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Krebs G, Rautio D, Fernández de la Cruz L, Hartmann AS, Jassi A, Martin A, Stringaris A, Mataix-Cols D. Practitioner Review: Assessment and treatment of body dysmorphic disorder in young people. J Child Psychol Psychiatry 2024; 65:1119-1131. [PMID: 38719455 DOI: 10.1111/jcpp.13984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/16/2024] [Indexed: 07/24/2024]
Abstract
Body dysmorphic disorder (BDD) is a relatively common and highly impairing mental disorder that is strikingly underdiagnosed and undertreated in Child and Adolescent Mental Health Services (CAMHS). The only clinical guidelines for the management of BDD in youth were published nearly 20 years ago, when empirical knowledge was sparse. Fortunately, there has been a surge in research into BDD over the last 10 years, shedding important insights into the phenomenology, epidemiology, assessment and treatment of the disorder in young people. This review aimed to provide an overview of recent research developments of relevance to clinicians and healthcare policymakers. We summarise key findings regarding the epidemiology of BDD in youth, which indicate that the disorder usually develops during teenage years and affects approximately 2% of adolescents at any one point in time. We provide an overview of aetiological research, highlighting that BDD arises from an interplay between genetic and environmental influences. We then focus on screening and assessment strategies, arguing that these are crucial to promote detection and diagnosis of this under-recognised condition. Additionally, we summarise the recommended treatment approaches for BDD in youth, namely cognitive behaviour therapy with or without selective serotonin reuptake inhibitors. The review concludes by highlighting key knowledge gaps and priorities for future research including, but not limited to, better understanding aetiological factors, long-term consequences and treatment.
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Affiliation(s)
- Georgina Krebs
- Anxiety, self-Image and Mood (AIM) Laboratory, Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
- National Specialist OCD, BDD and Related Disorders Clinic for Young People, Pears Maudsley Centre, South London and Maudsley NHS Foundation Trust, London, UK
| | - Daniel Rautio
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Healthcare Services, Region Stockholm, Stockholm, Sweden
| | - Lorena Fernández de la Cruz
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Healthcare Services, Region Stockholm, Stockholm, Sweden
| | - Andrea S Hartmann
- Division of Clinical Psychology and Psychotherapy of Childhood and Adolescence, Faculty of Psychology, University of Konstanz, Konstanz, Germany
| | - Amita Jassi
- National Specialist OCD, BDD and Related Disorders Clinic for Young People, Pears Maudsley Centre, South London and Maudsley NHS Foundation Trust, London, UK
| | - Alexandra Martin
- Department of Clinical Psychology and Psychotherapy, School of Human and Social Sciences, University of Wuppertal, Wuppertal, Germany
| | - Argyris Stringaris
- Anxiety, self-Image and Mood (AIM) Laboratory, Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
- Division of Psychiatry, University College London, London, UK
- First Department of Psychiatry, National and Kapodistrian University of Athens, Athens, Greece
| | - David Mataix-Cols
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Healthcare Services, Region Stockholm, Stockholm, Sweden
- Department of Clinical Sciences, Lund University, Lund, Sweden
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Lee AD, Hale EW, Mundra L, Le E, Kaoutzanis C, Mathes DW. The heart of it all: Body dysmorphic disorder in cosmetic surgery. J Plast Reconstr Aesthet Surg 2023; 87:442-448. [PMID: 37944455 DOI: 10.1016/j.bjps.2023.10.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Revised: 09/17/2023] [Accepted: 10/08/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND Body Dysmorphic Disorder (BDD) represents a prevalent mental health condition characterized by distress arising from self-perceived physical imperfections. BDD serves as a contraindication to aesthetic surgery. Recognizing BDD holds paramount importance for plastic surgeons, as it is instrumental in averting the exacerbation of this condition while ensuring appropriate referrals. OBJECTIVE This study aimed to investigate the prevalence of BDD in cosmetic surgery patients and to pinpoint key characteristics associated with BDD. This information provides plastic surgeons with specific factors to consider during preoperative evaluations. METHODS We employed TriNetX database to identify patients with BDD who underwent cosmetic surgery identified by Current Procedural Terminology codes. Demographics and patient characteristics were identified using the International Classification of Diseases 10 codes. We calculated odds ratios (OR) by using chi-squared tests to assess risk factors among patients with BDD. RESULTS Of 226,374 patients who underwent plastic surgery between August 2002 and August 2022, fewer than 0.1% were diagnosed with BDD. Of the BDD patients, 52.1% were diagnosed after cosmetic surgery. Compared with the control group, BDD patients were more likely to undergo rhinoplasty (OR=1.784, p = 0.004) and nonlocalized lipectomy (OR=1.448, p = 0.021) and less likely to undergo blepharoplasty (OR=0.451, p = 0.002). Findings indicated a strong association between BDD patients undergoing cosmetic procedures and comorbid psychiatric conditions such as depression (OR=4.279, p < 0.05), anxiety (OR=5.490, p < 0.05), and Attention-Deficit Hyperactivity Disorder (OR=3.993, p < 0.05). CONCLUSIONS These findings underscore the ongoing significance of BDD in the context of cosmetic surgery, potentially indicating a lower surgery rate among BDD patients compared with previous estimates. Nevertheless, avenues for further improvement persist. Our data affirm the noteworthy occurrence of postsurgery BDD development, thereby highlighting the ongoing necessity for psychiatric evaluation in surgical patients.
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Affiliation(s)
- Anna D Lee
- Division of Plastic and Reconstructive Surgery, University of Colorado Anschutz Medical Center, 13001 E 17th Pl, Aurora, CO 80045, United States.
| | - Elijah W Hale
- University of Colorado School of Medicine, 13001 E 17th Pl, Aurora, CO 80045, United States
| | - Leela Mundra
- Division of Plastic and Reconstructive Surgery, University of Colorado Anschutz Medical Center, 13001 E 17th Pl, Aurora, CO 80045, United States
| | - Elliot Le
- Division of Plastic and Reconstructive Surgery, University of Colorado Anschutz Medical Center, 13001 E 17th Pl, Aurora, CO 80045, United States
| | - Christodoulos Kaoutzanis
- Division of Plastic and Reconstructive Surgery, University of Colorado Anschutz Medical Center, 13001 E 17th Pl, Aurora, CO 80045, United States
| | - David W Mathes
- Division of Plastic and Reconstructive Surgery, University of Colorado Anschutz Medical Center, 13001 E 17th Pl, Aurora, CO 80045, United States
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Applebaum SA, Placik OJ. Genital Self-Image and Esthetic Genital Surgery. Clin Plast Surg 2022; 49:509-516. [PMID: 36162946 DOI: 10.1016/j.cps.2022.06.004] [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: 11/03/2022]
Abstract
Genital self-image describes the perception of one's genital appearance as being "normal" or "abnormal," and a disharmonious image leads to an increasing number of women seeking esthetic genital surgery each year. The concept of what constitutes "normal" is strongly influenced by the media, cultural norms, and sexual relations. In reality, the extent of normalcy is highly variable and overall patient education regarding extremes of size and shape should be provided to all patients considering surgery. When performed with appropriate training, expertise, and attention to detail in a properly selected patient, esthetic genital surgery is associated with minimal complications or sequelae.
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Affiliation(s)
- Sarah A Applebaum
- Division of Plastic Surgery, Northwestern University Feinberg School of Medicine, 880 West Central Road, Street 6100, Arlington Heights, IL 60005, USA; Department of Surgery, University of Maryland Medical Center, 22 South Greene Street, S8B02, Baltimore, MD 21201, USA.
| | - Otto J Placik
- Division of Plastic Surgery, Northwestern University Feinberg School of Medicine, 880 West Central Road, Street 6100, Arlington Heights, IL 60005, USA.
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Craythorne SL, Shaw RL, Larkin M. A phenomenological exploration of self-identified origins and experiences of body dysmorphic disorder. Front Psychol 2022; 13:963810. [PMID: 36248531 PMCID: PMC9563380 DOI: 10.3389/fpsyg.2022.963810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 09/02/2022] [Indexed: 11/25/2022] Open
Abstract
Body dysmorphic disorder (BDD) is a debilitating mental health condition that presently affects ~2% of the general population. Individuals with BDD experience distressing preoccupations regarding one or more perceived defects in their physical appearance. These preoccupations and perceived distortions can have a profound impact on key areas of social functioning and psychological health. Individuals' BDD origins have not been explored in significant depth and have been, often unhelpfully, conflated with social media usage and exposure to idealistic imagery of the body. Such generalisations fail to acknowledge the complexity of BDD development and onset, highlighting the importance of moving towards an understanding of people's implicit theories regarding their own experience. It is therefore essential to gain insight into how individuals make sense of the experiences which they believe led to the development and onset of BDD. The aim of this exploratory study was to elicit and phenomenologically analyse the accounts of individuals with lived experience of BDD in order to examine their beliefs about its origins and understand how they navigate the world with a distorted sense of self. Participants provided written and verbal accounts regarding both their BDD onset and experiences of living with the disorder. Both components of the study were analysed using Interpretative Phenomenological Analysis. Four main themes were generated from the data: Exposure to bullying and external critique of appearance; Experiencing rejection, shame, and a sense of not being enough; Developing an awareness of the solidification of concerns, and Learning about and reflecting upon triggers. Participants attributed their BDD onset to adverse experiences such as childhood bullying, receiving appearance-focused criticism, rejection and being subjected to emotional and physical abuse. The findings from this study highlight the complexity of BDD development and onset in individuals, and the need for appropriate care and treatment for those affected by BDD.
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Affiliation(s)
- Shioma-Lei Craythorne
- Institute of Health and Neurodevelopment, Aston University, Birmingham, United Kingdom
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Salari N, Kazeminia M, Heydari M, Darvishi N, Ghasemi H, Shohaimi S, Mohammadi M. Body dysmorphic disorder in individuals requesting cosmetic surgery: A systematic review and meta-analysis. J Plast Reconstr Aesthet Surg 2022; 75:2325-2336. [PMID: 35715310 DOI: 10.1016/j.bjps.2022.04.098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 04/14/2022] [Accepted: 04/26/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Body dysmorphic disorder (BDD) is known as a mental disorder in which a person suffers from concern and distress with the perceived defects in their appearance and subsequently can experience significant impairment in social, occupational, and interpersonal functioning. Various studies have reported different BDD prevalence rates in patients with cosmetic surgery. However, there has been no comprehensive study that has examined the results of these studies. Therefore, this study aims to determine BDD prevalence in individuals requesting cosmetic surgery in a systematic review and meta-analysis. METHODS In this review study, a search was conducted in national and international databases of Cochrane, Embase, ScienceDirect, Scopus, PubMed, and Web of Science (WoS) between 1878 and January 2020. A random-effects model was used to analyze the data, and heterogeneity of studies was examined with the I2 index. Data analysis was done using comprehensive meta-analysis (Version 2). RESULTS BDD prevalence in individuals requesting cosmetic surgery in 48 articles with a sample size of 14,913 was 19.2% (95% CI: 15.8-23%). Regarding heterogeneity based on meta-regression, a significant difference between the sample size (p<0.001) and BDD prevalence in patients with cosmetic surgery was observed. CONCLUSION The results of this study showed that BDD prevalence in individuals requesting cosmetic surgery is high. Therefore, with the provision of feedback at hospitals, appropriate interventions, such as pre-screening for body image disturbance, should be mandated.
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Affiliation(s)
- Nader Salari
- Department of Biostatistics, School of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mohsen Kazeminia
- Student Research Committee of Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mohammadbagher Heydari
- Department of General Surgery, Faculty of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Niloofar Darvishi
- Student Research Committee of Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Hooman Ghasemi
- Student Research Committee of Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Shamarina Shohaimi
- Department of Biology, Faculty of Science, University Putra Malaysia, Serdang, Selangor, Malaysia
| | - Masoud Mohammadi
- Cellular and Molecular Research Center, Gerash University of Medical Sciences, Gerash, Iran.
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Reliability and Validity of the Self-Report Chinese Version of the Yale-Brown Obsessive-Compulsive Scale Modified for Body Dysmorphic Disorder (BDD-YBOCS) in Patients Undergoing Plastic Surgery. Aesthetic Plast Surg 2022; 46:2023-2030. [PMID: 35201378 PMCID: PMC9512866 DOI: 10.1007/s00266-022-02784-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 01/09/2022] [Indexed: 11/06/2022]
Abstract
Background To develop a self-report Chinese version of the Yale-Brown Obsessive–Compulsive Scale Modified for Body Dysmorphic Disorder (BDD-YBOCS) and determine its validity and reliability in patients seeking a consultation with a plastic surgeon or undergoing plastic surgery in China. Methods Forward and backward translation and cultural adaptation of the BDD-YBOCS were performed according to recommended guidelines. The self-report Chinese version of the BDD-YBOCS was psychometrically tested using data collected from a cross-sectional validation study, which included 240 patients seeking a consultation with a plastic surgeon or undergoing plastic surgery at the Department of Plastic Surgery, Jiangsu Province Hospital of Chinese Medicine, Nanjing, China, between May and September 2020. Item analysis used the independent sample t test and bivariate Pearson test. Content validity was established through expert interviews. Construct validity was measured with exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). Convergent validity and discriminant validity were analyzed using Pearson’s correlation to evaluate the association between the self-report Chinese version of the BDD-YBOCS and the Body Dysmorphic Disorder Questionnaire (BDDQ). Internal reliability was assessed using Cronbach’s α. Results No items were removed from the original English version of the BDD-YBOCS based on expert interviews and factor analysis. A total of 220 patients completed the study survey (91.7%). EFA extracted 3 factors, which accounted for 64.50% of the variance. CFA supported a 3-factor structure (χ2/df = 1.322, RMSEA = 0.054, GFI = 0.904, NFI = 0.902, CFI = 0.974 and TLI = 0.966). The scale had good convergent and discriminant validity. Cronbach’s α for the scale was 0.871 (P < 0.001) and ranged from 0.852 to 0.873 when individual items were removed. Conclusion The self-report Chinese version of the BDD-YBOCS shows good validity and reliability for use in patients seeking a consultation with a plastic surgeon or undergoing plastic surgery in China. Level of Evidence IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
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Schut C, Dalgard FJ, Bewley A, Evers AWM, Gieler U, Lien L, Sampogna F, Ständer S, Tomas-Aragones L, Vulink N, Finlay AY, Legat FJ, Titeca G, Jemec GB, Misery L, Szabó C, Grivcheva-Panovska V, Spillekom-van Koulil S, Balieva F, Szepietowski JC, Reich A, Roque Ferreira B, Lvov A, Romanov D, Marron SE, Gracia-Cazaña T, Svensson Å, Altunay IK, Thompson A, Zeidler C, Kupfer J. Body dysmorphia in common skin diseases: Results of an observational, cross-sectional multi-centre study among dermatological out-patients in 17 European countries. Br J Dermatol 2022; 187:115-125. [PMID: 35041211 DOI: 10.1111/bjd.21021] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 12/20/2021] [Accepted: 01/15/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Body dysmorphic disorder (BDD) is a common psychiatric disorder associated with high costs for healthcare systems as patients may repeatedly ask for different, often not effective interventions. BDD symptoms are more prevalent in patients with dermatological conditions than the general population, but there are no large sample studies comparing the prevalence of BDD symptoms between patients with dermatological conditions and healthy skin controls. OBJECTIVES To compare the prevalence of BDD symptoms between patients with different dermatological conditions and healthy skin controls and to describe sociodemographic, physical and psychological factors associated with BDD symptoms to identify patients who may have a particularly high chance of having this condition. METHODS This observational cross-sectional, comparative multi-centre study included 8295 participants: 5487 consecutive patients with different skin diseases (56% female) recruited among dermatological out-patients at 22 clinics in 17 European countries and 2808 healthy skin controls (66% female). All patients were examined by a dermatologist. BDD symptoms were assessed by the Dysmorphic Concern Questionnaire (DCQ). Sociodemographic data, information on psychological factors and physical conditions were collected. Each patient was given a dermatological diagnosis according to ICD-10 by a dermatologist. RESULTS The participation rate of invited dermatological patients was 82.4% on average across all centres. BDD symptoms were five times more prevalent in patients with dermatological conditions than in healthy skin controls (10.5% vs. 2.1%). Patients with hyperhidrosis, alopecia and vitiligo had a more than eleven-fold increased chance (adjusted Odds Ratio (OR) > 11) of having BDD symptoms compared to healthy skin controls, and patients with atopic dermatitis, psoriasis, acne, hidradenitis suppurativa, prurigo and bullous diseases had a more than six-fold increased chance (adjusted OR > 6) of having BDD symptoms. Using a logistic regression model, BDD symptoms were significantly related to lower age, female sex, higher psychological stress and feelings of stigmatisation. CONCLUSIONS This study reveals that clinical BDD symptoms are significantly associated with common dermatological diseases. As such symptoms are associated with higher levels of psychological distress and multiple unhelpful consultations, general practitioners and dermatologists should consider BDD and refer patients when identified to an appropriate service for BDD screening and management.
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Affiliation(s)
- Christina Schut
- Institute of Medical Psychology, Justus-Liebig-University, Gießen, Germany
| | - Florence J Dalgard
- Division of Mental Health and Addiction, Vestfold Hospital Trust, Tønsberg, Norway.,Department of Dermatology and Venereology, Skåne University Hospital, Malmo, Sweden
| | - Anthony Bewley
- Barts Health NHS Trust & Queen Mary University of London, UK
| | - Andrea W M Evers
- Health, Medical and Neuropsychology Department, Leiden University, The Netherlands
| | | | - Lars Lien
- Faculty of Social and Health Sciences, Inland Norway University of Applied Sciences, Elverum, Norway.,Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Brumunddal, Norway
| | | | - Sonja Ständer
- Department of Dermatology and Centre for Chronic Pruritus, University Hospital Münster, Münster, Germany
| | - Lucia Tomas-Aragones
- Department of Psychology, University of Zaragoza, Spain.,Aragon Psychodermatology Research Group Zaragoza, Spain
| | - Nienke Vulink
- Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Andrew Y Finlay
- Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, UK
| | - Franz J Legat
- Department of Dermatology, Medical University of Graz, Graz, Austria
| | | | - Gregor B Jemec
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Laurent Misery
- Department of Dermatology, University Hospital of Brest, Brest, France
| | - Csanád Szabó
- Department of Dermatology and Allergology, University of Szeged, Hungary
| | - Vesna Grivcheva-Panovska
- University St. Cyril and Methodius, School of Medicine, PHI University Clinic of Dermatology Skopje, N. Macedonia
| | - Saskia Spillekom-van Koulil
- Radbout Institute for Health Sciences, Department of Medical Psychology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Flora Balieva
- Department of Dermatology, Stavanger University Hospital, Stavanger, Norway.,Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Jacek C Szepietowski
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Poland
| | - Adam Reich
- Department of Dermatology, Institute of Medical Sciences, Medical College of Rzeszow University, Poland
| | - Bárbara Roque Ferreira
- Centre for Philosophy of Science of the University of Lisbon, Portugal.,Department of Dermatology, Centre Hospitalier de Mouscron, Belgium.,University of Brest, Lien, France
| | - Andrey Lvov
- Central State Medical Academy of Department of Presidential Affairs, Moscow, Russia.,Medical Research and Educational Centre, Lomonosov Moscow State University, Moscow, Russia
| | - Dmitry Romanov
- Department of Psychiatry and Psychosomatics, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia.,Department of Boundary Mental Conditions and Psychosomatic Disorders, Mental Health Research Centre, Moscow, Russia.,Moscow Scientific and Practical Centre of Dermatology, Venereology and Cosmetology of Moscow City Health Department, Moscow, Russia
| | - S E Marron
- Aragon Psychodermatology Research Group Zaragoza, Spain.,Department of Dermatology, University Hospital Miguel Servet, Zaragoza, Spain
| | | | - Å Svensson
- Department of Dermatology, Skane University Hospital, Malmö, Sweden
| | - Ilknur K Altunay
- University of Health Sciences, Şişli Hamidiye Etfal Training and Research Hospital, Dermatology and Venereology Clinic, Istanbul, Turkey
| | - Andrew Thompson
- South Wales Clinical Psychology Training Programme, Cardiff & Vale University Health Board & School of Psychology, Cardiff University, Cardiff, UK
| | - Claudia Zeidler
- Department of Dermatology and Centre for Chronic Pruritus, University Hospital Münster, Münster, Germany
| | - Joerg Kupfer
- Institute of Medical Psychology, Justus-Liebig-University, Gießen, Germany
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Fabris MA, Longobardi C, Badenes-Ribera L, Settanni M. Prevalence and Co-Occurrence of Different Types of Body Dysmorphic Disorder Among Men Having Sex with Men. JOURNAL OF HOMOSEXUALITY 2022; 69:132-144. [PMID: 32845221 DOI: 10.1080/00918369.2020.1813512] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Body dysmorphic disorder (BDD) is a relatively common psychiatric condition of which the prevalence has not been fully investigated in the non-clinical population, and in particular among men having sex with men (MSM). MSM have proven to be more inclined to develop body dissatisfaction and body image disorders compared to non-MSM. Our study investigates the prevalence of BDD and the prevalence and co-occurrence of muscle dysmorphia (MD) and penile dysmorphic disorder (PDD) in a sample of 261 Italian MSM recruited online. From our data, gathered through self-report measures, the prevalence of BDD, MD, and PDD in our populations was 5.4%, 8.8%, and 4.2%, respectively. Compared to their elders, younger adults (ages 18-34) appear to be at higher risk of BDD and especially of MD. Non-significant differences have been observed for the prevalence of PDD depending on the age range. Our study shows that the risk of body image disorders among MSM is quite common, especially among young adults, and higher than what is found among heterosexual men.
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Affiliation(s)
- M A Fabris
- Department of Psychology, University of Turin, Turin, Italy
| | - C Longobardi
- Department of Psychology, University of Turin, Turin, Italy
| | - L Badenes-Ribera
- Department of Methodology and Behavioral Science, University of Valencia, Valencia, Spain
| | - M Settanni
- Department of Psychology, University of Turin, Turin, Italy
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Alanazi AO, Aljohani RA, Aljohani MF, Alhussaini AA, Alnemer FK, Qasim SS, Alduraye GS, Layqah L, Alharbi FF. Epidemiological Features and Clinical Manifestations of Patients With Somatoform Disorder at a Tertiary Medical City in Riyadh, Saudi Arabia. Cureus 2021; 13:e19799. [PMID: 34956787 PMCID: PMC8693054 DOI: 10.7759/cureus.19799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/22/2021] [Indexed: 11/05/2022] Open
Abstract
Background Somatoform disorder (SD), known as the presence of physical symptoms suggesting a physical condition, for which there are no demonstrable organic findings or established physiological mechanisms with positive evidence that the symptoms are related to psychological causes. The aim of this study was to highlight the epidemiological characteristics, demographic features, comorbidities, and clinical presentations of patients with SD. Materials and methods This was a retrospective study of SD patients at King Abdulaziz Medical City in Riyadh, Saudi Arabia. We reviewed the patients' electronic health records from January 2015 to December 2020 for collecting the patients' demographic information, including gender, age, marital status, and occupation. The types of SD, presenting symptoms of each disorder, department to which patients initially presented, comorbidities, and management were also documented. The diagnosis of SD was based on the International Classification of Diseases, Tenth Revision (ICD-10). Results In total, 89 patients were included in the study. The majority (n=50, 56.2%) were female, with a mean age of 42.7±17.1 years. More than half of the sample was married (n=54, 60.7%). The most common subtype of SD was somatization disorder followed by conversion disorder, pain disorder, and hypochondriasis, diagnosed in 69 (77.5%), 12 (13.5%), 5 (5.6%), and three (3.4%) patients, respectively. Neurological symptoms and pain were the most frequent presenting symptoms for all the somatoform patients. More than half of the sample (n=48, 53.9%) initially presented at an outpatient clinic. Conclusions The number of SD patients was less than expected, and a third did not receive any treatment. This emphasizes the need for more SD awareness among clinicians in various medical specialties. Appropriate SD and other mental disorders education for physicians may support achieving a better identification of SD and subsequently an improved quality of life for the patients.
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Affiliation(s)
- Abdulkarim O Alanazi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | - Raed A Aljohani
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | - Mohammad F Aljohani
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | | | - Faisal K Alnemer
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | - Salman S Qasim
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | - Ghada S Alduraye
- Department of Mental Health, Ministry of the National Guard Health Affairs, Riyadh, SAU.,Department of Research Office, King Abdullah International Medical Research Center, Riyadh, SAU
| | - Laila Layqah
- Department of Research Office, King Abdullah International Medical Research Center, Riyadh, SAU
| | - Fares F Alharbi
- Department of Mental Health, Ministry of the National Guard Health Affairs, Riyadh, SAU.,Department of Research Office, King Abdullah International Medical Research Center, Riyadh, SAU.,College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
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10
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Dons F, Mulier D, Maleux O, Shaheen E, Politis C. Body dysmorphic disorder (BDD) in the orthodontic and orthognathic setting: A systematic review. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2021; 123:e145-e152. [PMID: 34728407 DOI: 10.1016/j.jormas.2021.10.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 10/25/2021] [Indexed: 11/17/2022]
Abstract
General prevalence of Body Dysmorphic Disorder (BDD), a psychiatric disorder in which patients focus on an imagined body defect not visible to others, varies between 0.7 and 2.5%. Up to 86% present with complaints in the area of teeth or face. Patients with BDD pursue an aesthetic rather than functional recovery, making BDD a possible contraindication to treatment. The aim of this systematic review was to review prevalence of BDD within the orthodontic and/or orthognathic population, to describe diagnostic tools for early detection of patients with BDD and to assess the outcome after treatment. A systematic search was conducted up to November 2020 using PubMed, Embase, Web of Science Core Collection and Cochrane Library. Following the screening of 1423 articles, 5 prospective studies were included. Prevalence of BDD within the orthodontic and orthognathic population varied from 5.2% to 13% (average of 6.2%). Literature showed a trend of higher BDD prevalence within younger, female and single patient population, although results are not conclusive. Questionnaires can be useful for preliminary detection of BDD. General anamnesis with questioning medical or psychiatric history, medication and personal expectations remains very important. Red flags could be previous consultations for the same problem or presence of psychiatric comorbidities. Prospective studies are necessary to map satisfaction of these patients and need for re-interventions after treatment.
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Affiliation(s)
- Flore Dons
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium.
| | - Delphine Mulier
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium; Department of Imaging and Pathology, OMFS IMPATH Research Group, Faculty of Medicine, KU Leuven, Leuven, Belgium
| | - Olivia Maleux
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Eman Shaheen
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium; Department of Imaging and Pathology, OMFS IMPATH Research Group, Faculty of Medicine, KU Leuven, Leuven, Belgium
| | - Constantinus Politis
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium; Department of Imaging and Pathology, OMFS IMPATH Research Group, Faculty of Medicine, KU Leuven, Leuven, Belgium
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Ionescu CG, Talasman AA, Badarau IA. Somatization and Sleep Quality on Patients with Comorbid Anxiety/Depression. MÆDICA 2021; 16:246-254. [PMID: 34621347 DOI: 10.26574/maedica.2021.16.2.246] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background: Somatization is a common symptom among patients with comorbid anxiety and depression. It is associated with poorer outcome, long-term evolution, worse sleep patterns and an overall lower quality of life. Previous studies suggest that sleep disturbances exacerbate somatization, which in turn negatively affects sleep. The purpose of this study was to determine the correlation between anxiety/depression and somatization/sleep quality in hospitalized psychiatric patients. Methods:Participants comprised 103 hospitalized patients with somatic symptoms disorder as major diagnosis and anxiety and depression disorders as comorbid diagnoses. All subjects were given SOMS-2 and SOMS-7 (Screening for Somatoform Symptoms) for somatization symptoms, HAM-A (Hamilton Anxiety Rating Scale) for anxiety, HAM-D 17 (Hamilton Depression Rating Scale) for depression and PSQI (Pittsburgh Sleep Quality Index) for sleep quality. The Somatic Symptom Disorder-B criteria scale (SSD-12) has been also used for the psychological impact of somatization. The same scales were administered to a control group of 77 participants by trained physicians. Results:There was a negative correlation between the scores of HAM-A/HAM-D scales and those of SSD-12. Also, positive associations between the scores of anxiety and depression scales in patients with sleep disturbances were found. Sleep scores being assessed with PSQI were significantly higher after hospitalization in 80% of participants and did not correlate with neither anxiety/depression nor somatization. In the participant group, SOMS-2 results were not correlated with any social and demographic variables. All scales scores were worse in the study group than the control group. Conclusion:Anxiety and depression symptoms may be associated with higher somatization symptoms but not with the psychological impact of somatization. Also, somatization may not directly impact sleep quality scores. Further approaches are needed to better understand the relationship between sleep quality and somatization, on one hand, and its modulation by comorbid psychiatric disorders, on the other hand.
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Affiliation(s)
- Claudiu G Ionescu
- "Carol Davila" University of Medicine and Pharmacy, Physiology Department, Bucharest, Romania
| | - Ana A Talasman
- "Carol Davila" University of Medicine and Pharmacy, Psychiatry Department, Bucharest, Romania
| | - Ioana A Badarau
- "Carol Davila" University of Medicine and Pharmacy, Physiology Department, Bucharest, Romania
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12
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Somatic Symptoms and Sleep Disorders: A Literature Review of Their Relationship, Comorbidities and Treatment. Healthcare (Basel) 2021; 9:healthcare9091128. [PMID: 34574901 PMCID: PMC8465276 DOI: 10.3390/healthcare9091128] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 08/19/2021] [Accepted: 08/27/2021] [Indexed: 12/02/2022] Open
Abstract
This study aimed to investigate the relationship between somatic symptom disorder (SSD) and sleep disorders, following three research questions: (1) How are these disorders correlated? (2) What are the comorbidities reported in these patients? and (3) What are the most effective pharmacological and non-pharmacological treatments for both conditions? PubMed, Scopus, OVID, Medline, and ProQuest databases were searched for relevant articles published between 1957–2020. Search terms included “somatic symptoms disorder”, “sleep disorders”, “insomnia”, “somatoform”, “somatization”, “therapeutic”, “psychotherapy”, and alternative, formerly used terms for SSD. Forty papers were finally included in the study. Prevalence of insomnia in SSD patients ranged between 20.4–48%, with this being strongly correlated to somatic symptoms and psychosocial disability. The most relevant comorbidities were generalized anxiety disorder, depression, fatigue, negative mood, substance use, orthorexia, alexithymia, anorexia, weight loss, poor eating habits, and acute stress disorder. Patients receiving antidepressant therapy reported significant improvements in insomnia and somatic symptoms. In terms of non-pharmacological interventions, cognitive-behavioral therapy (CBT) showed improvements in sleep outcomes, while the Specialized Treatment for Severe Bodily Distress Syndromes (STreSS) may represent an additional promising option. Future research could include other medical and psychosocial variables to complete the picture of the relationship between sleep disorders and somatic symptoms.
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13
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Collison J, Harrison L. Prevalence of Body Dysmorphic Disorder and Predictors of Body Image Disturbance in Adolescence. ADOLESCENT PSYCHIATRY 2020. [DOI: 10.2174/2210676610999200420112129] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background:
Body dysmorphic disorder encompasses a range of cognitive and
behavioural states stemming from distressing, negative evaluations of one’s appearance. Despite
the seriousness of this condition, little is known about who is likely to receive a diagnosis
and more importantly what the putative risk factors are. This is particularly so among
adolescent samples, where the extant literature is considerably smaller.
Objective:
This study had two broad aims: to estimate the prevalence of body dysmorphic
disorder within a young-adult population, and to examine the predictors of body image disturbance.
Methods:
Three-hundred and four adolescents (242 females; Mage = 17.68) completed the
Body Image Disturbance Questionnaire and Body Dysmorphic Disorder Questionnaire,
along with measures of clinical psychopathology, self-esteem, experiences of parenting, and
bullying.
Results:
Body dysmorphic disorder was present in 3.9% of the sample, which is in line with
previous estimates among adolescents. More interestingly, results indicated that instances of
high stress, low self-esteem, and reported experiences of bullying were able to predict 48%
of body image dissatisfaction.
Conclusions:
Psychological interventions should be directed towards adolescents with body
image concerns, especially if they also report bullying, elevated stress, or diminished selfesteem.
However, additional research is still warranted to gain an increasingly accurate understanding
of the prevalence of body dysmorphic disorder and who is susceptible to developing
this disorder and how we can best serve these individuals in the community.
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Affiliation(s)
- James Collison
- School of Psychology, Western Sydney University, Sydney, New South Wales, Australia
| | - Lisa Harrison
- School of Psychology, Western Sydney University, Sydney, New South Wales, Australia
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14
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Spataro EA, Kandathil CK, Saltychev M, Olds CE, Most SP. Correlation of the Standardized Cosmesis and Health Nasal Outcomes Survey With Psychiatric Screening Tools. Aesthet Surg J 2020; 40:1373-1380. [PMID: 31917417 DOI: 10.1093/asj/sjaa004] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Identifying mental health disorders, including body dysmorphic disorder (BDD), is important prior to rhinoplasty surgery; however, these disorders are underdiagnosed, and screening tools are underutilized in clinical settings. OBJECTIVES The authors sought to evaluate the correlation of a rhinoplasty outcomes tool (Standardized Cosmesis and Health Nasal Outcomes Survey [SCHNOS]) with psychiatric screening tools. METHODS Patients presenting for rhinoplasty consultation were prospectively enrolled and administered mental health instruments to assess depression (Patient Health Questionnaire-9), anxiety (Generalized Anxiety Disorder-7), and BDD (BDD Questionnaire-Aesthetic Surgery [BDDQ-AS]) as well as the SCHNOS rhinoplasty outcomes scale. Convergent validity of SCHNOS scores with these mental health instruments was assessed as well as calculation of an optimal SCHNOS-C score to screen for BDD. RESULTS A total 76 patients were enrolled in the study. The average SCHNOS-O score (standard deviation) was 46.1 (34.0) and the average SCHNOS-C score was 61.1 (27.0). Five (7%) patients screened positive for depression, and 24 (32%) patients screened positive for mild, 5 (7%) for moderate, and 4 (5%) for severe anxiety. Twenty-four (32%) patients screened positive for BDD by BDDQ-AS scores. SCHNOS-O and SCHNOS-C did not correlate with Patient Health Questionnaire-9 or Generalized Anxiety Disorder-7 scores; SCHNOS-C did correlate with BDDQ-AS. A score of 73 or greater on SCHNOS-C maximized the sensitivity and specificity of also screening positive for BDD with BDDQ-AS. This score correlated with a sensitivity of 62.5%, specificity of 80.8%, and number needed to diagnose of 2.3, meaning for every 2 patients with a score of ≥73 on SCHNOS-C, 1 will have a positive BDDQ-AS score. CONCLUSIONS SCHNOS-C correlates with BDDQ-AS and may help screen rhinoplasty patients at higher risk for BDD. LEVEL OF EVIDENCE: 2
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Affiliation(s)
- Emily A Spataro
- Division of Facial Plastic and Reconstructive Surgery, Washington University School of Medicine, St. Louis, MO
| | - Cherian K Kandathil
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA
| | - Mikhail Saltychev
- Department of Physical and Rehabilitation Medicine, Turku University Hospital and University of Turku, Turku, Finland
| | - Cristen E Olds
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA
| | - Sam P Most
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA
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15
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Dilger AE, Sykes JM. Unhappy Patients Can Turn into Angry Patients: How to Deal with Both. Facial Plast Surg Clin North Am 2020; 28:461-468. [PMID: 33010864 DOI: 10.1016/j.fsc.2020.06.004] [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
Patient satisfaction is the ultimate measure of success in cosmetic facial plastic surgery. A successful outcome depends on patient selection, technical performance, and postoperative care. Patient perception can be influenced by physician-patient interactions. Surgical training focuses on diagnosis-identifying variations in physical condition and treatment. Although these skills are essential to a well-trained and successful facial plastic surgeon, the importance of proper patient selection, management of expectations, and empathetic communication in cosmetic surgery are often overlooked in education and cannot be understated. This article outlines the contributing factors to difficult physician-patient relationships and strategies for mitigating these situations.
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Affiliation(s)
- Amanda E Dilger
- Facial Plastic and Reconstructive Surgery, Beverly Hills, CA, USA; Roseville Facial Plastic Surgery, Roseville, CA, USA
| | - Jonathan M Sykes
- Facial Plastic Surgery, UC Davis Medical Center, Sacramento, CA, USA; Facial Plastic Surgery, Roxbury Institute, Beverly Hills, CA, USA.
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16
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Jones AT, O'Connell NK, David AS. Epidemiology of functional stroke mimic patients: a systematic review and meta‐analysis. Eur J Neurol 2019; 27:18-26. [DOI: 10.1111/ene.14069] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 08/21/2019] [Indexed: 11/30/2022]
Affiliation(s)
- A. T. Jones
- Institute of Psychiatry, Psychology and Neuroscience King's College London London UK
| | - N. K. O'Connell
- Department of Public Health and Primary Care Institute of Population Health Trinity College Dublin Dublin Ireland
| | - A. S. David
- Institute of Mental Health University College London London UK
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17
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Blackman G, Cherfi Y, Morrin H, Ellis CM, Bashford J, Ruths F, David AS. The Association Between Benign Fasciculations and Health Anxiety: A Report of Two Cases and a Systematic Review of the Literature. PSYCHOSOMATICS 2019; 60:499-507. [DOI: 10.1016/j.psym.2019.04.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 04/03/2019] [Accepted: 04/04/2019] [Indexed: 12/14/2022]
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Abstract
Illness anxiety disorder is a primary disorder of anxiety about having or developing a serious illness. The core feature is the cycle of worry and reassurance seeking regarding health, as opposed to a focus on relief of distress caused by somatic symptoms (as in Somatic Symptom Disorder). Clinically significant health anxiety is common, with estimates ranging up to 13% in the general adult population. There are evidence-based treatments, including psychopharmacology and cognitive behavioral therapy, that can significantly alleviate symptoms. An understanding of the core psychopathology and clinical features of illness anxiety disorder is essential to fostering a working alliance with patients with health anxiety, as is the maintenance of an empathic, curious, and nonjudgmental stance toward their anxiety. Collaboration between medical providers is essential to avoid the pitfalls of excess testing and medical treatment.
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19
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Vaughn DA, Kerr WT, Moody TD, Cheng GK, Morfini F, Zhang A, Leow AD, Strober MA, Cohen MS, Feusner JD. Differentiating weight-restored anorexia nervosa and body dysmorphic disorder using neuroimaging and psychometric markers. PLoS One 2019; 14:e0213974. [PMID: 31059514 PMCID: PMC6502309 DOI: 10.1371/journal.pone.0213974] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 03/05/2019] [Indexed: 12/22/2022] Open
Abstract
Anorexia nervosa (AN) and body dysmorphic disorder (BDD) are potentially life-threatening conditions whose partially overlapping phenomenology—distorted perception of appearance, obsessions/compulsions, and limited insight—can make diagnostic distinction difficult in some cases. Accurate diagnosis is crucial, as the effective treatments for AN and BDD differ. To improve diagnostic accuracy and clarify the contributions of each of the multiple underlying factors, we developed a two-stage machine learning model that uses multimodal, neurobiology-based, and symptom-based quantitative data as features: task-based functional magnetic resonance imaging data using body visual stimuli, graph theory metrics of white matter connectivity from diffusor tensor imaging, and anxiety, depression, and insight psychometric scores. In a sample of unmedicated adults with BDD (n = 29), unmedicated adults with weight-restored AN (n = 24), and healthy controls (n = 31), the resulting model labeled individuals with an accuracy of 76%, significantly better than the chance accuracy of 35% ( p^<10‑4). In the multivariate model, reduced white matter global efficiency and better insight were associated more with AN than with BDD. These results improve our understanding of the relative contributions of the neurobiological characteristics and symptoms of these disorders. Moreover, this approach has the potential to aid clinicians in diagnosis, thereby leading to more tailored therapy.
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Affiliation(s)
- Don A. Vaughn
- Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, Los Angeles, California, United States of America
| | - Wesley T. Kerr
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America
- Department of Biomathematics, University of California Los Angeles, Los Angeles, California, United States of America
- Department of Internal Medicine, Eisenhower Medical Center, Rancho Mirage, California, United States of America
| | - Teena D. Moody
- Department of Psychology, Harvard University, Cambridge, Massachusetts, United States of America
| | - Gigi K. Cheng
- Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, Los Angeles, California, United States of America
| | - Francesca Morfini
- Department of Psychology, Harvard University, Cambridge, Massachusetts, United States of America
| | - Aifeng Zhang
- Department of Psychiatry, University of Illinois College of Medicine, Chicago, Illinois, United States of America
| | - Alex D. Leow
- Department of Psychiatry, University of Illinois College of Medicine, Chicago, Illinois, United States of America
| | - Michael A. Strober
- Department of Psychology, Harvard University, Cambridge, Massachusetts, United States of America
| | - Mark S. Cohen
- Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, Los Angeles, California, United States of America
- Department of Psychology, Harvard University, Cambridge, Massachusetts, United States of America
- Departments of Neurology, Radiology, Biomedical Physics, Psychology, Bioengineering and California Nanosystems Institute, University of California Los Angeles, Los Angeles, California, United States of America
| | - Jamie D. Feusner
- Department of Psychology, Harvard University, Cambridge, Massachusetts, United States of America
- * E-mail:
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20
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Cheng Q, Xu Y, Xie L, Hu Y, Lv Y. Prevalence and environmental impact factors of somatization tendencies in eastern Chinese adolescents: a multicenter observational study. CAD SAUDE PUBLICA 2019; 35:e00008418. [DOI: 10.1590/0102-311x00008418] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 08/17/2018] [Indexed: 11/22/2022] Open
Abstract
The aim of this study is at examining the prevalence and impact factors of adolescent somatization tendencies (ST) across three eastern Chinese provinces. A multicenter school-based cross-sectional study was conducted in these provinces from 2015 to 2016. The sample included 11,153 middle-school students aged 13-18 years, who were randomly selected using a multi-phase stratified cluster sampling technique. We also designed a multicenter school-based case-control study to evaluate the potential environmental impact of ST factors on this population. The overall positive rate of ST among the eastern Chinese adolescents was 12.1%. Somatic symptoms score (SSS) and positive ST rate were higher in females than males. Additionally, the SSS and positive ST rate for the 18-year-old group were significantly higher than in other age groups. In comparison to those in urban areas, adolescents in rural areas had significantly higher SSS and positive ST rate. Multiple conditional regression analyses revealed that family medical history, anxiety and depression scores; superstitious beliefs; left-behind adolescents; teacher-student support; family conflict; and family independence and achievement orientation were significantly linked to ST in adolescents. The models also indicated family medical history was the strongest impact factor to adolescent ST, even though ST were prevalent in the three studied eastern Chinese provinces. Gender, age, and dwelling differences were very significant in the SSS and positive ST rate in adolescents. This study concludes that adolescent ST are influenced by multiple environments.
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Affiliation(s)
- Qinglin Cheng
- Hangzhou Center for Disease Control and Prevention, China
| | - Yong Xu
- Medical College of Soochow University, China
| | - Li Xie
- Hangzhou Center for Disease Control and Prevention, China
| | - Yunkai Hu
- Fuyang Center for Disease Control and Prevention, China
| | - Yongxiang Lv
- Jin’an District Center for Disease Control and Prevention, China
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21
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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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22
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Müllerová J, Weiss P. Plastic surgery in gynaecology: Factors affecting women’s decision to undergo labiaplasty. Mind the risk of body dysmorphic disorder: A review. J Women Aging 2018; 32:241-258. [DOI: 10.1080/08952841.2018.1529474] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Jana Müllerová
- 1st Medical Faculty, Charles University, Prague, Czech Republic
- Institute of Sexology, Charles University, Prague, Czech Republic
| | - Petr Weiss
- 1st Medical Faculty, Charles University, Prague, Czech Republic
- Institute of Sexology, Charles University, Prague, Czech Republic
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23
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Skjernov M, Fink P, Fallon B, Rasmussen F, Simonsen E. Feasibility Study of Group Cognitive Behavioral Therapy for Severe Health Anxiety. J Cogn Psychother 2018; 32:223-240. [PMID: 32746404 DOI: 10.1891/0889-8391.32.4.223] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Severe health anxiety (SHA) is prevalent, often undiagnosed, persistent untreated, and costly. Meta-analyses have shown effectiveness of mostly individual cognitive behavioral therapy (CBT), whereas Group-CBT has only been studied and shown feasibility in one uncontrolled study of psychiatric outpatients also including self-referrals. We aimed to examine feasibility of Group-CBT for physician-referred psychiatric outpatients with SHA and a future randomized controlled trial (RCT). Group-CBT was conducted in two groups of seven participants. Feasibility was examined about recruitment rate, attrition, organization, and effectiveness. Effectiveness was measured by standardized self-report questionnaires: Whiteley Index-7 (WI-7) and Short Health Anxiety Inventory, and clinician rated remission and functioning from baseline to 3-month follow-up (3FU). Recruitment rate was 1.4 participant per month. Attrition showed dropout of 7%. Organization harbored only one senior therapist. Group-CBT showed effectiveness on all measures except WI-7 at 3FU; this latter explained by participants with concurrent borderline personality disorder. Group-CBT seems feasible for physician-referred psychiatric outpatients with SHA. With modifications, an RCT seems feasible.
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Affiliation(s)
- Mathias Skjernov
- Clinic for Liaison Psychiatry in Koege, Region Zealand, Denmark .,Psychiatric Research Unit, Region Zealand, Denmark.,Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Per Fink
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus, Denmark
| | - Brian Fallon
- Columbia University Medical Center, New York City, New York
| | | | - Erik Simonsen
- Psychiatric Research Unit, Region Zealand, Denmark.,Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
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24
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Cerea S, Bottesi G, Grisham JR, Ghisi M. Body dysmorphic disorder and its associated psychological and psychopathological features in an Italian community sample. Int J Psychiatry Clin Pract 2018; 22:206-214. [PMID: 29069974 DOI: 10.1080/13651501.2017.1393545] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Body Dysmorphic Disorder (BDD) is a psychiatric condition characterized by preoccupation with perceived defects in physical appearance that are not observable or appear slight to others, along with low self-esteem, high perfectionism, and high comorbidity. Little is known about BDD prevalence and phenomenology in the Italian context, and no data are currently available on BDD prevalence using DSM-5 criteria in the Italian context. The aims of the current study were to explore the prevalence and the phenomenology of BDD and its associated psychological and psychopathological features such as self-esteem, perfectionistic traits, social anxiety, depressive, and obsessive-compulsive symptoms in a community sample. METHODS Six hundred and fifteen community individuals completed a battery of self-report questionnaires. RESULTS 10 (1.63%) individuals met DSM-5 diagnostic criteria for BDD; hair, nose and teeth were the most common areas of concern. Individuals with BDD reported also lower levels of self-esteem, more severe social anxiety symptomatology, general distress, depression and obsessive-compulsive features than people without BDD. CONCLUSIONS BDD is not a rare condition in the Italian context and it emerged to be associated with significant morbidity.
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Affiliation(s)
- Silvia Cerea
- a Department of General Psychology , University of Padua , Padua , Italy
| | - Gioia Bottesi
- a Department of General Psychology , University of Padua , Padua , Italy
| | - Jessica R Grisham
- b School of Psychology , University of New South Wales , Sydney , Australia
| | - Marta Ghisi
- a Department of General Psychology , University of Padua , Padua , Italy
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25
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Schmaling KB, Fales JL. The association between borderline personality disorder and somatoform disorders: A systematic review and meta-analysis. CLINICAL PSYCHOLOGY-SCIENCE AND PRACTICE 2018. [DOI: 10.1111/cpsp.12244] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Karen B. Schmaling
- Department of Psychology; Washington State University; Vancouver Washington
| | - Jessica L. Fales
- Department of Psychology; Washington State University; Vancouver Washington
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26
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Research challenges in somatoform disorders: A narrative review. Asian J Psychiatr 2018; 34:65-66. [PMID: 29656277 DOI: 10.1016/j.ajp.2018.04.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 02/14/2018] [Accepted: 04/01/2018] [Indexed: 11/21/2022]
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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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Abstract
The DSM–IV classification of body dysmorphic disorder (BDD) refers to an individual's preoccupation with an ‘imagined’ defect in his or her appearance or markedly excessive concern with a slight physical anomaly (American Psychiatric Association, 1994). An Italian psychiatrist, Morselli, first used the term ‘dysmorphophobia’ in 1886, although it is now falling into disuse, probably because ICD–10 (World Health Organization, 1992) has discarded it, subsuming the condition under hypochondriacal disorder.
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Möllmann A, Dietel FA, Hunger A, Buhlmann U. Prevalence of body dysmorphic disorder and associated features in German adolescents: A self-report survey. Psychiatry Res 2017; 254:263-267. [PMID: 28482195 DOI: 10.1016/j.psychres.2017.04.063] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Revised: 02/26/2017] [Accepted: 04/27/2017] [Indexed: 11/17/2022]
Abstract
Prior research has not yet investigated the prevalence of body dysmorphic disorder (BDD) in adolescents and young adults based on criteria from the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5). In the current study, the point prevalence of BDD, comorbid symptoms, and associated features, such as appearance-related suicidality, level of insight or history of plastic surgeries, were examined in a non-clinical sample of German adolescents and young adults (n=308), between 15 and 21 years old, using self-report measures. Eleven participants (3.6%; 95% CI=[1.9, 5.8]) met DSM-5 criteria for BDD. Self-reported BDD (vs. no-BDD) was related to respondents showing significantly more obsessive-compulsive (OC) symptoms and lower degrees of insight regarding appearance concerns. Significantly more adolescents and young adults with vs. without self-reported BDD (36.4% vs. 8.8%) reported appearance-related suicidal ideation. In conclusion, body dysmorphic symptoms are common in adolescents and young adults and are associated with high rates of comorbid symptoms and suicidal ideation.
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Affiliation(s)
- Anne Möllmann
- Institute of Psychology, University of Münster, Fliednerstraße 21, 48149 Münster, Germany.
| | - Fanny A Dietel
- Institute of Psychology, University of Münster, Fliednerstraße 21, 48149 Münster, Germany
| | - Antje Hunger
- Faculty of Social Sciences and Cultural Studies, Department of Social Work, University of Applied Sciences, Münsterstraße 156, 40476 Düsseldorf, Germany
| | - Ulrike Buhlmann
- Institute of Psychology, University of Münster, Fliednerstraße 21, 48149 Münster, Germany
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Villadsen A, Thorgaard MV, Hybel KA, Jensen JS, Thomsen PH, Rask CU. Health anxiety symptoms in children and adolescents diagnosed with OCD. Eur Child Adolesc Psychiatry 2017; 26:241-251. [PMID: 27357512 DOI: 10.1007/s00787-016-0884-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 06/21/2016] [Indexed: 11/30/2022]
Abstract
Health anxiety (HA) is an overlooked area in paediatric research. Little is known about the occurrence of HA symptoms in a child and adolescent psychiatric setting, and there are no age-appropriate diagnostic criteria and only limited number of assessment tools. It is therefore likely that HA is seen as part of obsessive-compulsive disorder (OCD) due to construct overlap and the diagnostic uncertainty of HA in this age group. In the present study, the extent of HA symptoms was investigated in 94 children and adolescents with a primary ICD-10 diagnosis of OCD. Self-reported HA symptoms were assessed using the Childhood Illness Attitude Scales. Clinician-rated OCD symptoms and severity were measured using the Children's Yale Brown Obsessive Compulsive Scale. Information on socio-demographics was obtained from the child's/adolescent's medical record. The distribution of HA symptoms resembled a normal curve shifted to the right compared with a normal population of Danish children, and 30 % presented with high HA symptoms. Chi-squared tests were used to examine the proportion of children and adolescents with high HA symptoms in relation to various clinical characteristics. Clinician-rated illness worries and comorbid anxiety disorder were associated with high self-reported HA symptoms. The results contribute to the understanding of how HA and OCD overlap conceptually in young patients and bring attention to the need for improved recognition of OCD patients dominated by illness worries. Further research in the description of childhood HA is important in order to understand whether HA is a distinct disorder early in life.
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Affiliation(s)
- Anna Villadsen
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Noerrebrogade 44, 8000, Aarhus C, Denmark. .,Centre for Child and Adolescent Psychiatry, Aarhus University Hospital, Aarhus C, Denmark.
| | - Mette V Thorgaard
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Noerrebrogade 44, 8000, Aarhus C, Denmark
| | - Katja A Hybel
- Centre for Child and Adolescent Psychiatry, Aarhus University Hospital, Aarhus C, Denmark
| | - Jens Søndergaard Jensen
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Noerrebrogade 44, 8000, Aarhus C, Denmark
| | - Per H Thomsen
- Centre for Child and Adolescent Psychiatry, Aarhus University Hospital, Aarhus C, Denmark
| | - Charlotte U Rask
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Noerrebrogade 44, 8000, Aarhus C, Denmark.,Centre for Child and Adolescent Psychiatry, Aarhus University Hospital, Aarhus C, Denmark
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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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Beneitez I, Nieto R. Do we understand pain from a biopsychosocial perspective? A review and discussion of the usefulness of some pain terms. Pain Manag 2016; 7:41-48. [PMID: 27712457 DOI: 10.2217/pmt-2016-0024] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Pain is a biopsychosocial phenomenon and should be assessed and managed from this perspective. However, the dualistic mind-body perspective is still present and affects the way this health situation is addressed. Following this approach, pain can either be attributed to an identifiable cause or considered as 'psychological' pain, for which there is neither an identifiable cause nor adequate treatment. Faced with this situation, first, we introduce some concepts that have been used (and are still frequently being used) to refer to pain with no identifiable cause. Next, we question the usefulness of these 'dualistic terms' and, finally, defend the biopsychosocial perspective to advance in the conceptualization of pain and avoid using terms that can foster a dualistic perspective.
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Affiliation(s)
- Imma Beneitez
- Universitat Oberta de Catalunya, Rambla del Poblenou, Barcelona, Spain
| | - Rubén Nieto
- Health Sciences Faculty, Universitat Oberta de Catalunya, Rambla del Poblenou, Barcelona, Spain
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33
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Zhang Y, Ma H, Wang Y. Case report of body dysmorphic disorder in a suicidal patient. SHANGHAI ARCHIVES OF PSYCHIATRY 2016; 28:52-5. [PMID: 27688645 DOI: 10.3969/j.issn.1002-0829.215112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Few reports exist about the treatment of body dysmorphic disorder (BDD) in patients who are suicidal. This case report describes a 19-year-old male with BDD who had delusional-intensity beliefs about facial disfigurement that had gradually intensified over a 2-year period. However, he was initially misdiagnosed with depression partly because he was admitted immediately after a suicide attempt that was associated with depressive symptoms and social withdrawal, symptoms that subsequently proved to be secondary to his BDD. The symptoms resolved completely and his social functioning returned to normal after 8 weeks of inpatient treatment with fluoxetine and cognitive behavioral therapy. This report is a reminder that suicidal behavior and ideation can have many causes; to avoid misdiagnosis and inappropriate treatment, clinicians should consider other possibilities before assuming that suicidal behavior or ideation is the direct result of depression. We discuss the many changes in the understanding and diagnostic classification of BDD since it was first reported by Enrico Morselli in 1886.
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Affiliation(s)
| | - Hongxia Ma
- Second People's Hospital of Dali, Yunnan
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34
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Abstract
Rhinoplasty is perhaps the most complex cosmetic surgery procedure performed today. It is characterized by an intricate interplay between form and function, with patient satisfaction being dependent not only on improvement of nasal appearance but also resolution of preexisting airway symptoms. The prerequisite for successful execution of this challenging procedure is a thorough understanding of nasal anatomy and physiology. Hence, a thorough preoperative evaluation is at least as important and the surgical skill in performing the operation. Establishing an accurate diagnosis through a comprehensive nasal analysis is obligatory. As to the surgical approach, much has been written about the advantages and disadvantages of closed vs open rhinoplasty. The more commonly chosen open approach has numerous advantages, including improved visualization without distortion, thus, enabling precise diagnosis and correction of deformities. While the surgical treatment of existing nasal deformities is tailored to the needs of the individual patient, the authors have noted a total of 10 essential components to form the foundation for successful technical execution of rhinoplasty. These include: (1) septoturbinotomy; (2) opening the nose; (3) humpectomy/spreader flaps; (4) tip-plasty; (5) supratip-plasty; (6) columellar strut; (7) dorsal augmentation; (8) nasal base reduction; (9) osteotomies; and (10) rim grafts. Postoperative, a variety of problems, such as edema, may be successfully addressed without surgical intervention. Diligent postoperative management is critical in ensuring a positive patient experience. Finally, a comprehensive understanding of possible postoperative complications, such as bleeding, ecchymosis, edema, and persistent or new iatrogenic deformity is mandatory prior to offering rhinoplasty to patients.
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Affiliation(s)
- Arash Momeni
- Dr. Momeni is an Assistant Professor of Surgery, Division of Plastic and Reconstructive Surgery, Stanford University, Palo Alto, CA. Dr Gruber is an Adjunct Associate Clinical Professor, Division of Plastic and Reconstructive Surgery, Stanford University Medical Center, Palo Alto, CA; and an Associate Clinical Professor, Division of Plastic and Reconstructive Surgery, The University of California, San Francisco, San Francisco, CA
| | - Ronald P Gruber
- Dr. Momeni is an Assistant Professor of Surgery, Division of Plastic and Reconstructive Surgery, Stanford University, Palo Alto, CA. Dr Gruber is an Adjunct Associate Clinical Professor, Division of Plastic and Reconstructive Surgery, Stanford University Medical Center, Palo Alto, CA; and an Associate Clinical Professor, Division of Plastic and Reconstructive Surgery, The University of California, San Francisco, San Francisco, CA
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Ritter V, Fluhr JW, Schliemann-Willers S, Elsner P, Strauß B, Stangier U. Body dysmorphic concerns, social adaptation, and motivation for psychotherapeutic support in dermatological outpatients. J Dtsch Dermatol Ges 2016; 14:901-8. [PMID: 27607031 DOI: 10.1111/ddg.12908] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND OBJECTIVES Dermatologists are increasingly confronted with patients affected by body dysmorphic disorder (BDD). BDD is characterized by excessive preoccupation with one or more perceived defect(s) or flaw(s) in physical appearance which are not observable or appear slight to others. So far, there have been only few studies examining the prevalence of BDD in dermatological outpatients. In addition, the need for psychotherapeutic support in dermatological outpatients with body dysmorphic concerns has not yet been systematically examined. The objective of the present study was therefore to investigate the frequency of body dysmorphic concerns as well as social adaptation and the need for psychotherapeutic support in the aforementioned patient group. PATIENTS AND METHODS A total of 252 dermatological outpatients seen at a German university hospital were consecutively enrolled, and examined using the Dysmorphic Concerns Questionnaire, the Social Adaptation Self-Evaluation Scale, and the German version of the University of Rhode Island Change Assessment Scale. RESULTS 7.9 % of all outpatients (unselected sample) showed positive test results, suggesting clinically relevant body dysmorphic concerns. Patients with clinically relevant body dysmorphic concerns exhibited poor social adaptation. Contrary to expectations, these patients revealed a high motivation for change, indicating the necessity for psychotherapeutic support. CONCLUSIONS Our findings confirm previous prevalence rates of BDD in dermatological outpatients, and highlight the need for providing psychotherapeutic support to dermatological patients.
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Affiliation(s)
- Viktoria Ritter
- Institute for Psychology, Clinical Psychology and Psychotherapy, Goethe University, Frankfurt am Main, Germany.
| | - Joachim W Fluhr
- Department of Dermatology and Allergology, Charité - University Medicine, Berlin, Germany.,Department of Dermatology and Allergology, University Hospital, Jena, Germany
| | | | - Peter Elsner
- Department of Dermatology and Allergology, University Hospital, Jena, Germany
| | - Bernhard Strauß
- Institute for Psychosocial Medicine and Psychotherapy, University Hospital, Jena, Germany
| | - Ulrich Stangier
- Institute for Psychology, Clinical Psychology and Psychotherapy, Goethe University, Frankfurt am Main, Germany
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36
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Ritter V, Fluhr JW, Schliemann-Willers S, Elsner P, Strauß B, Stangier U. Körperdysmorphe Symptome, soziale Anpassung und Motivation zu psychotherapeutischer Beratung bei ambulanten dermatologischen Patienten. J Dtsch Dermatol Ges 2016; 14:901-9. [DOI: 10.1111/ddg.12908_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Viktoria Ritter
- Institut für Psychologie, Klinische Psychologie und Psychotherapie; Goethe-Universität Frankfurt am Main
| | - Joachim W. Fluhr
- Klinik für Dermatologie und Allergologie; Charité - Universitätsmedizin Berlin
- Klinik für Dermatologie und Allergologie; Universitätsklinikum Jena
| | | | - Peter Elsner
- Klinik für Dermatologie und Allergologie; Universitätsklinikum Jena
| | - Bernhard Strauß
- Institut für Psychosoziale Medizin und Psychotherapie; Universitätsklinikum Jena
| | - Ulrich Stangier
- Institut für Psychologie, Klinische Psychologie und Psychotherapie; Goethe-Universität Frankfurt am Main
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37
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Body dysmorphic disorder in different settings: A systematic review and estimated weighted prevalence. Body Image 2016; 18:168-86. [PMID: 27498379 DOI: 10.1016/j.bodyim.2016.07.003] [Citation(s) in RCA: 168] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2015] [Revised: 06/30/2016] [Accepted: 07/18/2016] [Indexed: 11/24/2022]
Abstract
Our aim was to systematically review the prevalence of body dysmorphic disorder (BDD) in a variety of settings. Weighted prevalence estimate and 95% confidence intervals in each study were calculated. The weighted prevalence of BDD in adults in the community was estimated to be 1.9%; in adolescents 2.2%; in student populations 3.3%; in adult psychiatric inpatients 7.4%; in adolescent psychiatric inpatients 7.4%; in adult psychiatric outpatients 5.8%; in general cosmetic surgery 13.2%; in rhinoplasty surgery 20.1%; in orthognathic surgery 11.2%; in orthodontics/cosmetic dentistry settings 5.2%; in dermatology outpatients 11.3%; in cosmetic dermatology outpatients 9.2%; and in acne dermatology clinics 11.1%. Women outnumbered men in the majority of settings but not in cosmetic or dermatological settings. BDD is common in some psychiatric and cosmetic settings but is poorly identified.
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Prevalence and Characteristics of Body Dysmorphic Disorder Among Patients in a Partial Hospital Program. J Nerv Ment Dis 2016; 204:554-7. [PMID: 27362701 DOI: 10.1097/nmd.0000000000000543] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Body dysmorphic disorder (BDD) is a common disorder that is usually associated with impaired functioning and high levels of suicidality. The current study is the first to assess prevalence of BDD among patients in a partial hospital program and compare patients with and without BDD on demographic and clinical variables. Participants were 207 patients with a variety of Axis I diagnoses. Prevalence of current BDD was 7.2%, and a diagnosis of BDD did not predict worse treatment outcome in the program. Patients with current BDD were more likely to be female and younger and have more comorbid diagnoses than patients without current BDD. No other significant differences were found at baseline between patients with and without current BDD. Results indicate that BDD is relatively common among patients in partial hospital programs and that such programs may be as beneficial to patients with BDD as to other patients.
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Shaffi Ahamed S, Enani J, Alfaraidi L, Sannari L, Algain R, Alsawah Z, Al Hazmi A. Prevalence of Body Dysmorphic Disorder and its Association With Body Features in Female Medical Students. IRANIAN JOURNAL OF PSYCHIATRY AND BEHAVIORAL SCIENCES 2016; 10:e3868. [PMID: 27803720 PMCID: PMC5088358 DOI: 10.17795/ijpbs-3868] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Revised: 12/16/2015] [Accepted: 04/10/2016] [Indexed: 11/25/2022]
Abstract
Background Body dysmorphic disorder (BDD) is a distressing psychiatric disorder. So far there have not been any studies on BDD in Saudi Arabia. Objectives The aim of this study was to determine the prevalence of body dysmorphic disorder in female medical students and to investigate whether there is an association between BDD and body features of concern, social anxiety and symptoms of BDD. Materials and Methods A cross sectional study was carried out on female medical students of the college of medicine, King Saud University, Riyadh, Saudi Arabia during January to April, 2015. Data were collected using the body image disturbance questionnaire, Body dysmorphic disorder symptomatology and social interaction anxiety scale. Descriptive statistics, bivariate and multivariate analysis were used to analyze the results. Results Out of 365 students who filled out the questionnaire, 4.4% (95% confidence intervals (CI): 2.54% to 7.04%) were positive for BDD with skin (75%) and fat (68.8%) as the most frequent body features of concern. Ten features (skin, fat, chest, hips, buttocks, arms, legs, lips, fingers, and shoulders) out of twenty-six were significantly associated with BDD. Arms and chest were independently associated with BDD. The odds of presence of body concern related to “arms” was 4.3 (95% C.I: 1.5, 12.1) times more in BDD subjects than non-BDD subjects, while concern about “chest” was 3.8 (1.3, 10.9) times more when compared to non-BDD subjects. No statistically significant association was observed between BDD and social anxiety (P = 0.13). Conclusions This was the first study conducted in Kingdom of Saudi Arabia (KSA) on female medical students, which quantified the prevalence of BDD and identified the body features associated with it. Body dysmorphic disorder is prevalent in female medical students but it is relatively rare and an unnoticed disorder.
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Affiliation(s)
- Shaik Shaffi Ahamed
- Prince Sattam Chair for Epidemiology and Public Health Chair, Department of Family & Community Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Jawaher Enani
- Prince Sattam Chair for Epidemiology and Public Health Chair, Department of Family & Community Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Lama Alfaraidi
- Prince Sattam Chair for Epidemiology and Public Health Chair, Department of Family & Community Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Lujain Sannari
- Prince Sattam Chair for Epidemiology and Public Health Chair, Department of Family & Community Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Rihaf Algain
- Prince Sattam Chair for Epidemiology and Public Health Chair, Department of Family & Community Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Zainah Alsawah
- Prince Sattam Chair for Epidemiology and Public Health Chair, Department of Family & Community Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Ali Al Hazmi
- Prince Sattam Chair for Epidemiology and Public Health Chair, Department of Family & Community Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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40
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Haller H, Cramer H, Lauche R, Dobos G. Somatoform disorders and medically unexplained symptoms in primary care. DEUTSCHES ARZTEBLATT INTERNATIONAL 2016; 112:279-87. [PMID: 25939319 DOI: 10.3238/arztebl.2015.0279] [Citation(s) in RCA: 83] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Revised: 02/20/2015] [Accepted: 02/20/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND The literature contains variable figures on the prevalence of somatoform disorders and medically unexplained symptoms in primary care. METHODS The pertinent literature up to July 2014 was retrieved by a systematic search in the PubMed/MEDLINE, PsychInfo, Scopus, and Cochrane databases. The methodological quality and heterogeneity (I2) of the retrieved trials were analyzed. The prevalence rates of medically unexplained symptoms, somatoform disorders, and their subcategories were estimated, along with corresponding 95% confidence intervals (CI), with the aid of random-effects modeling. RESULTS From a total of 992 identified publications, 32 studies from 24 countries involving a total of 70 085 patients (age range, 15-95 years) were selected for further analysis. All had been carried out between 1990 and 2012. The primary studies were more heterogeneous overall; point prevalences for the strict diagnosis of a somatization disorder ranged from 0.8% (95% CI 0.3-1.4%, I2 = 86%) to 5.9% (95% CI 2.4-9.4%, I2 = 96%), with higher estimated prevalences in studies that applied less restrictive diagnostic criteria. At least one type of somatoform disorder was diagnosable by DSM-IV and/or ICD-10 criteria in a fraction of primary-care patients that ranged from 26.2% (95% CI 19.1-33.3%, I2 = 98%) to 34.8% (95% CI 26.6-44.6%; I2 = 92%). The percentage of patients complaining of at least one medically unexplained symptom ranged from 40.2% (95% CI 0.9-79.4%; I2 = 98%) to 49% (95% CI 18-79.8%, I2 = 98%). The quality of the studies, in general, was only moderate. No relationship was found between study quality and prevalence estimates. CONCLUSION The statistical heterogeneity of the included studies is very high. Somatoform disorders and medically unexplained symptoms are more common than generally assumed. The found prevalences highlight the importance of these conditions in primary care.
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Affiliation(s)
- Heidemarie Haller
- Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen
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41
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ZHANG Y, MA H, WANG Y. Case report of body dysmorphic disorder in a suicidal patient. SHANGHAI ARCHIVES OF PSYCHIATRY 2016. [PMID: 27688645 PMCID: PMC4984612 DOI: 10.11919/j.issn.1002-0829.215112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Few reports exist about the treatment of body dysmorphic disorder (BDD) in patients who are suicidal. This case report describes a 19-year-old male with BDD who had delusional-intensity beliefs about facial disfigurement that had gradually intensified over a 2-year period. However, he was initially misdiagnosed with depression partly because he was admitted immediately after a suicide attempt that was associated with depressive symptoms and social withdrawal, symptoms that subsequently proved to be secondary to his BDD. The symptoms resolved completely and his social functioning returned to normal after 8 weeks of inpatient treatment with fluoxetine and cognitive behavioral therapy. This report is a reminder that suicidal behavior and ideation can have many causes; to avoid misdiagnosis and inappropriate treatment, clinicians should consider other possibilities before assuming that suicidal behavior or ideation is the direct result of depression. We discuss the many changes in the understanding and diagnostic classification of BDD since it was first reported by Enrico Morselli in 1886.
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Affiliation(s)
| | - Hongxia MA
- Second People's Hospital of Dali, Yunnan
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42
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Abstract
OBJECTIVE To assess the prevalence of and explanations for the avoidance of dairy foods, including symptoms attributed to their consumption, diagnoses and psychological predictors of avoidance. Also considered were comparisons with symptom-related avoidance of wheat in the same sample. DESIGN Cross-sectional population survey. SETTING The study was conducted in Australia using a national postal omnibus survey. SUBJECTS Adults aged 18 years and over (n 1184; 52·9 % female) selected at random from the Australian Electoral Roll. RESULTS Despite few claims of formally diagnosed allergy or intolerance, 11·8 % of the sample reported avoiding dairy products because of adverse physiological effects, which commonly included gastrointestinal symptoms. Unlike wheat (3·5 %) or wheat-and-dairy (3·6 %) avoidance, dairy avoidance (8·2 %) was predicted by age (negatively) and worry about illness (positively). CONCLUSIONS The findings are further evidence of a widespread tendency for consumers to exercise control over their health by eliminating dietary factors considered suspect without medical evidence or oversight. Unanswered questions include the decision processes underlying dairy avoidance, whether symptoms are attributed correctly, the agents and physiological mechanism(s) involved, the relative contributions of symptom severity and vigilance to the association with illness worry, and the nutritional adequacy of dairy avoiders' diets. Irrespective of the accuracy of self-diagnoses, if the elimination of suspect foods is an end in itself the paradoxical possibility for nutritional imbalances may have significant public health implications.
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Li W, Lai TM, Loo SK, Strober M, Mohammad-Rezazadeh I, Khalsa S, Feusner J. Aberrant early visual neural activity and brain-behavior relationships in anorexia nervosa and body dysmorphic disorder. Front Hum Neurosci 2015; 9:301. [PMID: 26082703 PMCID: PMC4451358 DOI: 10.3389/fnhum.2015.00301] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Accepted: 05/11/2015] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Body dysmorphic disorder (BDD) and anorexia nervosa (AN) share the clinical symptom of disturbed body image, which may be a function of perceptual distortions. Previous studies suggest visual or visuospatial processing abnormalities may be contributory, but have been unable to discern whether these occur early or late in the visual processing stream. We used electroencephalography (EEG) and visual event related potentials (ERP) to investigate early perceptual neural activity associated with processing visual stimuli. METHODS We performed EEG on 20 AN, 20 BDD, 20 healthy controls, all unmedicated. In order to probe configural/holistic and detailed processing, participants viewed photographs of faces and houses that were unaltered or filtered to low or high spatial frequencies, respectively. We calculated the early ERP components P100 and N170, and compared amplitudes and latencies among groups. RESULTS P100 amplitudes were smaller in AN than BDD and healthy controls, regardless of spatial frequency or stimulus type (faces or houses). Similarly, N170 latencies were longer in AN than healthy controls, regardless of spatial frequency or stimulus type, with a similar pattern in BDD at trend level significance. N170 amplitudes were smaller in AN than controls for high and normal spatial frequency images, and smaller in BDD than controls for normal spatial frequency images, regardless of stimulus type. Poor insight correlated with lower N170 amplitudes for normal and low spatial frequency faces in the BDD group. CONCLUSIONS Individuals with AN exhibit abnormal early visual system activity, consistent with reduced configural processing and enhanced detailed processing. This is evident regardless of whether the stimuli are appearance-or non-appearance-related, and thus may be a reflection of general, early perceptual abnormalities. As N170 amplitude could be a marker of structural encoding of faces, lower values may be associated with perceptual distortions and could contribute to poor insight in BDD. Future studies may explore visual ERP measures as potential biomarkers of illness phenotype.
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Affiliation(s)
- Wei Li
- Department of Neuroscience, University of California, Los Angeles Los Angeles, CA, USA
| | - Tsz M Lai
- Department of Neuroscience, University of California, Los Angeles Los Angeles, CA, USA
| | - Sandra K Loo
- Department of Psychiatry, University of California, Los Angeles Los Angeles, CA, USA
| | - Michael Strober
- Department of Psychiatry, University of California, Los Angeles Los Angeles, CA, USA
| | | | - Sahib Khalsa
- Department of Neuroscience, University of California, Los Angeles Los Angeles, CA, USA
| | - Jamie Feusner
- Department of Neuroscience, University of California, Los Angeles Los Angeles, CA, USA ; Department of Psychiatry, University of California, Los Angeles Los Angeles, CA, USA
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Nieuwoudt JE, Zhou S, Coutts RA, Booker R. Symptoms of Muscle Dysmorphia, Body Dysmorphic Disorder, and Eating Disorders in a Nonclinical Population of Adult Male Weightlifters in Australia. J Strength Cond Res 2015; 29:1406-14. [DOI: 10.1519/jsc.0000000000000763] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Grau K, Fegert JM, Allroggen M. [Body dysmorphic disorder]. ZEITSCHRIFT FUR KINDER-UND JUGENDPSYCHIATRIE UND PSYCHOTHERAPIE 2015; 43:29-35; quiz 36-7. [PMID: 25536894 DOI: 10.1024/1422-4917/a000330] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Body dysmorphic disorder (BDD) is a relatively common disorder with a point prevalence of 0.7-2.4 %. BDD is characterized by the patient's excessive concern with an imagined or slight defect in physical appearance. BDD usually begins in adolescence. Comorbidity rates and also suicidality rates are high. The course of BDD tends to be chronic. According to the present state of knowledge, cognitive-behavioral therapy and pharmacotherapy with selective serotonin reuptake inhibitors are valuable options in the therapy of BDD. The case report describes a recent case of BDD with typical clinical and therapy-related characteristics. The aim of this work is to strengthen the awareness of BDD in clinical practice of child and adolescent psychiatry, facilitating an adequate diagnosis and treatment of the affected individuals.
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Affiliation(s)
- Katharina Grau
- Klinik für Kinder- und Jugendpsychiatrie/-psychotherapie, Universitätsklinikum Ulm
| | - Jörg Michael Fegert
- Klinik für Kinder- und Jugendpsychiatrie/-psychotherapie, Universitätsklinikum Ulm
| | - Marc Allroggen
- Klinik für Kinder- und Jugendpsychiatrie/-psychotherapie, Universitätsklinikum Ulm
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Hedman E, Lekander M, Ljótsson B, Lindefors N, Rück C, Andersson G, Andersson E. Optimal cut-off points on the health anxiety inventory, illness attitude scales and whiteley index to identify severe health anxiety. PLoS One 2015; 10:e0123412. [PMID: 25849477 PMCID: PMC4388630 DOI: 10.1371/journal.pone.0123412] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Accepted: 02/28/2015] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Health anxiety can be viewed as a dimensional phenomenon where severe health anxiety in form of DSM-IV hypochondriasis represents a cut-off where the health anxiety becomes clinically significant. Three of the most reliable and used self-report measures of health anxiety are the Health Anxiety Inventory (HAI), the Illness Attitude Scales (IAS) and the Whiteley Index (WI). Identifying the optimal cut-offs for classification of presence of a diagnosis of severe health anxiety on these measures has several advantages in clinical and research settings. The aim of this study was therefore to investigate the HAI, IAS and WI as proximal diagnostic instruments for severe health anxiety defined as DSM-IV hypochondriasis. METHODS We investigated sensitivity, specificity and predictive value on the HAI, IAS and WI using a total of 347 adult participants of whom 158 had a diagnosis of severe health anxiety, 97 had obsessive-compulsive disorder and 92 were healthy non-clinical controls. Diagnostic assessments were conducted using the Anxiety Disorder Interview Schedule. RESULTS Optimal cut-offs for identifying a diagnosis of severe health anxiety was 67 on the HAI, 47 on the IAS, and 5 on the WI. Sensitivity and specificity were high, ranging from 92.6 to 99.4%. Positive and negative predictive values ranged from 91.6 to 99.4% using unadjusted prevalence rates. CONCLUSIONS The HAI, IAS and WI have very good properties as diagnostic indicators of severe health anxiety and can be used as cost-efficient proximal estimates of the diagnosis.
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Affiliation(s)
- Erik Hedman
- Karolinska Institutet, Department of Clinical Neuroscience, Division of Psychology, Stockholm, Sweden
- Karolinska Institutet, Department of Clinical Neuroscience, Osher Center for Integrative Medicine, Stockholm, Sweden
| | - Mats Lekander
- Karolinska Institutet, Department of Clinical Neuroscience, Osher Center for Integrative Medicine, Stockholm, Sweden
- Stockholm University, Stress Research Institute, Stockholm, Sweden
| | - Brjánn Ljótsson
- Karolinska Institutet, Department of Clinical Neuroscience, Division of Psychology, Stockholm, Sweden
| | - Nils Lindefors
- Karolinska Institutet, Department of Clinical Neuroscience, Division of Psychiatry, Stockholm, Sweden
| | - Christian Rück
- Karolinska Institutet, Department of Clinical Neuroscience, Division of Psychiatry, Stockholm, Sweden
| | - Gerhard Andersson
- Karolinska Institutet, Department of Clinical Neuroscience, Division of Psychiatry, Stockholm, Sweden
- Linköping University, Department of Behavioural Sciences and Learning, Linköping, Sweden
| | - Erik Andersson
- Karolinska Institutet, Department of Clinical Neuroscience, Division of Psychology, Stockholm, Sweden
- Karolinska Institutet, Department of Clinical Neuroscience, Division of Psychiatry, Stockholm, Sweden
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Brohede S, Wingren G, Wijma B, Wijma K. Prevalence of body dysmorphic disorder among Swedish women: a population-based study. Compr Psychiatry 2015; 58:108-15. [PMID: 25617963 DOI: 10.1016/j.comppsych.2014.12.014] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Revised: 12/17/2014] [Accepted: 12/23/2014] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Body dysmorphic disorder (BDD) is characterized by a highly distressing and impairing preoccupation with nonexistent or slight defects in appearance. Patients with BDD present to both psychiatric and non-psychiatric physicians. A few studies have assessed BDD prevalence in representative samples of the general population and have demonstrated that this disorder is relatively common. Our primary objective was to assess the prevalence of BDD in the Swedish population because no data are currently available. METHODS In the current cross-sectional study, 2891 randomly selected Swedish women aged 18-60 years participated. The occurrence of BDD was assessed using the Body Dysmorphic Disorder Questionnaire (BDDQ), which is a validated self-report measure derived from the Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV criteria for BDD. In addition, symptoms of depression and anxiety were measured using the Hospital Anxiety and Depression Scale (HADS). RESULTS The prevalence of BDD among Swedish women was 2.1%. The women with BDD had significantly more symptoms of depression and anxiety than the women without BDD. Depression (HADS depression score ≥ 8) and anxiety (HADS anxiety score ≥ 8) were reported by 42% and 72% of the women with BDD, respectively. CONCLUSIONS The results of the present study indicate that BDD is relatively common among Swedish women (2.1%) and that it is associated with significant morbidity.
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Affiliation(s)
- Sabina Brohede
- Unit of Medical Psychology, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University and Department of Pediatrics, County Council of Östergötland, Linköping, Sweden.
| | - Gun Wingren
- Occupational and Environmental Medicine, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden
| | - Barbro Wijma
- Gender and Medicine, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden
| | - Klaas Wijma
- Unit of Medical Psychology, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden
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Callaghan GM, Sandoz EK, Darrow SM, Feeney TK. The Body Image Psychological Inflexibility Scale: development and psychometric properties. Psychiatry Res 2015; 226:45-52. [PMID: 25618470 DOI: 10.1016/j.psychres.2014.11.039] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2013] [Revised: 11/04/2014] [Accepted: 11/11/2014] [Indexed: 10/24/2022]
Abstract
Body image disturbance and body dysmorphic disorder (BDD) have been researched from a variety of psychological approaches. Psychological inflexibility, or avoidance of one's own cognitive and affective states at a cost to personal values, may be a useful construct to understand these problems. In an effort to clarify the role of psychological inflexibility in body image disturbance and BDD, a measure was created based on the principles of Acceptance and Commitment Therapy (ACT). The scale was developed by generating new items to represent the construct and revising items from an existing scale measuring aspects of body image psychological inflexibility. The study was conducted with an ethnically diverse undergraduate population using three samples during the validation process. Participants completed multiple assessments to determine the validity of the measure and were interviewed for BDD. The 16-item scale has internal consistency (α = 0.93), a single factor solution, convergent validity, and test re-test reliability (r = 0.90). Data demonstrate a relationship between psychological inflexibility and body image disturbance indicating empirical support for an ACT conceptualization of body image problems and the use of this measure for body image disturbance and BDD.
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Affiliation(s)
- Glenn M Callaghan
- Department of Psychology, San Jose State University, San Jose, CA, United States
| | - Emily K Sandoz
- Department of Psychology, University of Louisiana at Lafayette, Lafayette, LA, United States
| | - Sabrina M Darrow
- Department of Psychiatry, University of California, San Francisco, San Francisco, CA, United States
| | - Timothy K Feeney
- Department of Psychology, University of Nevada, Reno, Reno, NV, United States
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Barahmand U, Shahbazi Z. Prevalence of and associations between body dysmorphic concerns, obsessive beliefs and social anxiety. Asia Pac Psychiatry 2015; 7:54-63. [PMID: 23857955 DOI: 10.1111/appy.12085] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2012] [Accepted: 03/27/2013] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Physical attractiveness has been of concern in different cultures and at different times. Physical attractiveness can influence one's thoughts and actions, and concerns regarding body image can be destructive, giving rise to psychological problems. The purpose of the present study was to determine the prevalence of body dysmorphic concerns, related sex differences and comorbidity with social anxiety and obsessive beliefs. METHOD Using a stratified and cluster sampling procedure, 1,200 males and females were randomly selected. Self-report measures on body image, social anxiety and obsessive beliefs were distributed of which 843 completed questionnaires (54.9% males and 45.1% females) were returned (return rate of 70.25%). Therefore, data pertaining to 463 males and 380 females ranging in age from 17 to 20 years with a mean age of 18.12 years (SD = 1.06) were analyzed. RESULTS Findings suggest a prevalence rate of 19.1% for body dysmorphic disorder, 23.6% for social anxiety and 8.8% for obsessive beliefs. Both social anxiety and obsessive beliefs were found to be comorbid with body dysmorphic concerns. The percentage of individuals reporting comorbid social anxiety (12.9%) was greater than that of those reporting comorbid obsessive beliefs (6.4%). Males with body dysmorphic concerns reported more obsessive beliefs (8.2% versus 4.1%), while their female counterparts reported more social anxiety (23.4% versus 4.2%). DISCUSSION In males, body image concerns appear to be more cognitive in quality, while in females, body image concerns seem more emotional in tone. As the measures used do not yield formal diagnoses, findings should be viewed with caution.
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Wang HR, Woo YS, Bahk WM. Potential role of anticonvulsants in the treatment of obsessive-compulsive and related disorders. Psychiatry Clin Neurosci 2014; 68:723-32. [PMID: 24735021 DOI: 10.1111/pcn.12186] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Revised: 01/26/2014] [Accepted: 04/11/2014] [Indexed: 11/29/2022]
Abstract
We reviewed the extant literature to evaluate the current evidence regarding the efficacy and safety of anticonvulsants in the treatment of obsessive-compulsive and related disorders. Relevant literature was accessed using the Cochrane database, embase and PubMed on 29 October 2013. Prospective studies examining the efficacy of anticonvulsants in obsessive-compulsive and related disorders were included. Case reports, case series, and retrospective studies were excluded. A total of 10 studies were included in this review. The studies of obsessive-compulsive disorder, except for two negative studies, showed favorable efficacy results of anticonvulsants. In one study on body dysmorphic disorder, levetiracetam showed favorable efficacy. In two lamotrigine studies for pathologic skin-picking, the efficacy findings were inconsistent. In one trichotillomania study, topiramate had reduced hair-pulling symptoms. Despite limited evidence, our review suggests that anticonvulsants have a potential role in the treatment of obsessive-compulsive and related disorders.
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Affiliation(s)
- Hee Ryung Wang
- Department of Psychiatry, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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