American Journal of Epidemiology Advance Access originally published online on February 17, 2007
American Journal of Epidemiology 2007 165(7):846; doi:10.1093/aje/kwk120
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LETTERS TO THE EDITOR |
RE: "MORTALITY AMONG CANADIAN WOMEN WITH COSMETIC BREAST IMPLANTS"
1 Butler Hospital, Brown Medical School, Providence, RI 02906
2 Department of Psychiatry and Human Behavior, Brown Medical School, Providence, RI 02906
(e-mail: Elizabeth_Didie{at}brown.edu)
The recent article by Villeneuve et al. (1), which reported an increased suicide rate among women who received breast implants or other cosmetic surgery compared with the general population, is timely and important. Four previous studies have also reported increased suicide rates among women who received breast implants for augmentation purposes (2–5). The reasons for this association are unclear. As noted by Villeneuve et al. (1), some studies found that women with breast implants who commit suicide are more likely to have had psychotherapy and more likely to have lower self-esteem and self-confidence (6), increased levels of depression (7), and an increased prevalence of mental illness as measured by psychiatric hospitalizations (3).
We would like to raise the possibility that some of these women may have had body dysmorphic disorder (BDD). BDD is a relatively common and severe mental disorder that consists of a distressing or impairing preoccupation with a nonexistent or slight defect in appearance (8); 19–40 percent of individuals with BDD have cosmetic surgery in an attempt to diminish their appearance concerns, which is usually ineffective (9, 10). In a recent study of 200 individuals with BDD (9), breast augmentation/lift was the second most frequent surgical procedure received for BDD-related concerns. Furthermore, BDD is a very distressing disorder (8). A high proportion of individuals with BDD have suicidal thinking (78–81 percent lifetime and 57 percent annually) and attempt suicide (22–28 percent lifetime and 2.8 percent annually) (11, 12). The rate of completed suicide (0.3 percent annually), while preliminary, appears markedly high (12).
It is important that future studies consider BDD as a risk factor for suicide in women who receive breast implants or other cosmetic procedures. This may be challenging, however, as many patients with BDD do not disclose their symptoms, and BDD often goes undiagnosed (8). Epidemiologic studies that use existing medical records and databases will likely underreport BDD's prevalence and miss a potential link among BDD, receipt of breast implants, and suicide. Prospective, longitudinal studies in which BDD is specifically asked about and identified are needed to shed light on this important issue.
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ACKNOWLEDGMENTS |
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Conflict of interest: none declared.
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References |
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 TOP References |
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- Villeneuve PJ, Holowaty EJ, Brisson J, et al. (2006) Mortality among Canadian women with cosmetic breast implants. Am J Epidemiol 164:334–41.
[Abstract/Free Full Text] - Brinton LA, Lubin JH, Burich MC, et al. (2001) Mortality among augmentation mammoplasty patients. Epidemiology 12:321–6.[CrossRef][Web of Science][Medline]
- Jacobson PH, Holmich LR, McLaughlin JK, et al. (2004) Mortality and suicide among Danish women with cosmetic breast implants. Arch Intern Med 164:2450–5.
[Abstract/Free Full Text] - Koot VC, Peeters PH, Granath F, et al. (2003) Total and cause specific mortality among Swedish women with cosmetic breast implants: prospective study. BMJ 326:527–8.
[Free Full Text] - Pukkala E, Kulmala I, Hovi SL, et al. (2003) Causes of death among Finnish women with cosmetic breast implants, 1971 –2001. Ann Plast Surg 51:339–42.[Web of Science][Medline]
- Sarwer DB, LaRossa D, Bartlett SP, et al. (2003) Body image concerns of breast augmentation patients. Plast Reconstr Surg 112:83–90.[Web of Science][Medline]
- Walden KJ, Thompson JK, Wells KE. (1997) Body image and psychological sequelae of silicone breast explantation: preliminary findings. Plast Reconstr Surg 100:1299–306.[Web of Science][Medline]
- Phillips KA. (2006) The presentation of body dysmorphic disorder in medical settings. Prim Psychiatry 13:51–9.
- Crerand C, Phillips KA, Menard W, et al. (2005) Non-psychiatric medical treatment of body dysmorphic disorder. Psychosomatics 46:549–55.
[Abstract/Free Full Text] - Hollander E, Cohen LJ, Simeon D. (1993) Body dysmorphic disorder. Psychiatr Ann 23:359–64.
- Phillips KA, Coles M, Menard W, et al. (2005) Suicidal ideation and suicide attempts in body dysmorphic disorder. J Clin Psychiatry 66:717–25.[Web of Science][Medline]
- Phillips KA and Menard W. (2006) Suicidality in body dysmorphic disorder: a prospective study. Am J Psychiatry 163:1280–2.
[Abstract/Free Full Text]
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