Childhood maltreatment and trauma is common and severe in body dysmorphic disorder

Peer Relationships and Social Media Use in Adolescents with Body Dysmorphic Disorder

Body dysmorphic disorder (BDD) is a common and debilitating disorder in adolescents, yet there is little research on the disorder in young people. The current study aimed to investigate peer relationship factors in 26 adolescents (aged 12 to 17 years) with BDD, compared to 27 adolescents with anxiety disorders and 25 adolescents without mental disorders. Participants completed self-report measures on peer appearance and general victimisation, peer support, appearance co-rumination and social media use. Adolescents with BDD and anxiety disorders perceived significantly less peer support than adolescents in the non-clinical control group. Although the frequency of perceived appearance and general victimisation did not differ significantly between groups, adolescents with BDD reported significantly more distress due to appearance victimisation than the non-clinical control group. Adolescents with BDD and anxiety disorders reported spending more time on social media than the non-clinical control group, and the BDD group engaged in significantly more online appearance comparisons than both the anxiety and control group. The relationships between BDD, victimisation, social media use, and other peer factors require further empirical investigation.

Adverse Childhood Experiences Among Adolescents With Body Dysmorphic Disorder: Frequency and Clinical Correlates

Increasing empirical attention has been given to the role of adverse childhood experiences (ACEs) in the development and maintenance of body dysmorphic disorder (BDD). Yet, current research has predominantly focused on adult and nonclinical BDD samples, and little is known about relevance of ACEs in adolescent BDD. The present study examined (a) the frequency of ACEs in adolescents with a primary diagnosis of BDD (n = 50) versus obsessive compulsive disorder (OCD) (n = 50) and (b) the clinical profile of ACE-exposed youth with BDD. ACEs were ascertained through a systematic search of electronic patient records, as well as through a parent- and self-report screening item for exposure to traumatic events. Results showed higher rate of peer victimisation (74% vs. 38%) and child maltreatment (44% vs. 24%) among BDD versus OCD youths; sexual abuse was the most common type of child maltreatment documented in the BDD group (28%) according to patient records. Parent-reported exposure to traumatic events was also significantly higher in the BDD than the OCD group (40% vs. 18%, respectively). Clinical presentation and treatment outcomes did not differ between those with versus without a history of ACEs. The current study is the first to demonstrate that a range of ACEs are common in adolescent BDD. Our findings highlight the importance of screening for these experiences. Although further research is needed, our findings also indicate that adolescents with BDD who have a history of ACEs are broadly similar in their clinical presentation to those without, and benefit from BDD-focused treatment.

Body dysmorphic disorder among Lebanese females: A cross-sectional study

BACKGROUND

Body dysmorphic disorder (BDD) is a mental health disorder characterized by an excessive preoccupation with perceived flaws or defects in one's appearance. This study aimed to assess the prevalence of BDD, identify the predictors of BDD, explore the associations of BDD with social anxiety and social phobia, and examine the effect of social media on BDD.

METHODS

In this cross-sectional study that was conducted between January and March 2023, Lebanese adult females completed an online survey that included questions about sociodemographic characteristics, cosmetic interventions, BDD, social media use, and Social Interaction Anxiety Scale (SISA-6)/Social Phobia Scale (SPS-6). The collected information was analyzed using descriptive statistics and regression analysis. Statistical significance was set at p value <0.05.

RESULTS

A sample of 1048 were eligible for analysis and the mean age was 29.94 ± 10.01 years. It was shown that 141 (13.5%) participants were BDD positive. The results of the multivariable logistic regression showed that only females living in urban areas (aOR = 2.351 [95% CI 1.502-3.680], p < 0.001), unmarried (aOR = 1.672 [95% CI 1.041-2.684], p = 0.033), reporting higher social media use score (aOR = 1.526 (95% CI 1.401-1.661), p < 0.001), and higher SIAS/SPS score (aOR = 1.040 (95% CI 1.022-1.060), p < 0.001) were significantly positively associated with BDD.

CONCLUSION

This study found a high BDD prevalence (13.5%) among Lebanese adult females compared with other regions and was associated with anxiety and increased social media platforms use. This highlights the need for a comprehensive approach in the assessment of BDD, along with preventive measures to address the negative impacts of social media on well-being and promote healthy body image.

Parental overcontrol is associated with dysmorphic concern severity: A cross-sectional study

BACKGROUND

Dysmorphic concern (DC) is a symptom affecting both clinical and non-clinical populations, with a severe impact on individuals' physical and psychological well-being. While Childhood Trauma (CT) has been identified as a risk factor for DC, there is a lack of research on a specific form of CT, that is, parental overcontrol. Therefore, the current study aimed to investigate the association between DC and parental overcontrol in a community sample of adults, controlling for other forms of CT and potential confounding variables.

METHOD

714 adults (508 females; mean age: 30.29 ± 11.67 years; age range: 18-77) participated in an online survey including the Body Image Concern Inventory (BICI), the Overcontrol subscale of the Measure Of Parental Style, and the Childhood Trauma Questionnaire - Short Form (CTQ-SF).

RESULTS

Parental overcontrol was independently associated with DC symptoms (β = 0.111; p = .005; CI = [0.119;0.666]), even after controlling for other forms of CT and sociodemographic and clinical confounding variables.

LIMITATIONS

The cross-sectional design of the study, the unbalanced sex ratio, the retrospective self-reported data about parental overcontrol and CT should be considered.

CONCLUSIONS

This finding suggests that parental overcontrol may play a role in the development and maintenance of DC symptoms, remarking the urge to take more into account parental overcontrol in the assessment of CT.

Understanding and treating body dysmorphic disorder

Body dysmorphic disorder (BDD) is a mental disorder that involves a distressing preoccupation with a perceived defect in physical appearance, associated with excessive or repetitive behaviours or mental acts aimed at camouflaging, checking or 'improving' the perceived area of concern. BDD is relatively common, affecting at least 2% of the population world-wide, yet is poorly understood. Professor Susan Rossell has produced a substantial body of influential research, which has improved our understanding of BDD. This includes a more comprehensive understanding of the phenomenology, neurocognition and neurobiology, as well as significant treatment advances. This work will be reviewed in this commentary.

Efficacy of Cognitive Therapy for Body Dysmorphic Disorder: A Randomized Controlled Pilot Trial

Dysfunctional cognitive processes and maladaptive interpersonal patterns have been postulated to maintain body dysmorphic disorder (BDD). The present trial evaluated CT for BDD (CT-BDD), which includes modules targeting maladaptive cognitive processing in BDD, as well as elements of schema therapy related to interpersonal problems. We investigated whether (a) CT-BDD is effective, as compared with a wait-list (WL) group at Week 12; (b) outcome of CT-BDD is maintained at posttreatment and 3- and 6-months follow-up; and (c) whether changes in shame and insight mediate changes in BDD symptom severity. Forty adults with BDD were randomized to 36 weeks immediate CT-BDD (n = 21), or to 12-week WL (n = 19). At Week 12, immediate CT-BDD was significantly superior to WL in clinician-rated BDD symptom severity, insight, self-reported BDD symptoms, shame, depression, general symptomatology, and life satisfaction. Changes in outcomes were associated with moderate to large effect sizes at Week 12. Reductions in shame and increase in insight separately mediated changes in BDD symptom severity during treatment at Week 12. From baseline to posttreatment, significant improvements occurred within CT-BDD in clinician-rated symptom severity, insight, depression, global functioning, self-reported BDD symptoms, shame, depression, general symptomatology, and life satisfaction. At posttreatment, improvements were associated with large effect sizes and were maintained at 3- and 6-month follow-up. Preliminary results support the efficacy of CT-BDD. Addressing interpersonal problems in addition to cognitive dysfunctions may increase the benefit of CBT for BDD patients.

Adverse childhood experiences and body dysmorphic symptoms: A meta-analysis

Adverse childhood experiences (ACEs) are considered a risk factor for the development of various forms of mental disorders, including body dysmorphic disorder (BDD). The aim of the present work was to examine the association between ACEs and BDD symptomatology and to identify features of studies that might moderate this association. We conducted a three-level meta-analysis of 27 articles that included 9167 participants. Results showed that the types of ACE examined (total ACE, abuse, neglect, teasing, and bullying) were positively associated with BDD symptomatology. Specifically, a low to moderate association was found for ACE overall, defined as abuse, neglect, bullying, or teasing (r = 0.289, 95% confidence interval (CI) [.240,.337), for bullying (r = 0.282, 95% CI [.206,.354]), and for abuse (r = 0.223, 95% CI [.169,.276]) were found; and a moderate to large association was found for experienced teasing (r = 0.423, 95% CI [.360,.482]). In addition, moderator analyses of the association between ACE and BDD symptomatology resulted in a predictive model in which the type of ACE, type of sample, and gender of participants moderated the magnitude of the association between ACEs and BDD symptomatology.