations, with raised heart rate sweating or shaking feet Mild – 0 to 10, Moderate – 10 to 30, Severe – 31 to 50, Extreme – 51 to 60,
  17. 17. Figure 3
  18. 18. Evaluation of Residual Traits in 61% with Severe to Extreme Score Still need to use hair filler and camouflage Will always have less hair than others around them Others may recognize the hair transplant on close look and form an opinion based on it Need to use a fixed hair style, Crown looks bald  Not enough to make you feel complete Density is inadequate, not equal all over More sessions required but are very expensive
  19. 19. Conclusion We need be more sensitive to apparently minor changes in hair loss patients Patient’s Personal perception of hair loss is more severe than the clinical evaluation Yale-Brown Scale, Sheehan Scale & DASS Scale can evaluate the Social, Personal, Psychological & Emotional effects in hair loss patients Incidence of BDD in hair loss is 28%, higher than rhinoplasty 20.7% Patients Concern for Hair loss, Obsessive Behavior, Work, Family and Social Life can be improved by 84% after a Hair Transplant, however, All 100% Patients have severe to extreme concern with the Personal & Emotional Perception of their hair loss & 61% continue to have it even after Hair Transplant Further evaluation and structured research on BDD in Hair loss is required

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