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Reddy V, Myers B, Chan S, Brownstone N, Thibodeaux Q, Koo J. Management strategies for borderline and narcissistic personality disorders in dermatology practice: a review. J DERMATOL TREAT 2020; 33:1265-1268. [PMID: 33019816 DOI: 10.1080/09546634.2020.1832190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Dermatologists are often ill-equipped to promptly identify and manage patients with personality disorders. Patients with borderline personality disorder (BPD) and narcissistic personality disorder (NPD) frequently present to dermatology clinics, particularly those that provide esthetic services. Although dermatologists should ideally utilize specific management strategies when working with these patients, there is a lack of awareness and availability of resources on how to do so. Here, we review the psychiatry, plastic and reconstructive surgery, and dermatology literature to provide recommendations on tangible management strategies for dermatologists to avoid common mistakes that are made while managing patients with BPD and NPD. Additionally, we also discuss common dermatologic manifestations of BPD and NPD to improve providers' ability to identify patients with these conditions in their practices.
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Affiliation(s)
- Vidhatha Reddy
- Department of Dermatology, University of California, San Francisco, San Francisco, CA, USA
| | - Bridget Myers
- Department of Dermatology, University of California, San Francisco, San Francisco, CA, USA
| | - Stephanie Chan
- Department of Dermatology, University of California, San Francisco, San Francisco, CA, USA
| | - Nicholas Brownstone
- Department of Dermatology, University of California, San Francisco, San Francisco, CA, USA
| | - Quinn Thibodeaux
- Department of Dermatology, University of California, San Francisco, San Francisco, CA, USA
| | - John Koo
- Department of Dermatology, University of California, San Francisco, San Francisco, CA, USA
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52
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Abstract
Body dysmorphic disorder and borderline personality disorder are common in esthetic practices and occur in up to 15% of patients. Operating on these patients may not only lead to dissatisfaction but may also worsen their premorbid condition and can induce negative behavior toward the practice. Preventing surgery and referring patients for cognitive therapy is essential. An adequate understanding of these conditions and the available screening tools is indispensable for all esthetic practitioners. Unrealistic emotional attribution to a facial shape, multiple procedures, a near-normal nose at the outset, childhood trauma, multiple comorbid mental conditions, and social dysfunction are red-flags to consider.
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53
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Bjureberg J, Enander J, Andersson E, Ivanov VZ, Rück C, Fernández de la Cruz L. Sudden Gains in Internet-Based Cognitive Behavior Therapy for Body Dysmorphic Disorder. Behav Ther 2020; 51:753-763. [PMID: 32800303 DOI: 10.1016/j.beth.2019.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 10/31/2019] [Accepted: 11/08/2019] [Indexed: 11/28/2022]
Abstract
Sudden gains have been associated with better short- and long-term treatment outcomes in a number of psychiatric disorders. However, no studies to date have evaluated sudden gains in body dysmorphic disorder (BDD). We used data from a previous randomized controlled trial evaluating the efficacy of an Internet-based cognitive-behavior treatment (CBT) for BDD. The sample consisted of 47 adults diagnosed with BDD. We compared the treatment outcomes of sudden gainers vs. gradual gainers (i.e., treatment responders with no sudden gains) and non-sudden gainers (i.e., gradual gainers plus nonresponders) at posttreatment and 3, 12, and 24 months after the end of the treatment. Twelve (25.5%) participants experienced a sudden gain. Compared to non-sudden gainers and to gradual gainers, sudden gainers showed significantly larger improvements on the Yale-Brown Obsessive-Compulsive Scale modified for BDD at posttreatment (g = 1.23 and g = .91, respectively), and at 3-month (g = 1.23 and g = 1.00, respectively), 12-month (g = 1.12 and g = .91, respectively), and 24-month follow-up (g = 1.11 and g = .97, respectively). This translated into higher rates of treatment responders and remitters in the sudden gainers across all time points. The occurrence of sudden gains in Internet-based CBT for BDD is associated with favorable short- and long-term treatment outcomes. This suggests that a sudden improvement during the treatment could be a marker of good prognosis, while non-sudden-including gradual-gainers are more likely to need continued support or booster sessions. Early identification of patients who are not progressing as expected and subsequent tailoring of the delivered intervention has the potential to improve treatment outcomes in this group.
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Affiliation(s)
- Johan Bjureberg
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet; Stockholm Health Care Services, Stockholm County Council, Stockholm
| | - Jesper Enander
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet
| | - Erik Andersson
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet
| | - Volen Z Ivanov
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet; Stockholm Health Care Services, Stockholm County Council, Stockholm
| | - Christian Rück
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet; Stockholm Health Care Services, Stockholm County Council, Stockholm
| | - Lorena Fernández de la Cruz
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet; Stockholm Health Care Services, Stockholm County Council, Stockholm.
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54
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Hammond BA, Reeve EA. A case of body dysmorphic disorder in an adolescent with hypohidrotic ectodermal dysplasia. Pediatr Dermatol 2020; 37:896-899. [PMID: 32643246 DOI: 10.1111/pde.14255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 05/20/2020] [Accepted: 05/30/2020] [Indexed: 11/27/2022]
Abstract
We report the case of an adolescent with hypohidrotic ectodermal dysplasia, who had obsessive-compulsive disorder and was later diagnosed with body dysmorphic disorder (BDD). BDD is a highly distressing, adolescent-onset disorder that may lead to social isolation, the development of comorbid mental health disorders and suicidality. Patients typically lack insight into their BDD and frequently present to dermatologists for medical treatment. In this paper, we address the challenges faced when working with patients with BDD.
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Affiliation(s)
| | - Elizabeth A Reeve
- HealthPartners Medical Group, Minneapolis, Minnesota, USA.,Department of Psychiatry, University of Minnesota Medical School, Minneapolis, Minnesota, USA
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55
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Senín-Calderón C, Perona-Garcelán S, Rodríguez-Testal JF. The dark side of Instagram: Predictor model of dysmorphic concerns. Int J Clin Health Psychol 2020; 20:253-261. [PMID: 32994798 PMCID: PMC7501442 DOI: 10.1016/j.ijchp.2020.06.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 06/19/2020] [Indexed: 11/29/2022] Open
Abstract
Dysmorphic concern are excessive preoccupation about one or several physical characteristics perceived as defects, usually unnoticeable by others. This study was intended to explore the relationship between Instagram use and dysmorphic concerns through appearance-related comparisons, ideas of reference and problems with emotion regulation, and find out whether this relationship is moderated by gender. METHOD The sample was comprised of 796 participants (Mage = 22.49; SD = 3.56; 54% women). RESULTS The results showed a non-significant direct effect between Instagram use and dysmorphic concerns. However, the relationship between these variables was statistically significant through appearance-related comparisons, ideas of reference about "laughing, commenting" and difficulties in emotion regulation. Gender did not moderate any relationship. CONCLUSIONS Men and women who made the most use of Instagram were equally vulnerable to dysmorphic concerns when they tended to compare their appearance with other users, had problems regulating their emotions, and showed interpretative biases related to the belief that others could make comments about them or laugh at them because of their imperfections. The implications of the study are discussed.
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Affiliation(s)
| | | | - Juan F Rodríguez-Testal
- Personality, Evaluation and Psychological Treatment Department, University of Seville, Spain
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56
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Baharvand P, Malekshahi F, Mahdiyan P. Prevalence of body image concern among schoolgirls aged 12-17 years in Iran. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2020; 9:210. [PMID: 33062743 PMCID: PMC7530431 DOI: 10.4103/jehp.jehp_259_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 04/01/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND/AIM Adolescent girls' concerns about their body images can negatively affect their social and academic performance. This study aimed to determine the prevalence of body image concern (BIC) in adolescent schoolgirls in Iran and its risk factors. PATIENTS AND METHODS This epidemiological study with cross-sectional design was conducted in 2018 on 396 middle schoolgirls aged 12-17 years (mean age = 14 years) living in Khorramabad, Iran. For screening BIC, the Persian version of BIC inventory (BICI) was used. Their birth order, school grade, school type, father's education, and household income were also recorded. Collected data were analyzed in SPSS v. 18 software using descriptive statistics and Chi-square test. RESULTS Of 396 girls, 106 (26.8%) had BIC, 89 (84%) reported moderate BIC, and 17 (16%) severe BIC. Their mean BICI score was 40.84 ± 12.93 (out of 42). Most of them reported to spend a significant amount of time checking their appearance in the mirror (n = 81, 20.5%) and examining flaws in their appearance (n = 74, 18.7%). A few of them were embarrassed to leave the house because of the appearance and avoided from looking at the appearance in the mirror (n = 6, 1.5%). There was no significant difference in BIC severity in terms of birth order, school grade, school type, father's education, and household income factors (P > 0.05). CONCLUSION The prevalence of BIC among schoolgirls in Iran is high. Appropriate therapeutic interventions should be carried out to improve their quality of life, mental health, and self-esteem to reduce the BIC prevalence.
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Affiliation(s)
- Parastoo Baharvand
- Department of Social Medicine, Social Determinants of Health Research Center, School of Medicine, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Farideh Malekshahi
- Department of Social Medicine, Social Determinants of Health Research Center, School of Medicine, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Pariya Mahdiyan
- Department of Social Medicine, School of Medicine, Lorestan University of Medical Sciences, Khorramabad, Iran
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57
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Jafferany M, Afrin A, Mkhoyan R, Khemani U, Sadoughifar R. Therapeutic implications of personality disorders in dermatology. Dermatol Ther 2020; 33:e13910. [PMID: 32594602 DOI: 10.1111/dth.13910] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 06/23/2020] [Indexed: 11/30/2022]
Abstract
There is a significant psychiatric comorbidity that exists in multiple dermatological conditions, stemming from the patient''s own psychological make up. This article reviews personality disorders and their types, which influence the course and prognosis of several psychodermatological disorders. Self-inflicted skin lesions, for example, are usually associated with obsessive-compulsive behavior, but they also share connections to Narcissistic and Borderline personality disorders. Body dysmorphic disorder is another psychodermatological condition seen in dermatology, aesthetic, and cosmetic surgery clinics, which is influenced by patient's personality type. In general, there is a significantly high proportion of personality disorders seen in aesthetic and cosmetic surgery. The management of patients with personality disorders is challenging, but joint liaison between psychiatry and dermatology has proven helpful and can provide patients with the best care for their psychological needs and dermatologic care.
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Affiliation(s)
- Mohammad Jafferany
- College of Medicine, Central Michigan University, Saginaw, Michigan, USA
| | - Antara Afrin
- College of Human Medicine, Central Michigan University, Lansing, Michigan, USA
| | | | - Usha Khemani
- Grant Government Medical College and Sir J.J.Group of Hospitals, Mumbai, India
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58
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Hartmann AS, Staufenbiel T, Bielefeld L, Buhlmann U, Heinrichs N, Martin A, Ritter V, Kollei I, Grocholewski A. An empirically derived recommendation for the classification of body dysmorphic disorder: Findings from structural equation modeling. PLoS One 2020; 15:e0233153. [PMID: 32492037 PMCID: PMC7269265 DOI: 10.1371/journal.pone.0233153] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 04/29/2020] [Indexed: 01/10/2023] Open
Abstract
Body dysmorphic disorder (BDD), together with its subtype muscle dysmorphia (MD), has been relocated from the Somatoform Disorders category in the DSM-IV to the newly created Obsessive-Compulsive and Related Disorders category in the DSM-5. Both categorizations have been criticized, and an empirically derived classification of BDD is lacking. A community sample of N = 736 participants completed an online survey assessing different psychopathologies. Using a structural equation modeling approach, six theoretically derived models, which differed in their allocation of BDD symptoms to various factors (i.e. general psychopathology, somatoform, obsessive-compulsive and related disorders, affective, body image, and BDD model) were tested in the full sample and in a restricted sample (n = 465) which indicated primary concerns other than shape and weight. Furthermore, measurement invariance across gender was examined. Of the six models, only the body image model showed a good fit (CFI = 0.972, RMSEA = 0.049, SRMR = 0.027, TLI = 0.959), and yielded better AIC and BIC indices than the competing models. Analyses in the restricted sample replicated these findings. Analyses of measurement invariance of the body image model showed partial metric invariance across gender. The findings suggest that a body image model provides the best fit for the classification of BDD and MD. This is in line with previous studies showing strong similarities between eating disorders and BDD, including MD. Measurement invariance across gender indicates a comparable presentation and comorbid structure of BDD in males and females, which also corresponds to the equal prevalence rates of BDD across gender.
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Affiliation(s)
| | | | - Lukas Bielefeld
- Institute of Psychology, Osnabrück University, Osnabrück, Germany
| | - Ulrike Buhlmann
- Institute of Psychology, Münster University, Münster, Germany
| | - Nina Heinrichs
- Department of Psychology, University of Bremen, Bremen, Germany
| | - Alexandra Martin
- Institute of Psychology, Wuppertal University, Wuppertal, Germany
| | - Viktoria Ritter
- Institute of Psychology, Goethe University Frankfurt, Frankfurt, Germany
| | - Ines Kollei
- Institute of Psychology, Otto-Friedrich-University of Bamberg, Bamberg, Germany
| | - Anja Grocholewski
- Institute of Psychology, Technische Universität Braunschweig, Brunswick, Germany
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59
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Mattina GF, Slyepchenko A, Steiner M. Obsessive–compulsive and related disorders. HANDBOOK OF CLINICAL NEUROLOGY 2020; 175:369-386. [DOI: 10.1016/b978-0-444-64123-6.00025-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/11/2023]
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60
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Sevilla-Cermeño L, Rautio D, Andrén P, Hillborg M, Silverberg-Morse M, Lahera G, Mataix-Cols D, Fernández de la Cruz L. Prevalence and impact of insomnia in children and adolescents with body dysmorphic disorder undergoing multimodal specialist treatment. Eur Child Adolesc Psychiatry 2020; 29:1289-1299. [PMID: 31760510 PMCID: PMC7497371 DOI: 10.1007/s00787-019-01442-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Accepted: 11/12/2019] [Indexed: 11/25/2022]
Abstract
Pediatric body dysmorphic disorder (BDD) is challenging to treat. This study aimed to establish the prevalence of insomnia in youth with BDD and explore its impact on clinical outcomes. Sixty-six children and adolescents with BDD consecutively referred to a specialist clinic completed a range of clinical measures, including the Yale-Brown Obsessive-Compulsive Scale Modified for BDD-Adolescent Version (BDD-YBOCS-A), and the Insomnia Severity Index (ISI). Patients with clinical insomnia (ISI score ≥ 9) were compared to the rest of the sample on socio-demographic and clinical features. Fifty-six patients who received multimodal treatment were re-assessed post-treatment. A mixed-model ANOVA was performed to compare treatment outcomes between the insomnia vs. no insomnia groups, and Chi-squared tests were used to compare response and remission rates. According to the ISI, 48% of the sample qualified as having insomnia at baseline. These participants showed significantly higher self-reported BDD symptom severity, more depressive symptoms, and more functional impairment in daily activities. Patients with insomnia improved less on the BDD-YBOCS-A than those without insomnia, although the difference did not reach statistical significance. The rates of responders and remitters were lower in the insomnia group, compared to the non-insomnia group. Insomnia is prevalent in pediatric BDD, and is associated with more severe psychopathology and worse functioning in daily activities. Furthermore, youth experiencing BDD and insomnia may benefit from multimodal treatment to a lesser extent than those without insomnia. If these results are replicated in larger samples, treatment refinements for pediatric BDD could include specific modules to directly target insomnia.
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Affiliation(s)
- Laura Sevilla-Cermeño
- Karolinska Institutet, Department of Clinical Neuroscience, Child and Adolescent Psychiatry Research Center, Gävlegatan 22 (Entré B), Floor 8, 113 30, Stockholm, Sweden.
- Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden.
- Departamento de Medicina y Especialidades Médicas, Universidad de Alcalá, Madrid, Spain.
| | - Daniel Rautio
- Karolinska Institutet, Department of Clinical Neuroscience, Child and Adolescent Psychiatry Research Center, Gävlegatan 22 (Entré B), Floor 8, 113 30, Stockholm, Sweden
- Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - Per Andrén
- Karolinska Institutet, Department of Clinical Neuroscience, Child and Adolescent Psychiatry Research Center, Gävlegatan 22 (Entré B), Floor 8, 113 30, Stockholm, Sweden
- Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - Maria Hillborg
- Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | | | - Guillermo Lahera
- Departamento de Medicina y Especialidades Médicas, Universidad de Alcalá, Madrid, Spain
| | - David Mataix-Cols
- Karolinska Institutet, Department of Clinical Neuroscience, Child and Adolescent Psychiatry Research Center, Gävlegatan 22 (Entré B), Floor 8, 113 30, Stockholm, Sweden
- Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - Lorena Fernández de la Cruz
- Karolinska Institutet, Department of Clinical Neuroscience, Child and Adolescent Psychiatry Research Center, Gävlegatan 22 (Entré B), Floor 8, 113 30, Stockholm, Sweden
- Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
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61
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Senín‐Calderón C, Gálvez‐González J, Perona‐Garcelán S, Camacho C, Rodríguez‐Testal JF. Dysmorphic concern and behavioural impairment related to body image in adolescents. INTERNATIONAL JOURNAL OF PSYCHOLOGY 2019; 55:832-841. [DOI: 10.1002/ijop.12646] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Accepted: 12/07/2019] [Indexed: 11/12/2022]
Affiliation(s)
| | | | - Salvador Perona‐Garcelán
- Personality, Evaluation and Psychological Treatment Department University of Seville Seville Spain
- University Hospital Virgen del Rocío Sevilla Spain
| | - Carlos Camacho
- Department of Experimental Psychology University of Seville Seville Spain
| | - Juan F. Rodríguez‐Testal
- Personality, Evaluation and Psychological Treatment Department University of Seville Seville Spain
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Abstract
A new measure specifically designed for adolescents to assess body dysmorphic disorder (BDD) symptoms is needed to identify youth who could benefit from intervention to reduce their BDD-related symptomology. To address this gap, the Multidimensional Youth Body Dysmorphic Inventory (MY BODI) was developed and the psychometric properties were evaluated. Following development and expert assessment, Australian secondary school students (N = 582; 55% female; Mage = 13.62, SD = 1.59, aged 11 to 18 years, grades 7 to 12) completed a survey with the new items and validation measures. Results from the factor analysis supported a 3-factor, 21-items measure, which aligned with the DSM-5 diagnostic criteria of Impairment/avoidance, Preoccupation/repetitive behaviours, and Insight/distress. Supporting the convergent validity of the measure, the MY BODI total score and sub-scale scores correlated with measures of BDD symptoms, including the Appearance Anxiety Inventory (AAI) and Body Dysmorphic Disorder Questionnaire-Adolescent Version (BDDQ-A). This study provides preliminary validation of the MY BODI, a self-report measure of BDD symptoms and symptom severity, using a response set aimed to facilitate more reliable reporting, which may identify risk for BDD, and symptoms of BDD.
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Abstract
Drug use disorders (DUDs) are highly prevalent in body dysmorphic disorder (BDD), but motives for illicit drug use in BDD have not yet been explored. This study examined motives for drug use and clinical correlates of drug use motives in a sample of individuals with BDD and lifetime drug use, using the Drug Use Motives Questionnaire and 3 additional body image-specific drug use motives. As predicted, the Drug Use Motives Questionnaire coping motive was positively associated with attempted suicide and a lifetime DUD. All 3 body image-specific motives for drug use were also significantly associated with a lifetime DUD. In addition, they were the only variables that were significantly associated with greater severity of BDD. These results build on previous evidence suggesting that coping motives are related to problematic substance use and suicide attempts in BDD.
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64
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Groves K, Kennett S, Gillmeister H. Evidence for altered configural body processing in women at risk of disorders characterized by body image disturbance. Br J Psychol 2019; 111:508-535. [PMID: 31264721 DOI: 10.1111/bjop.12412] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Revised: 05/01/2019] [Indexed: 02/01/2023]
Abstract
Two studies were conducted to assess appearance-related visual processing mechanisms in populations at risk of disorders characterized by body image disturbance. Using inverted stimuli, Experiment 1 assessed visual processing mechanisms associated with body, face, and house viewing in adolescents. Experiment 2 applied the same protocol to assess appearance-related configural processing in high- and low-risk adolescent women, and women recovering from disorders characterized by body image disturbance. Experiment 1 found evidence for typical configural face and body processing, although adolescent women reported higher levels of body image concern (BIC) and self-objectified to a greater extent than adolescent men. In Experiment 2, typical body inversion effects were seen in the low-risk group, whilst there was some evidence to suggest a disruption to the configural processing of body stimuli in high-risk adolescents and in women recovering from body image disorders. Women in recovery were also quicker to respond to all stimuli, whilst high-risk adolescents took longer to respond to bodies than to other stimuli. Configural face processing was intact in all groups, and effects did not directly relate to BIC or self-objectification. These findings have implications for future research looking to inform early interventions and treatment, suggesting that there could be a tendency to visually process individual body parts at the expense of the whole-body form in women at risk of developing body image disorders, as well as those in recovery.
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65
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Krebs G, Quinn R, Jassi A. Is perfectionism a risk factor for adolescent body dysmorphic symptoms? Evidence for a prospective association. J Obsessive Compuls Relat Disord 2019; 22:100445. [PMID: 31534902 PMCID: PMC6737990 DOI: 10.1016/j.jocrd.2019.100445] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 05/13/2019] [Accepted: 05/17/2019] [Indexed: 11/25/2022]
Abstract
The current study tested the hypothesis that perfectionism is a risk factor for the development of body dysmorphic disorder (BDD), as proposed by prevailing cognitive behavioural models. School students aged 14-16 years completed questionnaires 6 months apart (Time 1: N = 302; Time 2: N = 68) assessing perfectionism, BDD symptoms, and anxiety and depression. Robust regression models tested concurrent and prospective associations between perfectionism and BDD symptoms, with and without adjustment for coexisting anxiety and depression. Total perfectionism was positively associated with concurrent BDD symptoms, even when controlling for coexisting anxiety and depression. Moreover, total perfectionism predicted changes in BDD symptoms between Time 1 and Time 2. Examination of perfectionism subscales indicated that only self-oriented perfectionism, not socially-prescribed perfectionism, predicted BDD symptoms concurrently and prospectively while controlling for coexisting psychopathology. This study provides preliminary evidence for self-oriented perfectionism being a risk factor for the development of BDD in youth. If replicated, these findings could highlight the potential value of targeting self-oriented perfectionism in prevention and early intervention programs for BDD.
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Affiliation(s)
- Georgina Krebs
- King's College London, MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, De Crespigny Park, London, United Kingdom
- National and Specialist OCD and Related Disorders Clinic for Young People, South London and Maudsley NHS Foundation Trust, London, UK
| | - Rachel Quinn
- King's College London, Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, De Crespigny Park, London, United Kingdom
| | - Amita Jassi
- National and Specialist OCD and Related Disorders Clinic for Young People, South London and Maudsley NHS Foundation Trust, London, UK
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66
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Abstract
Background and Objectives:
Body Dysmorphic Disorder (BDD) is characterized
by an abnormal preoccupation with alleged misshapen body parts. There is often poor insight
and effort is made to hide the imagined defects, and consultation may be sought seeking
unnecessary cosmetic surgery or procedures. It is underdiagnosed and established treatment
protocols are lacking. The disease has a chronic and undulating course and is seriously
compromises quality of life. Despite the fact that the prime age of onset of BDD is during
adolescence relatively little has been written about it during this phase of life. This review
aims to comprehensively cover the present understanding of BDD, including clinical
features, epidemiology, psychopathology, nomenclature, comorbidity and management.
Methods:
A literature search was undertaken using suitable key words on Google Scholar,
MEDLINE & PsychoINFO up to June 2018 limited to articles in English.
Results:
he prevalence of BDD is variable in the general and psychiatric population with
equal gender distribution. Both sexes are equally affected. It is associated with poor
functioning and a chronic course. There is considerable comorbidity and diagnostic overlap
between BDD and obsessive-compulsive disorder, major depressive disorder, social anxiety
disorder, anorexia nervosa, schizophrenia spectrum disorders and personality disorders.
Psychiatric consultation is often late. Selective Serotonin Reuptake Inhibitors (SSRIs) and
Cognitive Behavior Therapy (CBT) are currently the first line modalities for treatment.
Internet based CBT, Acceptance and commitment therapy, and repetitive Transcranial
Magnetic Stimulation (rTMS) are emerging treatment options.
Conclusions:
BDD is a complex disorder with still lot of uncertainty about its diagnostic
placement, treatment approaches, especially for refractory patients, and prognosis. Further
study is needed to clarify its prevalence, especially in adolescents; to fully understand its
neurobiological aspects, to determine its exact relation to obsessive compulsive related
disorders, and to develop better treatment approaches.
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Affiliation(s)
- Himanshu Sharma
- Pramukh Swami Medical College & Shree Krishna Hospital, Karamsad, India
| | - Bharti Sharma
- Government Arts College, Garbada, Dahod, Gujarat, India
| | - Nisheet Patel
- Pramukh Swami Medical College & Shree Krishna Hospital, Karamsad, India
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67
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Giraldo-O’Meara M, Belloch A. The Appearance Intrusions Questionnaire. EUROPEAN JOURNAL OF PSYCHOLOGICAL ASSESSMENT 2019. [DOI: 10.1027/1015-5759/a000406] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Abstract. This study aims to examine whether Body Dysmorphic Disorder (BDD) related preoccupations might consist of unwanted intrusive cognitions, and if so, their degree of universality, its dimensionality from normality to BDD psychopathology, and their associations with symptom measures. The Appearance Intrusions Questionnaire (AIQ) was designed to assess intrusive thoughts related to appearance defects (AITs). A sample of 410 undergraduate university students completed a former 54-item version of the AIQ. Principal Components Analyses (PCA) and Parallel Analysis yielded a five-factor structure and a reduction to 27 items. The 27-items AIQ was examined in a new sample of 583 non-clinical community participants. Confirmatory Factor Analyses (CFAs) grouped the AITs in five factors: Defect-related, Others-related, Concealment, Bodily functions, and Urge to do something. Up to 90% of the participants experienced AITs. The AIQ scores were more associated with BDD, Obsessive-Compulsive Disorder (OCD), and body image measures than with worry, suggesting that AITs are closer to obsessional intrusions than to worries. The new AIQ might be a valid and reliable measure of AITs and would help to reliably detect individuals at risk for BDD in nonclinical populations using a brief self-report.
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Affiliation(s)
- Martha Giraldo-O’Meara
- Department of Personality Psychology, Research Unit for Obsessive-Compulsive and Related Disorders, I’TOC, Universidad de Valencia, Spain
| | - Amparo Belloch
- Department of Personality Psychology, Research Unit for Obsessive-Compulsive and Related Disorders, I’TOC, Universidad de Valencia, Spain
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68
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Dong N, Nezgovorova V, Hong K, Hollander E. Pharmacotherapy in body dysmorphic disorder: relapse prevention and novel treatments. Expert Opin Pharmacother 2019; 20:1211-1219. [DOI: 10.1080/14656566.2019.1610385] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Nancy Dong
- Department of Psychiatry and Behavioral Sciences, Autism and Obsessive-Compulsive Spectrum Program, Anxiety and Depression Program, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA
| | - Vera Nezgovorova
- Department of Psychiatry and Behavioral Sciences, Autism and Obsessive-Compulsive Spectrum Program, Anxiety and Depression Program, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA
| | - Kevin Hong
- Department of Psychiatry and Behavioral Sciences, Autism and Obsessive-Compulsive Spectrum Program, Anxiety and Depression Program, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA
| | - Eric Hollander
- Department of Psychiatry and Behavioral Sciences, Autism and Obsessive-Compulsive Spectrum Program, Anxiety and Depression Program, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA
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69
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Phillipou A, Castle DJ, Rossell SL. Direct comparisons of anorexia nervosa and body dysmorphic disorder: A systematic review. Psychiatry Res 2019; 274:129-137. [PMID: 30784781 DOI: 10.1016/j.psychres.2019.01.106] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 01/31/2019] [Accepted: 01/31/2019] [Indexed: 11/29/2022]
Abstract
Anorexia nervosa (AN) and body dysmorphic disorder (BDD) are serious psychiatric conditions, both of which are associated with a disturbance of body image. The aim of this paper was to review those studies that have directly compared groups of individuals with AN and BDD, to determine similarities and differences in presentation between the two conditions. The literature was searched to September 2018, and studies were included if they were English language, empirical research papers published in peer-reviewed journals, specifically comparing AN and BDD patients. Fifteen relevant studies were identified. The results suggested that individuals with AN and BDD share a number of similarities, including their degree of body dissatisfaction. Differences between the conditions included primary concerns with body shape and weight in AN, and much more diffuse concerns (but predominantly the face) in BDD. The small number of studies, along with the limited replication of results emphasises the need for greater research in this area. However, the studies undertaken to date highlight the high degree of overlap between AN and BDD and suggests that the conditions may represent similar body image disorders. This has implications for the nosological status of AN and BDD.
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Affiliation(s)
- Andrea Phillipou
- Centre for Mental Health, Swinburne University of Technology, Melbourne, Australia; Department of Mental Health, St Vincent's Hospital, Melbourne, Australia; Department of Psychiatry, The University of Melbourne, Melbourne, Australia; Department of Mental Health, Austin Health, Melbourne, Australia.
| | - David Jonathan Castle
- Department of Mental Health, St Vincent's Hospital, Melbourne, Australia; Department of Psychiatry, The University of Melbourne, Melbourne, Australia
| | - Susan Lee Rossell
- Centre for Mental Health, Swinburne University of Technology, Melbourne, Australia; Department of Mental Health, St Vincent's Hospital, Melbourne, Australia
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70
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Fontenelle LF, Zeni-Graiff M, Quintas JN, Yücel M. Is There A Role For Lifestyle Interventions In Obsessive-Compulsive And Related Disorders? Curr Med Chem 2019; 25:5698-5711. [DOI: 10.2174/0929867325666180104150854] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2016] [Revised: 12/01/2017] [Accepted: 12/08/2017] [Indexed: 01/12/2023]
Abstract
Many of the currently available treatments for obsessive-compulsive and related
disorders (OCRDs) such as pharmacotherapy augmentation strategies, partial hospitalization
programs, deep brain stimulation, and neurosurgery are efficacious for individuals
suffering from more severe forms of these conditions. Unfortunately, the application
of these treatments in milder forms of illness and subclinical samples, which affect a
substantial portion of the population, is not justifiable by their costs (e.g. cognitivebehavioral
therapy) and/or potential for side effects (serotonin-reuptake inhibitors associated
sexual side effects). As such, there is an urgent need to develop simple yet effective
treatments, such as modifiable lifestyle interventions, that can be employed on a broader
scale. Here, we review the current state of evidence that supports or refutes the efficacy of
lifestyle approaches for OCRDs. We focus on dimensions of lifestyle that are deemed important
for cardiovascular diseases; namely, physical activity, stress, sleep, diet and eating
behaviors, alcohol consumption, and smoking. Despite the relative scarcity of welldesigned
randomized controlled trials targeting unhealthy life styles in OCRDs, we found
meditation-based therapies and interventions focusing on eliminating sedentarism to be
promising approaches. In the future, these strategies may represent valid alternative for
subjects with subthreshold symptoms or at risk for OCRDs or other “compulsive” disorders.
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Affiliation(s)
- Leonardo F. Fontenelle
- Obsessive, Compulsive, and Anxiety Spectrum Research Program. Institute of Psychiatry, Federal University of Rio de Janeiro, Brazil
| | - Maiara Zeni-Graiff
- Obsessive, Compulsive, and Anxiety Spectrum Research Program. Institute of Psychiatry, Federal University of Rio de Janeiro, Brazil
| | - Julliana N. Quintas
- Obsessive, Compulsive, and Anxiety Spectrum Research Program. Institute of Psychiatry, Federal University of Rio de Janeiro, Brazil
| | - Murat Yücel
- Brain & Mental Health Laboratory, Monash Institute of Cognitive and Clinical Neurosciences and School of Psychological Sciences, Monash University, Victoria, Australia
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71
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Enander J, Ljótsson B, Anderhell L, Runeborg M, Flygare O, Cottman O, Andersson E, Dahlén S, Lichtenstein L, Ivanov VZ, Mataix-Cols D, Rück C. Long-term outcome of therapist-guided internet-based cognitive behavioural therapy for body dysmorphic disorder (BDD-NET): a naturalistic 2-year follow-up after a randomised controlled trial. BMJ Open 2019; 9:e024307. [PMID: 30647044 PMCID: PMC6340432 DOI: 10.1136/bmjopen-2018-024307] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES Most patients with body dysmorphic disorder (BDD) do not receive evidence-based treatment. A randomised controlled trial (RCT) has found that a therapist-guided internet-based cognitive-behavioural therapy (CBT) programme for BDD (BDD-NET) can be delivered safely via the internet with significant improvements in BDD symptom severity in the short term. The purpose of this study was to evaluate if the therapeutic gains of BDD-NET are maintained 2 years after treatment. SETTING Academic medical centre. PARTICIPANTS A naturalistic 2-year follow-up study of the 88 self-referred adult outpatients with a diagnosis of BDD that had received BDD-NET within the context of the RCT. PRIMARY AND SECONDARY OUTCOMES The primary outcome was the BDD-Yale-Brown Obsessive-Compulsive Scale (YBOCS). Responder status was defined as a ≥30% reduction in symptoms. Remission was defined as no longer meeting Diagnostic and Statistical Manual of Mental Disorders 5th edition criteria for BDD. Secondary outcomes included measures of depression, global functioning and quality of life. RESULTS The efficacy of BDD-NET was sustained long- term, with further improvements observed on the BDD-YBOCS during the follow-up period. At follow-up, 69% (95% CI 57% to 80%) were classified as responders and 56% (95% CI 43% to 69%) were in remission. Gains on depressive symptoms and global functioning were also sustained but not quality of life. A majority of participants reported that the main reason for seeking help for their BDD was the possibility to access the treatment from home. CONCLUSION BDD-NET is an effective treatment for BDD, and the patients' gains are maintained in the long term. BDD-NET has the potential to increase access to CBT and may lower the threshold for BDD sufferers to seek help in the first place. TRIAL REGISTRATION NUMBER NCT02010619.
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Affiliation(s)
- Jesper Enander
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Brjánn Ljótsson
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Lina Anderhell
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Martin Runeborg
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Oskar Flygare
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Oskar Cottman
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Erik Andersson
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Sofia Dahlén
- Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - Linn Lichtenstein
- Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - Volen Z Ivanov
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - David Mataix-Cols
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - Christian Rück
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
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72
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Marron S, Gracia-Cazaña T, Miranda-Sivelo A, Lamas-Diaz S, Tomas-Aragones L. Screening for Body Dysmorphic Disorders in Acne Patients: A Pilot Study. ACTAS DERMO-SIFILIOGRAFICAS 2019. [DOI: 10.1016/j.adengl.2018.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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73
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Detección de trastorno dismórfico corporal en pacientes con acné: estudio piloto. ACTAS DERMO-SIFILIOGRAFICAS 2019; 110:28-32. [DOI: 10.1016/j.ad.2018.08.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2018] [Revised: 07/23/2018] [Accepted: 08/03/2018] [Indexed: 11/17/2022] Open
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74
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Tatiana Soler P, Novaes J, Miguel Fernandes H. Influencing Factors of Social Anxiety Disorder and Body Dysmorphic Disorder in a Nonclinical Brazilian Population. Psychol Rep 2018; 122:2155-2177. [PMID: 30388392 DOI: 10.1177/0033294118805003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
The aims of this study were twofold: (i) to investigate the prevalence of social anxiety disorder and body dysmorphic disorder in a nonclinical, Brazilian population and (ii) to examine the effects of selected factors such as sociodemographic characteristics (sex, age, marital status, workload, education, and income), body mass index, current diet, physical activity, and use of aesthetic treatment. A total of 428 adults (279 women and 149 men) aged 18 to 60 years ( M = 31.51, SD = 10.73) participated in the study. Social anxiety disorder was measured using a Brazilian version of the Social Phobia Inventory ( Osório, Crippa, & Loureiro, 2009 ). Body dysmorphic disorder by using a body dysmorphic symptoms scale validated for the Brazilian population ( Ramos & Yoshida, 2012 ). The main results showed that 28.7% of the sample reported symptoms of social anxiety disorder. Body dysmorphic disorder was more prevalent among women, individuals who had sought aesthetic treatment and individuals who were physically inactive. Moreover, lower levels of social anxiety disorder were observed in physically active individuals who had sought aesthetic treatment compared with physically inactive individuals who had sought aesthetic treatment. Social anxiety disorder was negatively correlated with age, daily workload, and income, while body dysmorphic disorder was positively associated with body mass index and negatively with income. These results show that social anxiety disorder and body dysmorphic disorder are differentially influenced by the selected factors investigated in this study.
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Affiliation(s)
| | - Jefferson Novaes
- Department of Physical Education, Federal University of Rio de Janeiro; Federal University of Juiz de Fora, Brazil
| | - Helder Miguel Fernandes
- Research Centre in Sports Sciences, Health Sciences and Human Development, CIDESD, Portugal; Research in Education and Community Intervention, Portugal
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75
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Abstract
Body dysmorphic disorder is an obsessive-compulsive spectrum disorder involving a perceived defect in physical appearance that most commonly develops in early adolescence and causes significant functional impairment and suicidality at much higher rates than in affected adults. Patients may also present with subthreshold body dysmorphic disorder or obsessive concerns over a diagnosable dermatologic condition, both of which can present similarly to body dysmorphic disorder. Pediatric dermatologists can play an important role in detecting body dysmorphic disorder and body dysmorphic disorder-like symptoms, which may occur in as many as 20% of dermatology patients. Greater awareness of the prevalence, clinical presentation, and effect of these symptoms, as well as better screening tools and greater collaboration with our mental health colleagues, may lead to earlier, more effective intervention.
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Affiliation(s)
- Margaret H Dennin
- Pritzker School of Medicine, University of Chicago, Chicago, IL, USA
| | - Margaret S Lee
- Department of Dermatology, School of Medicine, Boston University, Boston, MA, USA.,Department of Pediatrics, School of Medicine, Boston University, Boston, MA, USA
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76
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Thungana Y, Moxley K, Lachman A. Body dysmorphic disorder: A diagnostic challenge in adolescence. S Afr J Psychiatr 2018; 24:1114. [PMID: 30263210 PMCID: PMC6138111 DOI: 10.4102/sajpsychiatry.v24i0.1114] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 05/11/2018] [Indexed: 11/17/2022] Open
Abstract
Body dysmorphic disorder (BDD) is a chronic and disabling condition that is characterised by distressing preoccupations with perceived defects in one’s own appearance, which might be slight or not observable to others. It is considered to be an obsessive–compulsive spectrum disorder and is associated with depression, feelings of shame and poor quality of life. It is primarily a disorder of childhood or adolescent onset, and sub-clinical BDD symptoms begin, on average, several years before an individual’s symptoms meet full criteria for the disorder. Here we report the case of an adolescent admitted to an inpatient psychiatric unit for treatment of psychotic symptoms that were poorly responsive to standard treatments. This challenging case of BDD in an adolescent highlights the various comorbidities of the disorder, as well as the difficulties associated with BDD diagnosis.
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Affiliation(s)
- Yanga Thungana
- Department of Psychiatry, Stellenbosch University, South Africa.,Department of Psychiatry, Walter Sisulu University, South Africa
| | - Karis Moxley
- Department of Psychiatry, Stellenbosch University, South Africa
| | - Anusha Lachman
- Department of Psychiatry, Stellenbosch University, South Africa
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77
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Buckley V, Krebs G, Bowyer L, Jassi A, Goodman R, Clark B, Stringaris A. Innovations in Practice: Body dysmorphic disorder in youth - using the Development and Well-Being Assessment as a tool to improve detection in routine clinical practice. Child Adolesc Ment Health 2018; 23:291-294. [PMID: 32677303 DOI: 10.1111/camh.12268] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/25/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND Body Dysmorphic Disorder (BDD) is a distressing disorder that is widely underdetected in youth. This study aimed to examine the potential utility of the Development and Well-Being Assessment (DAWBA) as a tool to improve recognition of BDD in routine clinical practice. METHODS One hundred and sixty-one patients assessed across two national and specialist child and adolescent mental health services, one specialising in mood disorders and one specialising in obsessive compulsive disorder and BDD, were included in this study. Results from the DAWBA were compared with clinical diagnosis to examine the utility of the DAWBA in detecting BDD. RESULTS Only 27% of participants who received a diagnosis of BDD at assessment had been referred with concerns about appearance anxiety suggesting significant under detection in youth mental health services. Using the single-screener question on the DAWBA, it was possible to correctly identify 97% of cases with BDD. CONCLUSIONS Body dysmorphic disorder often goes undetected in routine clinical practice. The DAWBA shows promise as a tool for helping clinicians to accurately detect BDD in routine clinical practice.
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Affiliation(s)
- Vanessa Buckley
- National & Specialist CAMHS Mood Disorders Clinic, South London and Maudsley NHS Foundation Trust, London, UK
| | - Georgina Krebs
- National & Specialist OCD, BDD and Related Disorders Clinic for Young People, South London & Maudsley NHS Foundation Trust, London, UK.,Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Laura Bowyer
- National & Specialist OCD, BDD and Related Disorders Clinic for Young People, South London & Maudsley NHS Foundation Trust, London, UK
| | - Amita Jassi
- National & Specialist OCD, BDD and Related Disorders Clinic for Young People, South London & Maudsley NHS Foundation Trust, London, UK
| | - Robert Goodman
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Bruce Clark
- National & Specialist OCD, BDD and Related Disorders Clinic for Young People, South London & Maudsley NHS Foundation Trust, London, UK
| | - Argyris Stringaris
- Mood Brain and Development Unit, Emotion & Development Branch, National Institute of Mental Health, Bethesda, MD, USA
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78
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Hong K, Nezgovorova V, Uzunova G, Schlussel D, Hollander E. Pharmacological Treatment of Body Dysmorphic Disorder. Curr Neuropharmacol 2018; 17:697-702. [PMID: 29701157 PMCID: PMC7059151 DOI: 10.2174/1570159x16666180426153940] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 03/15/2018] [Accepted: 04/24/2018] [Indexed: 11/29/2022] Open
Abstract
Body dysmorphic disorder is a challenging disorder that manifests as erroneously perceived flaws in one’s physical appearance and repetitive behaviors in response to appearance concerns. This disorder is also frequently comorbid with other psychiatric disorders, including major depressive disorder and autism spectrum disorder. It is currently understood to arise from a combination of biological, psychological, and environmental factors. Treatment of body dysmorphic disorder typically consists of a combination of pharmacotherapy and cognitive behavioral therapy. However, not all patients respond to treatment, and BDD symptoms remain even in those who do respond. This review outlines current pharmacological and neuromodulation treatments for body dysmorphic disorder and suggests directions for future studies of novel treatments such as augmentation with atypical antipsychotics and the use of intranasal oxytocin in cases of body dysmorphic disorder that show residual symptomatology even with tailored monotherapy. There is emerging evidence suggesting that non-invasive neurostimulatory techniques, such as repetitive transcranial magnetic stimulation, may be of value in treatment-resistant cases.
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Affiliation(s)
- Kevin Hong
- Department of Psychiatry and Behavioral Sciences, Autism and Obsessive-Compulsive Spectrum Program, Anxiety and Depression Program, Albert Einstein College of Medicine, Montefiore Medical Center, NY, United States
| | - Vera Nezgovorova
- Department of Psychiatry and Behavioral Sciences, Autism and Obsessive-Compulsive Spectrum Program, Anxiety and Depression Program, Albert Einstein College of Medicine, Montefiore Medical Center, NY, United States
| | - Genoveva Uzunova
- Department of Psychiatry and Behavioral Sciences, Autism and Obsessive-Compulsive Spectrum Program, Anxiety and Depression Program, Albert Einstein College of Medicine, Montefiore Medical Center, NY, United States
| | - Danya Schlussel
- Department of Psychiatry and Behavioral Sciences, Autism and Obsessive-Compulsive Spectrum Program, Anxiety and Depression Program, Albert Einstein College of Medicine, Montefiore Medical Center, NY, United States
| | - Eric Hollander
- Department of Psychiatry and Behavioral Sciences, Autism and Obsessive-Compulsive Spectrum Program, Anxiety and Depression Program, Albert Einstein College of Medicine, Montefiore Medical Center, NY, United States
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79
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De La Vega D, Giner L, Courtet P. Suicidality in Subjects With Anxiety or Obsessive-Compulsive and Related Disorders: Recent Advances. Curr Psychiatry Rep 2018; 20:26. [PMID: 29594718 DOI: 10.1007/s11920-018-0885-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
PURPOSE OF REVIEW Historically, anxiety disorders have not been considered as important determinants of suicide, but in the last years, many works have challenged this assumption. Here, we will review the available evidence on the relationship between suicide and anxiety disorders (e.g., obsessive-compulsive disorder, post-traumatic stress disorder, generalized anxiety disorder, panic disorder, and body dysmorphic disorder), with special emphasis on findings published in the last years. RECENT FINDINGS Overall, anxiety disorders increase the risk of suicide. Specifically, 16% of patients with social anxiety disorder reported suicidal ideation in the previous month, and 18% of them had a history of suicide attempts. Similarly, in patients with panic disorder, suicidal ideation prevalence ranged between 17 and 32%, and 33% of them had a history of suicide attempts. Generalized anxiety disorder (GAD) was the most frequent anxiety disorder in completed suicides (present in 3% of people who committed suicide) and also subthreshold GAD was clearly linked to suicide ideation. Post-traumatic stress disorder was positively associated with suicidal ideation, and in patients with obsessive-compulsive disorder, suicide ideation rates ranged from 10 to 53% and suicide attempts from 1 to 46%. Body dysmorphic disorders presented a suicide ideation prevalence of about 80%. Suicide risk is increased in subjects with anxiety disorder. This risk is higher in the presence of comorbidities, but it is not clear whether it is independent from such comorbidities in some disorders.
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Affiliation(s)
- Diego De La Vega
- Unidad de Hospitalización de Salud Mental, Unidad de Gestión Clínica de Salud Mental del Hospital Virgen Macarena, Servicio Andaluz de Salud, Sevilla, Spain
| | - Lucas Giner
- Department of Psychiatry, School of Medicine, Universidad de Sevilla, Av. Sánchez-Pizjuán s/n, 41009, Seville, Spain.
| | - Philippe Courtet
- CHRU Montpellier, University of Montpellier, INSERM unit 1061, Montpellier, France.,Fondamental Foundation, Créteil, France
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80
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Abstract
Body dysmorphic disorder (BDD) is a disabling illness with a high worldwide prevalence. Patients demonstrate a debilitating preoccupation with one or more perceived defects, often marked by poor insight or delusional convictions. Multiple studies have suggested that selective serotonin reuptake inhibitors and various cognitive behavioral therapy modalities are effective first-line treatments in decreasing BDD severity, relieving depressive symptoms, restoring insight, and increasing quality of life. Selective serotonin reuptake inhibitors have also recently been shown to be effective for relapse prevention. This review provides a comprehensive summary of the current understanding of BDD, including its clinical features, epidemiology, genetics, and current treatment modalities. Additional research is needed to fully elucidate the relationship between BDD and comorbid illnesses such as obsessive–compulsive-related disorders and depression and to develop therapies for refractory patients and those who have contraindications for pharmacological intervention.
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Affiliation(s)
- Kevin Hong
- Department of Psychiatry and Behavioral Sciences, Autism and Obsessive-Compulsive Spectrum Program, Anxiety and Depression Program, Albert Einstein College of Medicine, Montiefiore Medical Center, The Bronx, New York, USA
| | - Vera Nezgovorova
- Department of Psychiatry and Behavioral Sciences, Autism and Obsessive-Compulsive Spectrum Program, Anxiety and Depression Program, Albert Einstein College of Medicine, Montiefiore Medical Center, The Bronx, New York, USA
| | - Eric Hollander
- Department of Psychiatry and Behavioral Sciences, Autism and Obsessive-Compulsive Spectrum Program, Anxiety and Depression Program, Albert Einstein College of Medicine, Montiefiore Medical Center, The Bronx, New York, USA
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81
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Lavell CH, Webb HJ, Zimmer-Gembeck MJ, Farrell LJ. A prospective study of adolescents' body dysmorphic symptoms: Peer victimization and the direct and protective roles of emotion regulation and mindfulness. Body Image 2018; 24:17-25. [PMID: 29247735 DOI: 10.1016/j.bodyim.2017.11.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 11/27/2017] [Accepted: 11/29/2017] [Indexed: 10/18/2022]
Abstract
In this study, we examined whether peer appearance-related victimization was associated with adolescents' increasing body dysmorphic disorder (BDD) symptoms over 12 months. Also, given emotion regulation and mindfulness have been associated with less body dissatisfaction, we expected that they would protect against the negative impact of peer victimization on BDD symptoms. Participants were 367 Australian adolescents (Mage=13years). In multiple regressions, two aspects of emotion regulation, strategies and clarity, and two components of mindfulness, acting with awareness and being non-judgmental, were uniquely associated with fewer BDD symptoms at T2 relative to T1. There was evidence that one mindfulness component, observing, was a risk factor for more BDD symptoms. Further, acting with awareness and observing moderated the prospective relationship between victimization and BDD symptoms; low acting with awareness and high observing were risks for symptoms regardless of victimization, whereas high acting with awareness and low observing appeared protective of BDD symptoms, but only for adolescents who reported lower victimization.
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Affiliation(s)
- Cassie H Lavell
- School of Applied Psychology & Menzies Health Institute of Queensland, Griffith University, Gold Coast, Australia
| | - Haley J Webb
- School of Applied Psychology & Menzies Health Institute of Queensland, Griffith University, Gold Coast, Australia.
| | - Melanie J Zimmer-Gembeck
- School of Applied Psychology & Menzies Health Institute of Queensland, Griffith University, Gold Coast, Australia
| | - Lara J Farrell
- School of Applied Psychology & Menzies Health Institute of Queensland, Griffith University, Gold Coast, Australia
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82
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["How Beautiful Must I be?"- Physical Attractiveness and Mental Health in Adolescents]. Prax Kinderpsychol Kinderpsychiatr 2018; 67:18-30. [PMID: 29347893 DOI: 10.13109/prkk.2018.67.1.18] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
"How Beautiful Must I be?"- Physical Attractiveness and Mental Health in Adolescents Physical attractiveness is a high priority for young people. The beauty ideals and presentations spread in the media often reinforce self-doubt and self-insecurity. In 730 adolescents (age 13 to 20 years) it was measured, how they experience appearance-related social pressure (FASD), the extent to which physical deficits are perceived (BDDQ), and how these features are related to mental symptoms (SDQ). The results demonstrate that young people are very concerned about their appearance (30.7 %) and are overly concerned with perceived physical defects (29.5 %). In addition, there is a strong appearance-related social pressure through peers and parents. The young people particularly affected in these areas report more emotional and behavioral problems. The results suggest that attention should be given to physical self-assessment as an important factor in diagnosis and therapy.
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83
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Abramowitz JS. Presidential Address: Are the Obsessive-Compulsive Related Disorders Related to Obsessive-Compulsive Disorder? A Critical Look at DSM-5's New Category. Behav Ther 2018; 49:1-11. [PMID: 29405915 DOI: 10.1016/j.beth.2017.06.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 06/08/2017] [Accepted: 06/08/2017] [Indexed: 12/18/2022]
Abstract
The 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM) includes a new class of obsessive-compulsive and related disorders (OCRDs) that includes obsessive-compulsive disorder (OCD) and a handful of other putatively related conditions. Although this new category promises to raise awareness of underrecognized and understudied problems, the empirical validity and practical utility of this new DSM category is questionable. This article critically examines the arguments underlying the new OCRD class, illuminates a number of problems with this class, and then discusses implications for clinicians and researchers.
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84
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Schneider SC, Baillie AJ, Mond J, Turner CM, Hudson JL. The classification of body dysmorphic disorder symptoms in male and female adolescents. J Affect Disord 2018; 225:429-437. [PMID: 28858657 DOI: 10.1016/j.jad.2017.08.062] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Revised: 08/10/2017] [Accepted: 08/20/2017] [Indexed: 12/19/2022]
Abstract
BACKGROUND Body dysmorphic disorder (BDD) was categorised in DSM-5 within the newly created 'obsessive-compulsive and related disorders' chapter, however this classification remains subject to debate. Confirmatory factor analysis was used to test competing models of the co-occurrence of symptoms of BDD, obsessive-compulsive disorder, unipolar depression, anxiety, and eating disorders in a community sample of adolescents, and to explore potential sex differences in these models. METHODS Self-report questionnaires assessing disorder symptoms were completed by 3149 Australian adolescents. The fit of correlated factor models was calculated separately in males and females, and measurement invariance testing compared parameters of the best-fitting model between males and females. RESULTS All theoretical models of the classification of BDD had poor fit to the data. Good fit was found for a novel model where BDD symptoms formed a distinct latent factor, correlated with affective disorder and eating disorder latent factors. Metric non-invariance was found between males and females, and the majority of factor loadings differed between males and females. Correlations between some latent factors also differed by sex. LIMITATIONS Only cross-sectional data were collected, and the study did not assess a broad range of DSM-5 defined eating disorder symptoms or other disorders in the DSM-5 obsessive-compulsive and related disorders chapter. CONCLUSIONS This study is the first to statistically evaluate competing models of BDD classification. The findings highlight the unique features of BDD and its associations with affective and eating disorders. Future studies examining the classification of BDD should consider developmental and sex differences in their models.
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Affiliation(s)
- Sophie C Schneider
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia
| | - Andrew J Baillie
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia; NHMRC Centre of Research Excellence in Mental Health and Substance Use, Australia
| | - Jonathan Mond
- Centre for Rural Health, School of Health Sciences, University of Tasmania, Launceston, Australia; Centre for Health Research, School of Medicine, Western Sydney University, Sydney, Australia
| | - Cynthia M Turner
- School of Psychology, Australian Catholic University, Brisbane, Australia
| | - Jennifer L Hudson
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia.
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85
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Densham K, Webb HJ, Zimmer-Gembeck MJ, Nesdale D, Downey G. Early adolescents' body dysmorphic symptoms as compensatory responses to parental appearance messages and appearance-based rejection sensitivity. Body Image 2017; 23:162-170. [PMID: 29054091 DOI: 10.1016/j.bodyim.2017.09.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 09/27/2017] [Accepted: 09/27/2017] [Indexed: 11/29/2022]
Abstract
Body dysmorphic disorder (BDD) is marked by high distress and behavioral and functional impairments due to preoccupation with perceived appearance anomalies. Our aim was to examine parental correlates of offspring's symptoms characteristic of BDD, testing both direct associations and indirect associations via appearance-based rejection sensitivity (appearance-RS). Surveys were completed by 302 Australian adolescents (9-14 years) and their parents. Findings indicated parents' weight and appearance teasing and child-report (but not parent-report) of parental negative attitudes about weight and appearance were uniquely associated with offspring's heightened BDD-like symptoms, and associations were partially indirect via adolescents' appearance-RS. Findings support theory that identifies parents as socializers of children's appearance concerns, and show that BDD-like symptoms may be partly elevated because of the mediating role of appearance-RS. We propose that BDD symptoms could partly emerge as compensatory responses to parents' appearance messages, and the associated bias to expect and perceive rejection based on one's appearance.
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Affiliation(s)
- Kelly Densham
- Griffith University, School of Applied Psychology, Australia
| | - Haley J Webb
- Griffith University, School of Applied Psychology, Australia.
| | | | - Drew Nesdale
- Griffith University, School of Applied Psychology, Australia
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86
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Le TAP, Merricks K, Nadeau JM, Ramos A, Storch EA. Intensive Exposure and Response Prevention for Adolescent Body Dysmorphic Disorder With Comorbid Obsessive–Compulsive Disorder and Major Depressive Disorder. Clin Case Stud 2017. [DOI: 10.1177/1534650117737176] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Body dysmorphic disorder (BDD) primarily onsets during adolescence, and symptoms typically worsen when left untreated. Although use of cognitive-behavioral therapy (CBT) has established efficacy for adults with BDD, there is limited research and few case studies to suggest the same for adolescents and children. The present case describes the implementation of intensive (daily) treatment for Erin (pseudonym), a 17-year-old Caucasian female with primary BDD, as well as comorbid obsessive–compulsive disorder (OCD) and major depressive disorder (MDD), who was initially nonresponsive to outpatient supportive psychotherapy and pharmacotherapy. Treatment consisted of exposure and response prevention (ERP), concurrent with behavioral activation (BA). At discharge, Erin’s total score on the Children’s Yale–Brown Obsessive Compulsive Scale–Self-Report version (CY-BOCS-SR) decreased from 32 ( extreme severity) at pretreatment to 11 ( mild severity), as well as demonstrating improvement on other self-report measures. Despite significant reductions in ritual engagement, Erin’s symptoms never fully remitted. Based on telephone contact with her mother, Erin discontinued ERP upon returning home, where treatment gains were not maintained and symptoms returned to baseline severity. Thus, this case study demonstrates the effectiveness of intensive ERP for adolescent BDD, as well as demonstrating the lack of gain durability associated with withdrawing early from treatment. Furthermore, this case demonstrates that withdrawal from ERP prior to complete remission may lead to a resurgence of symptoms, thus making previous progress obsolete.
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Affiliation(s)
| | | | - Joshua M. Nadeau
- Rogers Behavioral Health–Tampa, FL, USA
- University of South Florida, St. Petersburg, USA
| | | | - Eric A. Storch
- Rogers Behavioral Health–Tampa, FL, USA
- University of South Florida, St. Petersburg, USA
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87
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Krebs G, Fernández de la Cruz L, Mataix-Cols D. Recent advances in understanding and managing body dysmorphic disorder. EVIDENCE-BASED MENTAL HEALTH 2017; 20:71-75. [PMID: 28729345 PMCID: PMC5566091 DOI: 10.1136/eb-2017-102702] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 05/30/2017] [Accepted: 05/30/2017] [Indexed: 11/07/2022]
Abstract
Body dysmorphic disorder (BDD) is a relatively common and disabling psychiatric disorder characterised by excessive and persistent preoccupation with perceived defects or flaws in one's appearance, which are unnoticeable to others, and associated repetitive behaviours (eg, mirror checking). The disorder generally starts in adolescence, but often goes unnoticed and is severely underdiagnosed. Left untreated, BDD typically persists and causes marked functional impairment in multiple domains. This clinical review considers recent advances in the epidemiology and classification of BDD, including its reclassification in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders under the new 'Obsessive-Compulsive and Related Disorders' chapter. Key issues in assessment are outlined including the use of validated screening instruments to minimise misdiagnosis and the importance of risk assessment in this population given the high rates of suicidality and inappropriate use of cosmetic treatments. In addition, current knowledge regarding the causes and mechanisms underlying BDD are summarised. The recommended treatments for BDD are outlined, namely cognitive behavioural therapy (CBT) and antidepressants, such as selective serotonin reuptake inhibitors. Both CBT and pharmacotherapy have been shown to be efficacious treatments for BDD in adult populations, and evidence is emerging to support their use in young people. Although the majority of patients improve with existing evidence-based treatment, a large proportion are left with clinically significant residual symptoms. Priorities for future research are therefore discussed including the need to further refine and evaluate existing interventions with the goal of improving treatment outcomes and to increase their availability.
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Affiliation(s)
- Georgina Krebs
- National and Specialist OCD, BDD and Related Disorders Clinic for Young People, South London and Maudsley NHS Foundation Trust, London, UK
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | | | - David Mataix-Cols
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden
- Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
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88
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Krebs G, Fernández de la Cruz L, Monzani B, Bowyer L, Anson M, Cadman J, Heyman I, Turner C, Veale D, Mataix-Cols D. Long-Term Outcomes of Cognitive-Behavioral Therapy for Adolescent Body Dysmorphic Disorder. Behav Ther 2017; 48:462-473. [PMID: 28577583 DOI: 10.1016/j.beth.2017.01.001] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 01/04/2017] [Accepted: 01/04/2017] [Indexed: 11/26/2022]
Abstract
Emerging evidence suggests that cognitive-behavioral therapy (CBT) is an efficacious treatment for adolescent body dysmorphic disorder (BDD) in the short term, but longer-term outcomes remain unknown. The current study aimed to follow up a group of adolescents who had originally participated in a randomized controlled trial of CBT for BDD to determine whether treatment gains were maintained. Twenty-six adolescents (mean age = 16.2, SD = 1.6) with a primary diagnosis of BDD received a course of developmentally tailored CBT and were followed up over 12 months. Participants were assessed at baseline, midtreatment, posttreatment, 2-, 6-, and 12-month follow-up. The primary outcome measure was the clinician-rated Yale-Brown Obsessive-Compulsive Scale Modified for BDD. Secondary outcomes included measures of insight, depression, quality of life, and global functioning. BDD symptoms decreased significantly from pre- to posttreatment and remained stable over the 12-month follow-up. At this time point, 50% of participants were classified as responders and 23% as remitters. Participants remained significantly improved on all secondary outcomes at 12-month follow-up. Neither baseline insight nor baseline depression predicted long-term outcomes. The positive effects of CBT appear to be durable up to 12-month follow-up. However, the majority of patients remained symptomatic and vulnerable to a range of risks at 12-month follow-up, indicating that longer-term monitoring is advisable in this population. Future research should focus on enhancing the efficacy of CBT in order to improve long-term outcomes.
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Affiliation(s)
- Georgina Krebs
- South London and Maudsley NHS Foundation Trust; Institute of Psychiatry, Psychology and Neuroscience, King's College London.
| | | | - Benedetta Monzani
- Institute of Psychiatry, Psychology and Neuroscience, King's College London
| | | | - Martin Anson
- South London and Maudsley NHS Foundation Trust; Canterbury Christ Church University
| | | | - Isobel Heyman
- Institute of Psychiatry, Psychology and Neuroscience, King's College London; Great Ormond Street Hospital and Institute of Child Health, University College London
| | | | - David Veale
- South London and Maudsley NHS Foundation Trust; Institute of Psychiatry, Psychology and Neuroscience, King's College London
| | - David Mataix-Cols
- Institute of Psychiatry, Psychology and Neuroscience, King's College London; Karolinska Institutet and Stockholm Health Care Services
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89
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Senín-Calderón C, Valdés-Díaz M, Benítez-Hernández MM, Núñez-Gaitán MC, Perona-Garcelán S, Martínez-Cervantes R, Rodríguez-Testal JF. Validation of Spanish Language Evaluation Instruments for Body Dysmorphic Disorder and the Dysmorphic Concern Construct. Front Psychol 2017; 8:1107. [PMID: 28713311 PMCID: PMC5492913 DOI: 10.3389/fpsyg.2017.01107] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 06/15/2017] [Indexed: 11/17/2022] Open
Abstract
Dysmorphic concern (DC) refers to excessive preoccupation with a slight or imagined defect in physical appearance with social avoidance and behavior directed at controlling the defect in appearance. This study attempted to adapt the factor structure of two instruments that cover the DC construct, the Dysmorphic Concern Questionnaire (DCQ) and the Body Dysmorphic Disorder Examination Self-Report (BDDE-SR), to Spanish and establish their psychometric properties. A total of 920 subjects (62.7% women, Mage = 32.44 years) participated. Exploratory and Confirmatory Factor Analysis of both scales found adequate goodness of fit indices. A one-dimensional structure was found for the DCQ and two first-order factors (dissatisfaction/preoccupation with body image (BI) and BI avoidance behavior) were identified for the BDDE-SR. The psychometric test–retest reliability and validity properties (content, convergent, and discriminant) were satisfactory. It is suggested that the DC construct includes both cognitive and behavioral aspects and may represent a continuum of severity with Body Dysmorphic Disorder at the end.
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Affiliation(s)
| | - María Valdés-Díaz
- Personality, Evaluation and Psychological Treatment Department, University of SevilleSeville, Spain
| | - Ma M Benítez-Hernández
- Personality, Evaluation and Psychological Treatment Department, University of SevilleSeville, Spain
| | - Ma C Núñez-Gaitán
- Personality, Evaluation and Psychological Treatment Department, University of SevilleSeville, Spain
| | - Salvador Perona-Garcelán
- Personality, Evaluation and Psychological Treatment Department, University of SevilleSeville, Spain.,Virgen del Rocío Outpatient Mental Hospital, Andalusian Health-CareSeville, Spain
| | | | - Juan F Rodríguez-Testal
- Personality, Evaluation and Psychological Treatment Department, University of SevilleSeville, Spain
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90
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Schneider SC, Turner CM, Mond J, Hudson JL. Prevalence and correlates of body dysmorphic disorder in a community sample of adolescents. Aust N Z J Psychiatry 2017; 51:595-603. [PMID: 27585880 DOI: 10.1177/0004867416665483] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Body dysmorphic disorder typically begins in adolescence, yet little is known about the prevalence and correlates of the disorder in this age group. The current study aimed to explore the presenting features of adolescents meeting probable criteria for body dysmorphic disorder in a large community sample, and compare levels of comorbid psychopathology, quality of life and mental health service use between adolescents with probable body dysmorphic disorder and those without. METHOD Questionnaires were completed at school by 3149 adolescents: 63% male, aged 12-18 years ( M = 14.58). These assessed Diagnostic and Statistical Manual of Mental Disorders (4th ed.) body dysmorphic disorder criteria, past mental health service use and symptoms of body dysmorphic disorder, anxiety, depression, obsessive-compulsive disorder and eating disorders. In male participants, additional measures assessed quality of life, muscularity concerns, emotional symptoms, peer problems, conduct problems and hyperactivity. RESULTS The prevalence of probable body dysmorphic disorder was 1.7%; there was no sex difference in prevalence, but older adolescents reported higher prevalence than younger adolescents. Probable body dysmorphic disorder participants reported substantially elevated levels of psychopathology, quality of life impairment and mental health service use compared to non-body dysmorphic disorder participants. CONCLUSIONS The prevalence of body dysmorphic disorder in adolescents is similar to adult samples, and probable body dysmorphic disorder is associated with comorbidity, distress and functional impairment in a community sample. Further research is required to better understand the presentation of body dysmorphic disorder in adolescents, and to improve diagnosis and treatment.
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Affiliation(s)
- Sophie C Schneider
- 1 Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, NSW, Australia
| | - Cynthia M Turner
- 2 School of Psychology, The University of Queensland, Brisbane, QLD, Australia
| | - Jonathan Mond
- 1 Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, NSW, Australia
| | - Jennifer L Hudson
- 1 Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, NSW, Australia
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91
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Schneider SC, Mond J, Turner CM, Hudson JL. Sex Differences in the Presentation of Body Dysmorphic Disorder in a Community Sample of Adolescents. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2017; 48:516-528. [PMID: 28541768 DOI: 10.1080/15374416.2017.1321001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The current study sought to explore sex differences in the presentation of probable full-syndrome and subthreshold body dysmorphic disorder (BDD) in adolescents from an Australian community sample. Specifically, it examined sex differences in the types of BDD symptoms endorsed, body areas of concern, and the association with elevated symptoms of comorbid disorders. In male participants, it also compared the presenting features of those with and without muscle dysmorphia. Of 3,149 adolescents assessed using self-report questionnaires, 162 (5.1%) reported probable BDD (57.4% male, Mage = 14.89 years, SD = 1.33, primarily from Oceanian or European cultural backgrounds). All participants completed measures of BDD symptoms; past mental health service use; and symptoms of anxiety, depression, obsessive-compulsive disorder, and eating disorders. Male participants completed additional measures of quality of life, drive for muscularity, hyperactivity, conduct disorder, peer problems, and emotional symptoms. Controlling for demographic variables that varied by sex, male and female participants reported similar BDD symptom severity, rates of most elevated comorbid symptoms, and mental health service use. Concerns regarding muscularity, breasts/nipples, and thighs differed by sex. Female participants were more likely than male participants to report elevated generalized anxiety symptoms. In male participants, muscle dysmorphia was not associated with greater severity across most measures. The presenting features of BDD were broadly similar in male and female participants, and in male participants with and without muscle dysmorphia. Future research should seek to increase mental health service use in adolescents with BDD and to improve rates of disorder detection in clinical settings.
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Affiliation(s)
| | - Jonathan Mond
- b School of Medicine , Western Sydney University.,c School of Health Sciences , University of Tasmania
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92
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Manohar H, Menon V. An Aberrant Presentation of Delusional Body Dysmorphic Disorder - Importance of Early Psychiatry Liaison. J Neurosci Rural Pract 2017; 8:309-310. [PMID: 28479822 PMCID: PMC5402514 DOI: 10.4103/0976-3147.203824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Affiliation(s)
- Harshini Manohar
- Department of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Vikas Menon
- Department of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
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93
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Schneider SC, Storch EA. Improving the Detection of Body Dysmorphic Disorder in Clinical Practice. J Cogn Psychother 2017; 31:230-241. [PMID: 32755898 DOI: 10.1891/0889-8391.31.4.230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The aim of this article is to raise awareness of the underdiagnosis of body dysmorphic disorder (BDD) in clinical practice and provide suggestions to overcome key barriers to BDD detection. Disclosure of BDD symptoms is uncommon during routine assessments but can be increased by asking specifically about such symptoms. When BDD symptoms are present, it is important to differentiate them from anxiety, depression, obsessive-compulsive disorder, and eating disorders, which may present with some similarities and are commonly comorbid with BDD. Assessment of BDD should be sensitive to issues of poor insight, elevated suicide risk, subthreshold BDD presentations, and the possibility of BDD by proxy. Furthermore, assessment should consider the potential impact of age, gender, ethnicity, and minor physical defects on the presentation of BDD. Improving the assessment of BDD in routine clinical practice will enhance disclosure, improve case conceptualization, and provide the opportunity to deliver appropriate treatment for this underdiagnosed and often serious disorder.
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Affiliation(s)
- Sophie C Schneider
- Department of Pediatrics, University of South Florida, St. Petersburg, Florida
| | - Eric A Storch
- University of South Florida, St. Petersburg, Florida.,Rogers Behavioral Health, Tampa, Florida.,Johns Hopkins All Children's Hospital, St. Petersburg, Florida
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94
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Introduction to the Special Issue on Body Dysmorphic Disorder. J Cogn Psychother 2017; 31:227-229. [PMID: 32755897 DOI: 10.1891/0889-8391.31.4.227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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95
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Bowyer L, Krebs G, Mataix-Cols D, Veale D, Monzani B. A critical review of cosmetic treatment outcomes in body dysmorphic disorder. Body Image 2016; 19:1-8. [PMID: 27517118 DOI: 10.1016/j.bodyim.2016.07.001] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Accepted: 07/14/2016] [Indexed: 11/18/2022]
Abstract
A high proportion of individuals with body dysmorphic disorder (BDD) undergo cosmetic treatments in an attempt to 'fix' perceived defect/s in their physical appearance. Despite the frequency with which such procedures are sought, few studies have prospectively examined the outcomes of cosmetic procedures in individuals with BDD. This article aims to critically review the literature and discuss the current debate that exists on outcomes of cosmetic treatment for individuals with BDD. An emerging literature suggests the majority of individuals with BDD have poor outcomes after cosmetic interventions; however, based on the current literature, it cannot be fully ruled out that certain individuals with mild BDD and localised appearance concerns may benefit from these interventions. Gaps in the current literature are highlighted, alongside recommendations for future research. Carefully conducted longitudinal studies with well-characterised patient populations are needed.
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Affiliation(s)
- Laura Bowyer
- National and Specialist OCD, BDD and Related Disorders Clinic, South London and Maudsley NHS Foundation Trust, London SE5 8AZ, UK.
| | - Georgina Krebs
- National and Specialist OCD, BDD and Related Disorders Clinic, South London and Maudsley NHS Foundation Trust, London SE5 8AZ, UK; King's College London, Social, Genetic and Development Centre, Institute of Psychiatry, Psychology and Neurosciences, London SE5 8AF, UK
| | - David Mataix-Cols
- Child and Adolescent Psychiatry Research Centre, Karolinska Institutet, Stockholm, Sweden
| | - David Veale
- Centre for Anxiety Disorders, South London and Maudsley NHS Foundation Trust, London SE5 8AZ, UK; King's College London, Institute of Psychiatry, Psychology & Neurosciences, London SE5 8AF, UK
| | - Benedetta Monzani
- King's College London, Institute of Psychiatry, Psychology & Neurosciences, London SE5 8AF, UK
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96
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Schneider SC, Baillie AJ, Mond J, Turner CM, Hudson JL. Measurement Invariance of a Body Dysmorphic Disorder Symptom Questionnaire Across Sex: The Body Image Questionnaire-Child and Adolescent Version. Assessment 2016; 25:1026-1035. [PMID: 27866170 DOI: 10.1177/1073191116679504] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Measures of body dysmorphic disorder symptoms have received little psychometric evaluation in adolescent samples. This study aimed to examine cross-sex measurement invariance in the Body Image Questionnaire-Child and Adolescent version (BIQ-C) to establish whether observed sex differences in total scores may be meaningful or due to differences in measurement properties. A sample of 3,057 Australian high school students completed the initial screening item of the measure (63.2% male, Mage = 14.58 years, SD = 1.37, range = 12-18 years). Of these participants, 1,512 (49.5%) reported appearance concerns and thus completed the full measure. Partial scalar measurement invariance was established among a revised two-factor, 9-item version of the BIQ-C (BIQ-C-9). Females reported significantly greater latent factor variance, higher BIQ-C-9 total and factor scores, and higher scores on most individual BIQ-C-9 items. The measure can be used with caution to compare body dysmorphic disorder symptoms between male and female adolescents, though sex-specific cutoff scores should be used.
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Affiliation(s)
| | | | - Jonathan Mond
- 2 Western Sydney University, Sydney, New South Wales, Australia.,3 University of Tasmania, Launceston, Tasmania, Australia
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97
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Stress exposure and generation: A conjoint longitudinal model of body dysmorphic symptoms, peer acceptance, popularity, and victimization. Body Image 2016; 18:14-8. [PMID: 27236472 DOI: 10.1016/j.bodyim.2016.04.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Revised: 04/22/2016] [Accepted: 04/24/2016] [Indexed: 11/22/2022]
Abstract
This study examined the bidirectional (conjoint) longitudinal pathways linking adolescents' body dysmorphic disorder (BDD) symptoms with self- and peer-reported social functioning. Participants were 367 Australian students (45.5% boys, mean age=12.01 years) who participated in two waves of a longitudinal study with a 12-month lag between assessments. Participants self-reported their symptoms characteristic of BDD, and perception of peer acceptance. Classmates reported who was popular and victimized in their grade, and rated their liking (acceptance) of their classmates. In support of both stress exposure and stress generation models, T1 victimization was significantly associated with more symptoms characteristic of BDD at T2 relative to T1, and higher symptom level at T1 was associated with lower perceptions of peer acceptance at T2 relative to T1. These results support the hypothesized bidirectional model, whereby adverse social experiences negatively impact symptoms characteristic of BDD over time, and symptoms also exacerbate low perceptions of peer-acceptance.
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98
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Angelakis I, Gooding PA, Panagioti M. Suicidality in body dysmorphic disorder (BDD): A systematic review with meta-analysis. Clin Psychol Rev 2016; 49:55-66. [PMID: 27607741 DOI: 10.1016/j.cpr.2016.08.002] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Revised: 07/26/2016] [Accepted: 08/18/2016] [Indexed: 11/19/2022]
Abstract
Although a considerable number of studies have indicated that the rates of suicidal thoughts and behaviors in Body Dysmorphic Disorder (BDD) are high, no systematic review has been undertaken to explore the strength and patterns of the relationship between suicidality and BDD. This is the first systematic review and meta-analysis which aimed to examine the association between BDD and suicidality and the mechanisms underlying suicidality in BDD. Searches of five bibliographic databases including Medline, PsychINFO, Embase, Web of Science and CINAHL, were conducted from inception to June 2015. Seventeen studies were included in the review. Meta-analyses were performed using random effect models to account for the high levels of heterogeneity in the data. A positive and statistically significant association was found between BDD and suicidality (OR=3.63, 95% CI=2.62 to 4.63). Subgroup analyses showed that BDD was associated with increased odds for both, suicide attempts (OR=3.30, 95% CI=2.18 to 4.43) and suicidal ideation (OR=2.57, 95% CI=1.44 to 3.69). The evidence concerning suicide deaths in BDD was scarce. BDD-specific factors and comorbid diagnoses of Axis I disorders were likely to worsen suicidality in BDD. However, the modest number, and the low methodological quality, of the studies included in this review suggest caution the interpretation of these findings.
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Affiliation(s)
| | | | - Maria Panagioti
- Division of Population Health, Health Services Research & Primary Care, University of Manchester, UK.
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Harrison A, Fernández de la Cruz L, Enander J, Radua J, Mataix-Cols D. Cognitive-behavioral therapy for body dysmorphic disorder: A systematic review and meta-analysis of randomized controlled trials. Clin Psychol Rev 2016; 48:43-51. [DOI: 10.1016/j.cpr.2016.05.007] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 04/15/2016] [Accepted: 05/28/2016] [Indexed: 10/21/2022]
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Greenberg JL, Mothi SS, Wilhelm S. Cognitive-Behavioral Therapy for Adolescent Body Dysmorphic Disorder: A Pilot Study. Behav Ther 2016; 47:213-24. [PMID: 26956653 DOI: 10.1016/j.beth.2015.10.009] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Revised: 10/28/2015] [Accepted: 10/30/2015] [Indexed: 11/28/2022]
Abstract
Body dysmorphic disorder (BDD) is a relatively common and severe disorder that typically onsets in adolescence, but often goes unrecognized. Despite BDD's severity and early onset, treatment outcome research on adolescent BDD is scarce. Cognitive-behavioral therapy is the gold-standard psychosocial treatment for BDD in adults and has shown promise in adolescents. The current study examined the development and testing of a new CBT for adolescents with BDD. We tested feasibility, acceptability, and treatment outcome in a sample of 13 adolescents (mean age 15.23years, range: 13-17) with primary BDD. Treatment was delivered in 12-22 weekly individual sessions. Standardized clinician ratings and self-report measures were used to assess BDD and related symptoms pre- and posttreatment and at 3- and 6-months follow-up. At posttreatment, BDD and related symptoms (e.g., insight, mood) were significantly improved. Scores on the Yale-Brown Obsessive Compulsive Scale for BDD indicated a 50% (intent-to-treat) and 68% (completer) improvement in BDD symptoms. Seventy-five percent of adolescents who started treatment and 100% of completers were considered treatment responders. Treatment gains were maintained at follow-up. High patient satisfaction ratings and patient feedback indicated that treatment was acceptable. This represents the largest study of a psychosocial treatment for adolescent BDD.
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Affiliation(s)
| | | | - Sabine Wilhelm
- Massachusetts General Hospital and Harvard Medical School
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