Zoom Dysmorphia and Increasing Use of Video Technology: Body Dysmorphic Disorder Screening by Telehealth

Prim Care Companion CNS Disord 2022;24(4):22br03294

To cite: Türk CB, Jafferany M. Zoom dysmorphia and increasing use of video technology: body dysmorphic disorder screening by telehealth. Prim Care Companion CNS Disord. 2022;24(4):22br03294.
To share: https://doi.org/10.4088/PCC.22br03294

© 2022 Physicians Postgraduate Press, Inc.

^aDepartment of Dermatology, University of Health Sciences, Istanbul Training and Research Hospital, Istanbul, Turkey
^bDepartment of Psychiatry, Central Michigan University, Saginaw, Michigan
*Corresponding author: Cemre Büşra Türk, MD, Department of Dermatology, Istanbul Training and Research Hospital, Kasap İlyas Mah Org Abdurrahman Nafiz Gürman Cd. PK:34098, Istanbul, Turkey (cbusraturk@gmail.com).

See letter by Teodoro.

Telehealth is defined as providing and facilitating health care, health information, and educational services through telecommunication and digital communication technologies.¹ A wide variety of technologies are currently being used, such as live videoconferencing, mobile health applications, remote patient monitoring, “store and forward” electronic transmission, text message, fax, e-mail, and telephone to provide telehealth services.¹ Even before the coronavirus disease 2019 (COVID-19) pandemic, videoconferencing technology was used to provide health care services to patients in rural areas, inmates, and military personnel.^1,2 However, with the advent of the COVID-19 pandemic, there has been a significant increase in the use of telehealth applications. In a recent study focusing on pandemic-based changes in US mental health care delivery, the authors³ reported increasing frequency of patients choosing telepsychology applications—up to 12 times more (85.33%) than the pre-pandemic level (7.07%).

The increasing use of videoconferencing applications has made individuals more concerned and anxious about their appearance. People became more aware of their looks as they started to see their faces on the screen for hours. They started comparing their appearance more with others because they could see images of others simultaneously on the screen. Despite the decrease in face-to-face patient examinations after the pandemic, > 50% of dermatologists state that cosmetic dermatology consultations have increased compared to pre-pandemic levels, and 82.7% report that their patients are not as satisfied with their appearance as before.⁴ Furthermore, 40% of individuals who were not interested in aesthetic procedures previously said that they sought aesthetic procedures after videoconferencing became more widespread.⁴

There are several options for using videoconferencing currently in practice. These applications are referred to as Zoom in everyday language and scientific literature. The concept of Zoom dysmorphia was discussed by Rice et al.⁵ It is defined as dissatisfaction with one’s own appearance secondary to the increasing use of Zoom in daily life and comparing one’s appearance with others and seeking cosmetic consultations.⁵ Prolonged Zoom dysmorphia may trigger development of body dysmorphic disorder (BDD) or may even worsen preexisting BDD.⁵ Considering the increasing demand for cosmetic applications after the pandemic and the possible effects of zoom dysmorphia on BDD, the probability of BDD patients presenting in cosmetic clinics may increase. Therefore, evaluation of patients for BDD is crucial, as BDD is considered a contraindication for major cosmetic procedures. Different screening tools for BDD in cosmetic settings are summarized in Table 1.^6–26

Considering the pandemic restrictions, physicians in cosmetic settings may prefer telehealth applications for BDD screening before any potential procedure. Currently, the recommended method for telepsychiatry is videoconferencing systems with appropriate verification, privacy, and security parameters. With regard to BDD screening tools, the questions may be sent to the patients by e-mail, and the patient may answer these questions during the videoconference interviews. With this screening method, the physician has a general idea about the patient’s physical appearance concerns and can select patients who are suitable for the procedure remotely before meeting face to face. Establishing a BDD diagnosis is sometimes a challenge due to the patients’ lack of insight and embarrassment about their complaints. Although interviews via telehealth may not be equivalent to the ideal structured psychiatric examination, telehealth interactions can be a good start for screening patients for BDD before cosmetic procedures.

It is predicted that virtual visits and videoconferencing apps will continue even after the COVID-19 pandemic, and physicians will continue to use telehealth applications in appropriate patients or when necessary. More studies are warranted to assess and validate psychometric features and the validity of these screening questionnaires in telehealth settings.

Submitted: March 24, 2022; accepted June 22, 2022.
Published online: August 18, 2022.
Relevant financial relationships: None.
Funding/support: None.
ORCID: Cemre Büşra Türk: https://orcid.org/0000-0002-9731-4561; Mohammad Jafferany: https://orcid.org/0000-0001-6358-9068