Relationship between social anxiety disorder and 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.

Self-focused brain predictors of cognitive behavioral therapy response in a transdiagnostic sample

BACKGROUND

Effective biomarkers of cognitive behavioral therapy (CBT) response provide information beyond available behavioral or self-report measures and may optimize treatment selection for patients based on likelihood of benefit. No single biomarker reliably predicts CBT response. In this study, we evaluated patterns of brain connectivity associated with self-focused attention (SFA) as biomarkers of CBT response for anxiety and obsessive-compulsive disorders. We hypothesized that pre-treatment as well as pre-to post-treatment changes in functional connectivity would be associated with improvement during CBT in a transdiagnostic sample.

METHODS

Twenty-seven patients with primary social anxiety disorder (n = 14) and primary body dysmorphic disorder (n = 13) were scanned before and after 12 sessions of CBT targeting their primary disorder. Eligibility was based on elevated trait SFA scores on the Public Self-Consciousness Scale. Seed-based resting state functional connectivity associated with symptom improvement was computed using a seed in the posterior cingulate cortex of the default mode network.

RESULTS

At pre-treatment, stronger positive connectivity of the seed with the cerebellum, and stronger negative connectivity with the putamen, were associated with greater clinical improvement. Between pre-to post-treatment, greater anticorrelation between the seed and postcentral gyrus, extending into the inferior parietal lobule and precuneus/superior parietal lobule was associated with clinical improvement, although this did not survive thresholding.

CONCLUSIONS

Pre-treatment functional connectivity with the default mode network was associated with CBT response. Behavioral and self-report measures of SFA did not contribute to predictions, thus highlighting the value of neuroimaging-based measures of SFA.

CLINICAL TRIALS REGISTRATION

ClinicalTrials.gov Identifier: NCT02808702 https://clinicaltrials.gov/ct2/show/NCT02808702.

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.

Prevalence and Severity of Social Anxiety Symptoms and Their Relationship With Body Dysmorphic Symptoms

Background Social anxiety disorder (SAD) is a subtype of anxiety characterized by avoidance, fear, and physical symptoms such as dry mouth, sweating, palpitations, and blushing. SAD is one of the most common mental disorders. Body dysmorphic disorder (BDD) is a mental disorder marked by a distressing or impairing preoccupation with imagined or minor flaws in one's physical appearance. Both disorders share similar symptoms. No satisfactory data have been provided about the prevalence of social anxiety symptoms in our region. In our study, we measured the prevalence and severity of SAD symptoms among adults in Riyadh City, as well as the sociodemographic factors associated with it. Additionally, the correlation between SAD and BDD was assessed. Methods Our study is quantitative, observational, and cross-sectional. It was conducted by administering a translated Arabic version of the Severity Measure for Social Anxiety Disorder scale and BDD scales in five locations in Riyadh, which include two general hospitals and three shopping malls. Data were analyzed using the SPSS version 22 (IBM Corp., Armonk, NY, USA). Descriptive statistical data are presented through mean values, standard deviations, and percentages. Results A total of 752 responses were received, of which 509 (68.32%) were from females with a mean age of 30.12 years. The majority of the sample had a low to middle family income, with 64% earning less than $2555 monthly. The sample possessed a good educational level; 63% had a bachelor's degree or higher. Our study also shows that 233 subjects (30.98%) had scores indicating a moderate to severe form of SAD. Among these participants, 86 (36.9%) had scores indicating a moderate to severe form of BDD. There was a significant positive correlation between SAD and BDD (r = 0.496). Conclusion The prevalence of SAD was 30.98%, which is higher compared to Western countries. Low income, education, and female gender have roles in the disease condition. Moreover, there was a linear relationship between SAD and BDD.

Multidimensional Perfectionism and Facial Symmetry, Attractiveness and Approachability: Comparing Those With High Versus Low Dysmorphic Concerns

Concerns pertaining to one's physical appearance or specific body parts is not uncommon in the community. Whether such dissatisfaction is related to superior (or inferior) face perception abilities, or interacts with related constructs, such as perfectionism, is unknown. The current study aimed to investigate whether multidimensional perfectionism (e.g. involving concern over mistakes or doubts over actions) and facial ratings differed in those with high versus low dysmorphic concerns (i.e. excessive preoccupation about perceived physical flaws). Respondents (N = 343) from the community took part in an online study, comprising questionnaires assessing dysmorphic concerns and perfectionism. They also completed a face perception task involving symmetry, attractiveness and approachability ratings for a series of faces, some of which had been digitally manipulated to yield differing degrees of symmetry. Respondents were divided into those with high (n = 147) versus low (n = 196) dysmorphic concerns. Group comparisons using analyses of variance were conducted. Those with high dysmorphic concerns exhibited significantly elevated overall perfectionism (as well as on facets involving concern over mistakes, personal standards, parental perceptions and doubts over actions). No significant group differences were uncovered for the face perception task, involving ratings of symmetry, attractiveness and approachability. Perfectionism differences existed in a non-clinical sample with high dysmorphic concerns, though further work is needed to elucidate consistent patterns regarding perfectionism facets. More research examining face perception deficits on the clinical end of the body image spectrum, such as in those with body dysmorphic disorder, as well as utilising alternate task versions involving self-referential stimuli, are recommended.

Measuring the neglected anxiety disorder: validation of the social anxiety spectrum-short version (SHY-SV) questionnaire

BACKGROUND

In the recent years, a growing body of literature stressed the importance of a dimensional perspective on mental disorders. In particular, since its conceptualization, one of the main concerns in the field of Social Anxiety Disorder (SAD) has been the definition of a diagnostic threshold, leading to the suggestion that SAD may be more properly classified as a spectrum of severity rather than a discrete disorder based on subjectively determined threshold. The purpose of the current research is to evaluate the psychometric qualities of the Social Anxiety Spectrum - Short Version (SHY-SV), a novel questionnaire designed to measure the complete range of social anxiety symptoms, from overt manifestations to subthreshold ones.

METHODS

42 subjects with a clinical diagnosis of social anxiety disorder (SAD) according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), 43 subjects with a clinical diagnosis of Obsessive-Compulsive Disorder (OCD) and 60 individuals without current or lifetime mental disorders (HC) were recruited from the Psychiatric Clinic of the University of Pisa. Subjects were assessed with the SCID-5, Liebowitz Social Anxiety Scale (LSAS) and the SHY-SV.

RESULTS

SHY-SV showed strong internal consistency, and both the total and domain scores had great test-retest reliability. The Pearson's coefficients for the SHY-SV domain scores ranged from 0.391 to 0.933, and they were positively and significantly correlated with one another (p 0.001). All the SHY-SV domain scores were highly correlated with the SHY-SV total score. Results from of the correlation coefficients between SHY-SV and alternative measures of SAD were all significant and positive. Significant differences among diagnostic groups on both SAD-SV domains and total scores were found. SAD-SV total score increased significantly and progressively from HCs, to the OCD up to the SAD group which showed the highest values.

CONCLUSION

The SHY-SV demonstrated significant convergent validity with other dimensional SAD measures, great internal consistency, and test-retest reliability. With an increasing score gradient from healthy controls to patients with OCD to those with SAD, the questionnaire performed differently in each of the three diagnostic categories.

Self-Focused Brain Predictors of Cognitive Behavioral Therapy Response in a Transdiagnostic Sample

Background

Effective biomarkers of cognitive behavioral therapy (CBT) response provide information beyond available behavioral or self-report measures and may optimize treatment selection for patients based on likelihood of benefit. No single biomarker reliably predicts CBT response. In this study, we evaluated patterns of brain connectivity associated with self-focused attention (SFA) as biomarkers of CBT response for anxiety and obsessive-compulsive disorders. We hypothesized that pre-treatment as well as pre- to post-treatment changes in functional connectivity would be associated with improvement during CBT in a transdiagnostic sample.

Methods

Twenty-seven patients with primary social anxiety disorder (n=14) and primary body dysmorphic disorder (n=13) were scanned before and after 12 sessions of CBT targeting their primary disorder. Eligibility was based on elevated trait SFA scores on the Public Self-Consciousness Scale. Seed-based resting state functional connectivity associated with symptom improvement was computed using a seed in the posterior cingulate cortex/precuneus that delineated a self-other functional network.

Results

At pre-treatment, stronger positive connectivity of the seed with the cerebellum, insula, middle occipital gyrus, postcentral gyrus, and precuneus/superior parietal lobule, and stronger negative connectivity with the putamen, were associated with greater clinical improvement. Between pre- to post-treatment, greater anticorrelation between the seed and precuneus/superior parietal lobule was associated with clinical improvement, although this did not survive thresholding.

Conclusions

Pre-treatment functional connectivity between regions involved in attentional salience, self-generated thoughts, and external attention predicted greater CBT response. Behavioral and self-report measures of SFA did not contribute to predictions, thus highlighting the value of neuroimaging-based measures of SFA.

Clinical Trials Registration

ClinicalTrials.gov Identifier: NCT02808702 https://clinicaltrials.gov/ct2/show/NCT02808702.

Olfactory Reference Syndrome: Its Relationship to Comorbidity of Social Anxiety Disorder and Obsessive-Compulsive Disorder

ABSTRACT

Olfactory reference syndrome (ORS) is known to have the clinical features of both obsessive-compulsive disorder (OCD) and social anxiety disorder (SAD). However, there has been no clear explanation as to why ORS has the characteristics of two different disorders. In the present study, the comorbidity rates of ORS in patients with SAD (without OCD, n = 83), ORS in patients with OCD (without SAD, n = 42), and patients with SAD and OCD comorbidity (n = 17) were compared. Of all 142 patients studied, 11 were diagnosed with ORS. The comorbidity rate of ORS in comorbid SAD/OCD group was significantly higher than those in both SAD and OCD groups. Logistic regression analysis of 100 cases of SAD and selected 69 cases of generalized SAD showed that the risk of ORS was significantly higher in patients with OCD and bulimia nervosa. Of 59 cases with OCD, the risk of ORS was significantly higher in patients with SAD. The results of the present study suggest that the comorbidity of SAD and OCD most likely explains the development of ORS.

The Association between Alexithymia and Social Media Addiction: Exploring the Role of Dysmorphic Symptoms, Symptoms Interference, and Self-Esteem, Controlling for Age and Gender

Given the popularity of social media and the growing presence of these tools in the daily lives of individuals, research about the elements that can be linked to their problematic use appears to be of great importance. The objective of this study was to investigate the factors that may contribute to the levels of social media addiction, by focusing on the role of alexithymia, body image concern, and self-esteem, controlled for age and gender. A sample of 437 social media users (32.5% men, 67.5% women; M_age = 33.44 years, SD = 13.284) completed an online survey, including the Bergen Social Media Addiction Scale, Body Image Concern Inventory, Rosenberg Self-Esteem Scale, and Twenty-Item Toronto Alexithymia Scale, together with a demographic questionnaire. Results showed a significant association between alexithymia and social media addiction, with the total mediation of body image concern (and more in detail, body dissatisfaction) and the significant moderation of self-esteem. Gender and age showed significant effects in these relationships. Such findings may offer further insights into the field of clinical research on social media addiction and may provide useful information for effective clinical practice.

Longitudinal study of social anxiety symptoms and appearance rejection in predicting body dysmorphic symptoms: Appearance-based rejection sensitivity as a mediator

Previous findings from cross-sectional studies suggest that social anxiety symptoms and negative peers' experiences regarding appearance were predictors of body dysmorphic symptoms through appearance-based rejection sensitivity. However, little is known about longitudinal relations and parental appearance rejection on body dysmorphic symptoms. Therefore, this study aims to examine the longitudinal mediation of appearance-based rejection sensitivity with social anxiety symptoms, remembered peers', maternal, and paternal appearance-based rejection as predictors, and body dysmorphic symptoms as an outcome. The study included 277 university students who completed questionnaires in two-measurements points 5 months apart. The results indicated that social anxiety symptoms predicted changes in body dysmorphic symptoms through appearance-based rejection sensitivity. In addition, remembered childhood peers' appearance-based rejection predicted both directly and indirectly changes in body dysmorphic symptoms over time. Maternal and paternal appearance-based rejection were not predictors of appearance-based rejection sensitivity or body dysmorphic symptoms. Findings support rejection sensitivity theory and the long-lasting impact of negative peers' experiences for impaired body dysmorphic symptoms. However, further research regarding remembered parental negative experiences is needed.

Maladaptive self-focused attention and default mode network connectivity: a transdiagnostic investigation across social anxiety and body dysmorphic disorders

Maladaptive self-focused attention (SFA) is a bias toward internal thoughts, feelings and physical states. Despite its role as a core maintaining factor of symptoms in cognitive theories of social anxiety and body dysmorphic disorders (BDDs), studies have not examined its neural basis. In this study, we hypothesized that maladaptive SFA would be associated with hyperconnectivity in the default mode network (DMN) in self-focused patients with these disorders. Thirty patients with primary social anxiety disorder or primary BDD and 28 healthy individuals were eligible and scanned. Eligibility was determined by scoring greater than 1SD or below 1SD of the Public Self-Consciousness Scale normative mean, respectively, for each group. Seed-to-voxel functional connectivity was computed using a DMN posterior cingulate cortex (PCC) seed. There was no evidence of increased DMN functional connectivity in patients compared to controls. Patients (regardless of diagnosis) showed reduced functional connectivity of the PCC with several brain regions, including the bilateral superior parietal lobule (SPL), compared to controls, which was inversely correlated with maladaptive SFA but not associated with social anxiety, body dysmorphic, depression severity or rumination. Abnormal PCC-SPL connectivity may represent a transdiagnostic neural marker of SFA that reflects difficulty shifting between internal versus external attention.

Appearance Concerns are Uniquely Associated with LPP Amplitude to Pictures of Oneself

A number of psychiatric disorders, including body dysmorphic disorder (BDD), anorexia nervosa, bulimia nervosa, and social anxiety disorder, are characterized by heightened appearance concerns and increased cognitive and perceptual biases toward one’s own physical appearance. In the present study, we examined individual differences in self-reported appearance anxiety and symptoms of BDD in relation to the late positive potential (LPP)—an index of stimulus significance—in response to pictures of oneself, strangers and objects among 83 female college students. The results indicated that the LPP was larger for pictures of oneself compared to pictures of strangers and objects. Further, the Yale–Brown Obsessive-Compulsive Scale Modified for Body Dysmorphic Disorder and Appearance Anxiety Inventory scales both related to an increased LPP to pictures of oneself but not to strangers or objects. The findings suggest that the LPP elicited by pictures of oneself may function as a neural marker of appearance concerns, which could be leveraged to study the development and maintenance of a range of psychiatric disorders characterized by increased appearance concerns.

Body dysmorphic disorder in children and young people

The incidence of body dysmorphic disorder (BDD) in young people is increasing. Causes of BDD are related to the prevalence of social media and adolescent development, especially the role that brain neuroplasticity has on influencing perception. There are long-term impacts of BDD, including depression and suicide. Prevention and promotion of positive body image are part of the nurse's role; treatment can prevent unnecessary aesthetic surgical interventions.

Appearance Concerns, Psychosocial Outcomes, and the Feasibility of Implementing an Online Intervention for Adolescents Receiving Outpatient Burn Care

The current study assessed the prevalence of appearance concerns, psychosocial difficulty, and use of an appearance-focused social and psychological support resource (Young Person's Face IT; YPF) within a population of teens (12-17 year-olds) receiving outpatient burn care with the goal to assess the feasibility of routine use of the resource in outpatient burn care. The study sample included 78 patients ages 12 to 17 receiving outpatient care for burns at one hospital. Appearance concerns were measured via the Burn Outcomes Questionnaire Appearance Subscale, the Appearance Subscale of the Body Esteem Scale for Adolescents, and a 2-part question which asked participants directly about appearance concerns related to the burn injury. A large majority (70.0%) of study participants reported appearance concerns on at least one appearance measure and girls reported more burn-related appearance concerns compared with boys. Psychosocial difficulty was measured via the Pediatric Symptom Checklist-17 (PSC-17) and measures of social functioning were collected and compared within the sample by burn size, burn location, sex, and appearance concerns. Internalizing symptoms were prevalent on the PSC-17 (18.6% risk) and decreased self-worth and increased social anxiety symptoms were significantly associated with having appearance concerns. Although interest in YPF was high (78.3%), actual use of the resource among those who signed up to pilot it (n = 46 participants) was low (19.4% use). Results indicate that there is a need for and interest in appearance-focused social anxiety resources for adolescents with burn injuries such as YPF, but more research is needed to understand its feasibility in clinical practice.

Interpretation Bias Across Body Dysmorphic, Social Anxiety and Generalized Anxiety Disorder—A Multilevel, Diffusion Model Account

Background

Interpretation biases are suggested to be transdiagnostic phenomena, but have rarely been compared across different disorders and current concerns.

Methods

We investigated explicit, decision-based, and more implicit, reaction time-based interpretation bias in individuals with body dysmorphic disorder (BDD; N = 29), social anxiety disorder (SAD; N = 36), generalized anxiety disorder (GAD; N = 22), and non-clinical controls (NC; N = 32), using an adapted Word Sentence Association Paradigm (WSAP).

Results

Results indicated that interpretation bias occurred transdiagnostically, while content-specific bias patterns varied meaningfully across groups. BDD and SAD shared explicit and, more inconsistently, implicit interpretation biases for appearance-related and social situations. The GAD group exhibited an explicit and implicit negative interpretation bias for general situations, and an additional implicit lack of positive bias. Mechanistic Wiener diffusion model analyses revealed that interpretation bias patterns were mainly driven by speeded information uptake, potentially mirroring disorder-specific associative memory organization.

Conclusions

These findings have important implications for understanding interpretation biases as both etiological and treatment factors.

Sudden Gains in Internet-Based Cognitive Behavior Therapy for Body Dysmorphic Disorder

Sudden gains have been associated with better short- and long-term treatment outcomes in a number of psychiatric disorders. However, no studies to date have evaluated sudden gains in body dysmorphic disorder (BDD). We used data from a previous randomized controlled trial evaluating the efficacy of an Internet-based cognitive-behavior treatment (CBT) for BDD. The sample consisted of 47 adults diagnosed with BDD. We compared the treatment outcomes of sudden gainers vs. gradual gainers (i.e., treatment responders with no sudden gains) and non-sudden gainers (i.e., gradual gainers plus nonresponders) at posttreatment and 3, 12, and 24 months after the end of the treatment. Twelve (25.5%) participants experienced a sudden gain. Compared to non-sudden gainers and to gradual gainers, sudden gainers showed significantly larger improvements on the Yale-Brown Obsessive-Compulsive Scale modified for BDD at posttreatment (g = 1.23 and g = .91, respectively), and at 3-month (g = 1.23 and g = 1.00, respectively), 12-month (g = 1.12 and g = .91, respectively), and 24-month follow-up (g = 1.11 and g = .97, respectively). This translated into higher rates of treatment responders and remitters in the sudden gainers across all time points. The occurrence of sudden gains in Internet-based CBT for BDD is associated with favorable short- and long-term treatment outcomes. This suggests that a sudden improvement during the treatment could be a marker of good prognosis, while non-sudden-including gradual-gainers are more likely to need continued support or booster sessions. Early identification of patients who are not progressing as expected and subsequent tailoring of the delivered intervention has the potential to improve treatment outcomes in this group.

Overlapping features between social anxiety and obsessive-compulsive spectrum in a clinical sample and in healthy controls: toward an integrative model

BACKGROUND

While the literature frequently highlighted an association between social anxiety disorder (SAD) and obsessive-compulsive disorder (OCD), few studies investigated the overlapping features of these conditions. The presented work evaluated the relationship between SAD and OCD spectrum in a clinical population and in healthy controls (HC).

METHODS

Fifty-six patients with OCD, 51 with SAD, 43 with major depressive disorder (MDD), and 59 HC (N = 209) were assessed using the Mini International Neuropsychiatric Interview, the Social Phobia Spectrum (SCI-SHY), and the Obsessive-Compulsive Spectrum (SCI-OBS).

RESULTS

SAD patients scored significantly higher than other groups on all SCI-SHY domains and total score; OCD patients scored significantly higher than HC. MDD patients scored significantly higher than HC on the SCI-SHY total, Behavioral inhibition, and Interpersonal sensitivity domains. OCD patients scored significantly higher than other groups on all SCI-OBS domains except Doubt, for which OCD and SAD scored equally high. SAD patients scored significantly higher than HC on the SCI-OBS total, Childhood/adolescence, Doubt, and Hypercontrol domains. MDD patients scored significantly higher than HC on the Hypercontrol domain. SCI-OBS and SCI-SHY were widely correlated among groups, although lower correlations were found among OCD patients. Stronger correlations were observed between SCI-SHY Interpersonal sensitivity and SCI-OBS Doubt, Obsessive-compulsive themes, and Hypercontrol; between SCI-SHY Specific anxieties/phobic features and SCI-OBS Obsessive-compulsive themes; and between SCI-SHY Behavioral inhibition and SCI-OBS Doubt, with slightly different patterns among groups.

CONCLUSION

OCD and SAD spectrums widely overlap in clinical samples and in the general population. Interpersonal sensitivity and obsessive doubts might represent a common cognitive core for these conditions.

An empirically derived recommendation for the classification of body dysmorphic disorder: Findings from structural equation modeling

Body dysmorphic disorder (BDD), together with its subtype muscle dysmorphia (MD), has been relocated from the Somatoform Disorders category in the DSM-IV to the newly created Obsessive-Compulsive and Related Disorders category in the DSM-5. Both categorizations have been criticized, and an empirically derived classification of BDD is lacking. A community sample of N = 736 participants completed an online survey assessing different psychopathologies. Using a structural equation modeling approach, six theoretically derived models, which differed in their allocation of BDD symptoms to various factors (i.e. general psychopathology, somatoform, obsessive-compulsive and related disorders, affective, body image, and BDD model) were tested in the full sample and in a restricted sample (n = 465) which indicated primary concerns other than shape and weight. Furthermore, measurement invariance across gender was examined. Of the six models, only the body image model showed a good fit (CFI = 0.972, RMSEA = 0.049, SRMR = 0.027, TLI = 0.959), and yielded better AIC and BIC indices than the competing models. Analyses in the restricted sample replicated these findings. Analyses of measurement invariance of the body image model showed partial metric invariance across gender. The findings suggest that a body image model provides the best fit for the classification of BDD and MD. This is in line with previous studies showing strong similarities between eating disorders and BDD, including MD. Measurement invariance across gender indicates a comparable presentation and comorbid structure of BDD in males and females, which also corresponds to the equal prevalence rates of BDD across gender.

Aussehensbezogene Zurückweisungssensitivität bei körperdysmorpher Störung und Essstörungen

Hintergrund

Die körperdysmorphe Störung (KDS) und die Essstörungen (ESS) weisen erhebliche Symptomüberschneidungen auf, was die Differenzialdiagnose erschwert. Die Psychopathologie der beiden Störungen deutet auf die aussehensbezogene Zurückweisungssensitivität („appearance-based rejection sensitivity“, ARS) als mögliches differenzierendes Merkmal hin.

Ziel der Arbeit

Die Studie soll Hinweise zu einer Verbesserung der Differenzialdiagnostik zwischen KDS und ESS geben. Dazu wurden die Störungen hinsichtlich der ARS miteinander verglichen. Auf Basis der bisherigen empirischen Forschung wurde davon ausgegangen, dass bei KDS höhere ARS-Werte vorliegen als bei ESS. Weiterhin sollte eine höhere Varianzaufklärung von KDS an der ARS unter Konstanthaltung von Störvariablen (sozialängstliche Symptome, Body-Mass-Index, Geschlecht) geprüft werden.

Material und Methoden

Eine Verfügbarkeitsstichprobe (n = 736) füllte online die Appearance-based Rejection Sensitivity Scale, die Liebowitz Social Anxiety Scale, den Eating Disorder Examination Questionnaire und ein DSM-5-Screening zu KDS aus.

Ergebnisse

Teilnehmer mit komorbid positivem KDS-ESS-Screening erzielten den höchsten ARS-Gesamtwert aber ähnlich hohe Werte wie Teilnehmer mit positivem ESS-Screening. Beide Gruppen erzielten signifikant höhere Werte als Teilnehmer mit positivem KDS-Screening, welche wiederum signifikant höhere Werte erzielten als symptomfreie Teilnehmer. Die Regressionsanalyse bestätigte eine höhere Varianzaufklärung an der ARS durch ESS als durch KDS bei Konstanthaltung von Störvariablen.

Diskussion

Die ARS konnte nicht als differenzierendes Merkmal zwischen KDS und ESS im Sinne der Hypothesen bestätigt werden. Allerdings könnten hohe ARS-Werte einen Hinweis auf eine ESS oder KDS darstellen, sehr hohe Werte für komorbide ESS-KDS-Symptome. Dies sollte diagnostisch abgesichert und ggf. in der Therapie berücksichtigt werden.

Serum oxytocin levels are elevated in body dysmorphic disorder and related to severity of psychopathology

The neurobiological mechanisms underlying the pathophysiology of body dysmorphic disorder (BDD) are not well-understood. Oxytocin is a central nervous system peptide which regulates socioemotional functioning and may mediate physiologic processes in a range of psychiatric disorders, particularly those characterized by interpersonal dysfunction. Examining the role of oxytocin in the development and maintenance of BDD may elucidate new targets for intervention. The present study examined endogenous serum oxytocin levels in BDD. Given the prominent deficits in social functioning in BDD, we expected that BDD would be characterized by low basal serum oxytocin concentrations, relative to healthy controls, and that low oxytocin levels would be associated with BDD symptom severity as well as poor performance on measures of social cognition. Twenty individuals with BDD and 28 healthy controls completed a fasting blood draw consisting of frequent sampling every five minutes for one hour to measure pooled levels of oxytocin. Contrary to our hypotheses, people with BDD displayed higher concentrations of oxytocin, compared to their healthy control counterparts, and their oxytocin levels were positively correlated with BDD symptom severity. There were no associations between oxytocin levels and measures of social cognition. These findings suggest increased production of endogenous oxytocin in BDD. Prospective research is needed to determine whether this contributes to or is a consequence of BDD symptomatology.

Motives for Illicit Drug Use Among Individuals With Body Dysmorphic Disorder

Drug use disorders (DUDs) are highly prevalent in body dysmorphic disorder (BDD), but motives for illicit drug use in BDD have not yet been explored. This study examined motives for drug use and clinical correlates of drug use motives in a sample of individuals with BDD and lifetime drug use, using the Drug Use Motives Questionnaire and 3 additional body image-specific drug use motives. As predicted, the Drug Use Motives Questionnaire coping motive was positively associated with attempted suicide and a lifetime DUD. All 3 body image-specific motives for drug use were also significantly associated with a lifetime DUD. In addition, they were the only variables that were significantly associated with greater severity of BDD. These results build on previous evidence suggesting that coping motives are related to problematic substance use and suicide attempts in BDD.

Body Dysmorphic Disorder in Adolescents

Background and Objectives:

Body Dysmorphic Disorder (BDD) is characterized by an abnormal preoccupation with alleged misshapen body parts. There is often poor insight and effort is made to hide the imagined defects, and consultation may be sought seeking unnecessary cosmetic surgery or procedures. It is underdiagnosed and established treatment protocols are lacking. The disease has a chronic and undulating course and is seriously compromises quality of life. Despite the fact that the prime age of onset of BDD is during adolescence relatively little has been written about it during this phase of life. This review aims to comprehensively cover the present understanding of BDD, including clinical features, epidemiology, psychopathology, nomenclature, comorbidity and management.

Methods:

A literature search was undertaken using suitable key words on Google Scholar, MEDLINE & PsychoINFO up to June 2018 limited to articles in English.

Results:

he prevalence of BDD is variable in the general and psychiatric population with equal gender distribution. Both sexes are equally affected. It is associated with poor functioning and a chronic course. There is considerable comorbidity and diagnostic overlap between BDD and obsessive-compulsive disorder, major depressive disorder, social anxiety disorder, anorexia nervosa, schizophrenia spectrum disorders and personality disorders. Psychiatric consultation is often late. Selective Serotonin Reuptake Inhibitors (SSRIs) and Cognitive Behavior Therapy (CBT) are currently the first line modalities for treatment. Internet based CBT, Acceptance and commitment therapy, and repetitive Transcranial Magnetic Stimulation (rTMS) are emerging treatment options.

Conclusions:

BDD is a complex disorder with still lot of uncertainty about its diagnostic placement, treatment approaches, especially for refractory patients, and prognosis. Further study is needed to clarify its prevalence, especially in adolescents; to fully understand its neurobiological aspects, to determine its exact relation to obsessive compulsive related disorders, and to develop better treatment approaches.

Application of a transdiagnostic treatment for emotional disorders to body dysmorphic disorder: A randomized controlled trial

BACKGROUND

Body dysmorphic disorder (BDD) is a common disorder which is associated with a high rate of comorbidity and functional impairment. Although research shows that cognitive-behavioral therapy can be an efficacious treatment for BDD, there is growing evidence that dysregulated emotion is a core deficit. The Unified Protocol for the Transdiagnostic Treatment of Emotional Disorders (UP) is a transdiagnostic, emotion focused cognitive-behavioral therapy protocol that has been developed to target emotion regulation processes that play an important role in the development and maintenance of many emotional disorders METHODS: : In the present study, 128 patients meeting criteria for BDD were randomized to either the UP (n = 64) or waitlist/treatment-as-usual (WL/TAU) condition. Diagnoses were determined using semi-structural interviews and patients also completed the Brown Assessment of Beliefs Scale (BABS), the Appearance Anxiety Inventory (AAI), the Difficulties in Emotion Regulation Scale (DERS), the Beck Depression Inventory (BDI) and the Clinical Global Impression (CGI).

RESULTS

Repeated measure ANOVA indicated that the UP significantly decreased depression, BDD symptoms and body-related anxiety, as well as significantly improving emotional regulation all with large effect sizes compared to the TAU/WL condition. Treatment gains as well as remission of comorbid conditions were maintained at the three-month follow-up.

LIMITATIONS

Our study limitations include restricted follow-up periods and excluding participants who were actively suicidal.

CONCLUSIONS

To our knowledge, this is the first examination of the UP for BDD, and results suggest that this disorder shares common mechanisms with other disorders of emotion, and that the UP may be an additional efficacious treatment for this condition.

Integrative analysis of shared genetic pathogenesis by obsessive‑compulsive and eating disorders

A number of common pathological features have been observed in obsessive‑compulsive disorder (OCD) and eating disorders (EDs). The present study examined the association between OCD and EDs at the genetic level in order to gain an improved understanding of the shared genetic basis of the diseases and identify novel potential risk genes for the two diseases. An integrated analysis using large‑scale disease‑gene association data and gene expression data was conducted. Disease‑gene association data were acquired from the Pathway Studio Mammalian database. Gene expression data were acquired from samples of 133 subjects, including 15 ED cases, 16 OCD cases and 102 normal controls. Genes associated with OCD and ED presented significant overlap (21 genes, P=6.70x10‑34), serving roles within multiple common genetic pathways (top 10 pathway enrichment P<4.30x10‑7) that were implicated in the two diseases. A genetic network of 17 genes was constructed, through which OCD and ED were observed to influence each other. Expression analysis revealed four novel common significant genes for OCD and ED (oxytocin receptor, glutamate decarboxylase 2, neuropeptide Y and glutamate ionotropic receptor kainate type subunit 3). These genes demonstrated a strong functional association with the two diseases. The results of the present study supported the presence of complex genetic associations between OCD and ED. Genes associated with one disease are worthy of further investigation as potential risk factors for the other. The findings of the present study may provide novel insights into the understanding of the pathogenesis of OCD and ED.

Influencing Factors of Social Anxiety Disorder and Body Dysmorphic Disorder in a Nonclinical Brazilian Population

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.

The relationship between body dysmorphic disorder and obsessive-compulsive disorder: A systematic review of direct comparative studies

OBJECTIVE

Current nosology conceptualises body dysmorphic disorder as being related to obsessive-compulsive disorder, but the direct evidence to support this conceptualisation is mixed. In this systematic review, we aimed to provide an integrated overview of research that has directly compared body dysmorphic disorder and obsessive-compulsive disorder.

METHOD

The PubMed database was searched for empirical studies which had directly compared body dysmorphic disorder and obsessive-compulsive disorder groups across any subject matter. Of 379 records, 31 met inclusion criteria and were reviewed.

RESULTS

Evidence of similarities between body dysmorphic disorder and obsessive-compulsive disorder was identified for broad illness features, including age of onset, illness course, symptom severity and level of functional impairment, as well as high perfectionism and high fear of negative evaluation. However, insight was clearly worse in body dysmorphic disorder than obsessive-compulsive disorder, and preliminary data also suggested unique visual processing features, impaired facial affect recognition, increased social anxiety severity and overall greater social-affective dysregulation in body dysmorphic disorder relative to obsessive-compulsive disorder.

CONCLUSION

Limitations included a restricted number of studies overall, an absence of studies comparing biological parameters (e.g. neuroimaging), and the frequent inclusion of participants with comorbid body dysmorphic disorder and obsessive-compulsive disorder. Risks of interpreting common features as indications of shared underlying mechanisms are explored, and evidence of differences between the disorders are placed in the context of broader research findings. Overall, this review suggests that the current nosological status of body dysmorphic disorder is somewhat tenuous and requires further investigation, with particular focus on dimensional, biological and aetiological elements.

Body dysmorphic disorder and its associated psychological and psychopathological features in an Italian community sample

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.

Non-weight-related body image concerns and Body Dysmorphic Disorder prevalence in patients with Anorexia Nervosa

Patients with Anorexia Nervosa (AN) and patients with Body Dysmorphic Disorder (BDD) are both characterized by body image disturbance and dissatisfaction; furthermore, these disorders share clinical features and frequently co-occur. However, few studies have explored the relation between AN and BDD. Therefore, the first aim of the study was assessing the prevalence of BDD and presence of non-weight-related body image concerns in patients with AN. Second, we were interested in comparing patients with AN and non-weight-related body image concerns, patients with weight-related body image concerns only, and a healthy control group with respect to several psychological and psychopathological features. Sixty-one female patients with AN were divided in two subgroups: 39 with non-weight-related body image concerns and 22 with weight-related body image concerns only. Sixteen (26.23%) patients with AN had probable comorbid BDD. Moreover, patients with AN and non-weight-related body image concerns reported, overall, greater psychopathology than patients with AN and weight-related body image concerns only, with the exception of AN core features and general distress. In conclusion, patients with AN and non-weight-related body image concerns showed a more severe body image disturbance unrelated to a more severe eating disorder pathology.

The classification of body dysmorphic disorder symptoms in male and female adolescents

BACKGROUND

Body dysmorphic disorder (BDD) was categorised in DSM-5 within the newly created 'obsessive-compulsive and related disorders' chapter, however this classification remains subject to debate. Confirmatory factor analysis was used to test competing models of the co-occurrence of symptoms of BDD, obsessive-compulsive disorder, unipolar depression, anxiety, and eating disorders in a community sample of adolescents, and to explore potential sex differences in these models.

METHODS

Self-report questionnaires assessing disorder symptoms were completed by 3149 Australian adolescents. The fit of correlated factor models was calculated separately in males and females, and measurement invariance testing compared parameters of the best-fitting model between males and females.

RESULTS

All theoretical models of the classification of BDD had poor fit to the data. Good fit was found for a novel model where BDD symptoms formed a distinct latent factor, correlated with affective disorder and eating disorder latent factors. Metric non-invariance was found between males and females, and the majority of factor loadings differed between males and females. Correlations between some latent factors also differed by sex.

LIMITATIONS

Only cross-sectional data were collected, and the study did not assess a broad range of DSM-5 defined eating disorder symptoms or other disorders in the DSM-5 obsessive-compulsive and related disorders chapter.

CONCLUSIONS

This study is the first to statistically evaluate competing models of BDD classification. The findings highlight the unique features of BDD and its associations with affective and eating disorders. Future studies examining the classification of BDD should consider developmental and sex differences in their models.

A multi-method analysis of distress tolerance in body dysmorphic disorder

Distress tolerance (DT) is a transdiagnostic construct linked to multiple psychiatric disorders. We conducted three studies using different methods to investigate the relationship between DT and body dysmorphic disorder (BDD). Study 1 found a significant relationship between low DT and more severe BDD symptoms in an adult community sample (N=81). In Study 2, we found a similar relationship between lower DT and greater BDD symptoms in a student sample (N=192). Furthermore, we found a unique relationship between greater BDD symptoms and lower self-reported tolerance of anger and sadness mood induction tasks. Greater BDD symptoms were not significantly associated with lower self-reported tolerance of a fear mood induction task. In Study 3, a clinical sample of individuals with BDD (N=40) reported lower DT than a sample of healthy controls (N=36). Findings suggest that low DT is a broad vulnerability factor related to BDD.

Level of Social Appearance Anxiety in Individuals with and without Alignment of Teeth

Objective

The aim of this study is to determine the level of social appearance anxiety in individuals with and without alignment of teeth and to demonstrate that orthodontic treatment is effective in reintegrating the individual into society, as well as in improving self-confidence communication skills, and self-esteem.

Methods

The present study included 50 patients (24 males and 26 females) with dental alignment and 50 patients (28 males and 22 females) without dental alignment. The study was performed as an interview study using the Social Appearance Anxiety Scale, which measures emotional, cognitive, and behavioral anxiety felt by the individual due to his/her appearance. Hypotheses were proven by t-test and one-way analysis of variance using the Statistical Package for the Social Sciences program.

Results

The mean level of social appearance anxiety was higher in patients with dental misalignment (p<0.05). The result of t-test analysis revealed no significant difference between the scores of male and female participants (p>0.05).

Conclusion

The level of social appearance anxiety increases in individuals with dental misalignment. However, it is independent from gender.

Improving the Detection of Body Dysmorphic Disorder in Clinical Practice

The aim of this article is to raise awareness of the underdiagnosis of body dysmorphic disorder (BDD) in clinical practice and provide suggestions to overcome key barriers to BDD detection. Disclosure of BDD symptoms is uncommon during routine assessments but can be increased by asking specifically about such symptoms. When BDD symptoms are present, it is important to differentiate them from anxiety, depression, obsessive-compulsive disorder, and eating disorders, which may present with some similarities and are commonly comorbid with BDD. Assessment of BDD should be sensitive to issues of poor insight, elevated suicide risk, subthreshold BDD presentations, and the possibility of BDD by proxy. Furthermore, assessment should consider the potential impact of age, gender, ethnicity, and minor physical defects on the presentation of BDD. Improving the assessment of BDD in routine clinical practice will enhance disclosure, improve case conceptualization, and provide the opportunity to deliver appropriate treatment for this underdiagnosed and often serious disorder.

Development of a Body Image Concern Scale using both exploratory and confirmatory factor analyses in Chinese university students

BACKGROUND

The body dysmorphic disorder is prevalent in general population and in psychiatric, dermatological, and plastic-surgery patients, but there lacks a structure-validated, comprehensive self-report measure of body image concerns, which is established through both exploratory and confirmatory factor analyses.

METHODS

We have composed a 34-item matrix targeting the body image concerns and trialed it in 328 male and 365 female Chinese university students. Answers to the matrix dealt with treatments including exploratory factor analyses, reserve of qualified items, and confirmatory factor analyses of latent structures.

RESULTS

Six latent factors, namely the Social Avoidance, Appearance Dissatisfaction, Preoccupation with Reassurance, Perceived Distress/Discrimination, Defect Hiding, and Embarrassment in Public, were identified. The factors and their respective items have composed a 24-item questionnaire named as the Body Image Concern Scale. Each factor earned a satisfactory internal reliability, and the intercorrelations between these factors were in a median level. Women scored significantly higher than men did on the Appearance Dissatisfaction, Preoccupation with Reassurance, and Defect Hiding.

CONCLUSION

The Body Image Concern Scale has displayed its structure validation and gender preponderance in Chinese university students.

Body Dysmorphic Symptoms Scale for patients seeking esthetic surgery: cross-cultural validation study

CONTEXT AND OBJECTIVE:

Rhinoplasty is one of the most sought-after esthetic operations among individuals with body dysmorphic disorder. The aim of this study was to cross-culturally adapt and validate the Body Dysmorphic Symptoms Scale.

DESIGN AND SETTING:

Cross-cultural validation study conducted in a plastic surgery outpatient clinic of a public university hospital.

METHODS:

Between February 2014 and March 2015, 80 consecutive patients of both sexes seeking rhinoplasty were selected. Thirty of them participated in the phase of cultural adaptation of the instrument. Reproducibility was tested on 20 patients and construct validity was assessed on 50 patients, with correlation against the Yale-Brown Obsessive Compulsive Scale for Body Dysmorphic Disorder.

RESULTS:

The Brazilian version of the instrument showed Cronbach's alpha of 0.805 and excellent inter-rater reproducibility (intraclass correlation coefficient, ICC = 0.873; P < 0.001) and intra-rater reproducibility (ICC = 0.939; P < 0.001). Significant differences in total scores were found between patients with and without symptoms (P < 0.001). A strong correlation (r = 0.841; P < 0.001) was observed between the Yale-Brown Obsessive Compulsive Scale for Body Dysmorphic Disorder and the Body Dysmorphic Symptoms Scale. The area under the receiver operating characteristic curve was 0.981, thus showing good accuracy for discriminating between presence and absence of symptoms of body dysmorphic disorder. Forty-six percent of the patients had body dysmorphic symptoms and 54% had moderate to severe appearance-related obsessive-compulsive symptoms.

CONCLUSIONS:

The Brazilian version of the Body Dysmorphic Symptoms Scale is a reproducible instrument that presents face, content and construct validity.

Body Dysmorphic Disorder in Patients Seeking Abdominoplasty, Rhinoplasty, and Rhytidectomy

BACKGROUND

Body dysmorphic disorder may negatively affect self-perception of body shape and lead patients to seek cosmetic surgery. This study estimates the level of body dissatisfaction and prevalence of body dysmorphic disorder symptoms in candidates for three plastic surgical procedures.

METHODS

Three hundred patients of both sexes divided into three groups (abdominoplasty, n = 90; rhinoplasty, n =151; and rhytidectomy, n =59) were classified as having (n =51, n =79, and n =25, respectively) or not having (n =39, n =72, and n =34, respectively) body dysmorphic disorder symptoms, based on the Body Dysmorphic Disorder Examination, which was administered preoperatively.

RESULTS

Prevalence rates of body dysmorphic disorder symptoms in the abdominoplasty, rhinoplasty, and rhytidectomy groups were 57, 52, and 42 percent, respectively. Significant between-group differences were observed regarding age (p < 0.001), body mass index (p = 0.001), and onset of body dysmorphic disorder symptoms (p < 0.001). Within-group differences in body dysmorphic disorder severity were observed in the abdominoplasty (p < 0.001), rhinoplasty (p < 0.001), and rhytidectomy (p = 0.005) groups. Body dysmorphic disorder severity was significantly associated with degree of body dissatisfaction (mean Body Dysmorphic Disorder Examination total scores; p < 0.001), avoidance behaviors (p< 0.001), sexual abuse (p = 0.026), suicidal ideation (p < 0.001), and suicide attempt (p = 0.012).

CONCLUSIONS

Abdominoplasty candidates showed the highest prevalence; rhytidectomy candidates exhibited the highest percentage of severe cases, and rhinoplasty candidates had the lowest percentage of severe cases.

Yale-Brown Obsessive Compulsive Scale modified for Body Dysmorphic Disorder (BDD-YBOCS): Brazilian Portuguese translation, cultural adaptation and validation

OBJECTIVE

To translate, culturally adapt, and validate a Brazilian Portuguese version of the Yale-Brown Obsessive Compulsive Scale modified for Body Dysmorphic Disorder (BDD-YBOCS).

METHODS

Ninety-three patients of both sexes seeking rhinoplasty were consecutively selected at the Plastic Surgery Outpatient Clinic of the Universidade Federal de São Paulo, Brazil, between May 2012 and March 2013. The BDD-YBOCS was translated into Brazilian Portuguese. Thirty patients participated in the cultural adaptation of the scale. The final version was tested for reliability in 20 patients, and for construct validity in 43 patients (correlation of the BDD-YBOCS with the Body Dysmorphic Disorder Examination [BDDE]).

RESULTS

Total Cronbach's alpha was 0.918. The BDD-YBOCS had excellent inter-rater (intra-class correlation coefficient [ICC] = 0.934; p < 0.001) and intra-rater reliability (ICC = 0.999; p < 0.001). Significant differences in BDD-YBOCS scores were found between patients with and without BDD symptoms (p < 0.001), and among patients with different levels of BDD severity (p < 0.001). A strong correlation (r = 0.781; p < 0.001) was observed between the BDDE and the BDD-YBOCS. The area under the receiver operating characteristic curve was 0.851, suggesting a very good accuracy for discriminating between presence and absence of BDD symptoms.

CONCLUSION

The Brazilian Portuguese version of the BDD-YBOCS is a reliable instrument, showing face, content and construct validity.

Prevalence of Body Dysmorphic Disorder and its Association With Body Features in Female Medical Students

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.

Intolerance of uncertainty in body dysmorphic disorder

Intolerance of uncertainty (IU) is a transdiagnostic construct associated with several anxiety and related disorders. Three studies were conducted to explore the potential relationship between IU and body dysmorphic disorder (BDD). Study 1 revealed a positive relationship between IU and BDD symptoms above symptoms of anxiety and depression in an unselected student sample (N=88). Study 2 demonstrated a similar relationship between IU and BDD symptoms above negative affectivity and intolerance of ambiguity in a community sample (N=116). Study 3 found that a clinical BDD sample (N=23) reported greater IU than healthy controls (N=20), though this relationship was accounted for by symptoms of anxiety and depression. Greater IU predicted functional impairment in the clinical sample above BDD symptoms and past-week anxiety and depression. The observed relationship between IU and BDD symptoms provides preliminary support for the relevance of IU to this population.

Training interpretation biases among individuals with body dysmorphic disorder symptoms

The current study provided an initial test of a Cognitive Bias Modification for Interpretations (CBM-I) training paradigm among a sample with elevated BDD symptoms (N=86). As expected, BDD-relevant interpretations were reduced among participants who completed a positive (vs. comparison) training program. Results also pointed to the intriguing possibility that modifying biased appearance-relevant interpretations is causally related to changes in biased, socially relevant interpretations. Further, providing support for cognitive behavioral models, residual change in interpretations was associated with some aspects of in vivo stressor responding. However, contrary to expectations there were no significant effects of condition on emotional vulnerability to a BDD stressor, potentially because participants in both training conditions experienced reductions in biased socially-threatening interpretations following training (suggesting that the "comparison" condition was not inert). These findings have meaningful theoretical and clinical implications, and fit with transdiagnostic conceptualizations of psychopathology.

Social anxiety and associations with eating psychopathology: Mediating effects of fears of evaluation

Recent work suggests unique relations among features of social anxiety disorder and eating disorder pathology. Thus, it may be important to determine specific facets of social anxiety that account for the relation between it and eating disorders. Given the similarities in social-evaluative concerns in both sets of symptoms, we hypothesized that fears of both positive and negative evaluation would each independently account for the relationship between social anxiety symptoms and eating pathology among college females (N=167). Results were partially supportive of hypotheses. Fear of negative evaluation independently accounted for a significant portion of the relationship between social anxiety and each domain of eating pathology that was tested, which included Drive for Thinness, Body Dissatisfaction, and Bulimic Symptoms. Body mass index appeared to play a moderating role on the relationship between fear of negative evaluation and body dissatisfaction, but not drive for thinness or bulimia symptoms. Clinical implications including diagnostic and treatment considerations will be discussed.

Neurobiological correlates of social anxiety disorder: an update

Social anxiety disorder (SAD) is a condition characterized by pervasiveness and impairment in social functioning, with a prevalence in the general population between 1.9% and 12.1%. The most consistent findings on its neurobiological underpinnings involve a wide range of neurotransmitters (serotonin, norepinephrine, glutamate, and GABA) and neuropeptides (oxytocin), but no comprehensive hypothesis is yet available. In particular, oxytocin is becoming increasingly established as a "prosocial neuropeptide" and, as such, is a major focus of current research, with a great range of therapeutic applications including SAD treatment. Specifically, the amygdala plays a pivotal role in conditioning and processing of fear, and exaggerated amygdala responses in SAD patients have been observed during various social-emotional stimuli. In addition to the amygdala, other brain areas of interest in SAD-related circuitry are represented by the medial prefrontal cortex, dorsal raphe, striatum, locus coeruleus, prefrontal cortex, insular cortex, and anterior cingulate cortex. The aim of this review is to provide an update on neurobiological correlates of SAD, with a special focus on neurotransmitters and brain areas possibly involved, and suggestions for future research that could lead to more specific therapeutic interventions.

Prevalence of and associations between body dysmorphic concerns, obsessive beliefs and social anxiety

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.

A study of poor insight in social anxiety disorder

We investigated levels of insight among patients with Social Anxiety Disorder (SAD) as compared to patients with Obsessive-Compulsive Disorder (OCD) and evaluated whether levels of insight in SAD were related to specific sociodemographic and/or clinical features. Thirty-seven SAD patients and 51 OCD patients attending a tertiary obsessive-compulsive and anxiety disorders clinic were assessed with a sociodemographic and clinical questionnaire, a structured diagnostic interview, the Brown Assessment of Beliefs Scale (BABS), the Social Phobia Inventory (SPIN), the Beck Depression Inventory (BDI), the Sheehan Disability Scale (SDS), and the Treatment Adherence Survey-patient version (TAS-P). According to the BABS, SAD patients exhibited insight levels that were as low as those exhibited by OCD patients, with up to 29.7% of them being described as "poor insight" SAD. Although poor insight SAD patients were more frequently married, less depressed and displayed a statistical trend towards greater rates of early drop-out from cognitive-behavioral therapy, their insight levels were not associated with other variables of interest, including sex, age, employment, age at onset, duration of illness, associated psychiatric disorders, SPIN and SDS scores. Patients with poor insight SAD might perceive their symptoms as being less distressful and thus report fewer depressive symptoms and high rates of treatment non-adherence.

Social anxiety disorder, a lifelong disorder? A review of the spontaneous remission and its predictors

OBJECTIVE

Based on clinical observations, social anxiety disorder (SAD) is usually described as a chronic disorder. Its natural course in the community is less clear.

METHOD

The present review summarises prospective and retrospective spontaneous remission rates of SAD in the community and its predictors that were published after 1987. Remission rates were specified as partial, defined as still having social fears, but not fulfilling the diagnostic criteria, and full, defined as having no social fears anymore.

RESULTS

In prospective studies, remission rates of SAD varied between 36% and 93% and in retrospective studies between 3% and 80%. The estimated average remission rate in prospective studies was 50% for full remission and 79% when including partial remission. In retrospective studies, the average remission rate was 26% during the last year and 56% over the lifetime. Diverse predictors of remission of SAD have been found that can be clustered into less severe anxiety, less additional psychopathology, less stress, employment, and mental health.

CONCLUSION

The enormous variation in remission rates indicates that SAD might have different course types (short, fluctuating, and chronic) and is not necessarily a chronic disorder. Prevention and treatment should be focused on enhancing positive and reducing negative factors.

Own-body perception in body dysmorphic disorder

INTRODUCTION

This paper reviews the literature as it relates to perceptual processes in body dysmorphic disorder (BDD).

METHODS

A narrative-style review of the literature was undertaken to explore the relationship between BDD and obsessive-compulsive disorder, the empirical evidence for aberrant own-body perception in BDD, and the possible role of the parietal cortex in the disorder.

RESULTS

The extant literature appears to support the postulation that BDD is underpinned by a dysfunction in somatoperception-the process by which individuals formulate a sense of what they look like.

CONCLUSIONS

Investigation of somatoperceptive processes in BDD and related brain structures would provide important insight about the development and maintenance of this complex and often neglected psychiatric condition, and, in turn, help improve its treatment.