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Addison M, James A, Borschmann R, Costa M, Jassi A, Krebs G. Suicidal thoughts and behaviours in body dysmorphic disorder: Prevalence and correlates in a sample of mental health service users in the UK. J Affect Disord 2024; 361:515-521. [PMID: 38821371 DOI: 10.1016/j.jad.2024.05.145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 04/22/2024] [Accepted: 05/27/2024] [Indexed: 06/02/2024]
Abstract
BACKGROUND Previous research indicates an association of body dysmorphic disorder (BDD) with suicidal thoughts and behaviours, but has largely relied on small cohorts drawn from specialist clinics. METHODS Anonymised health-records from the South London and Maudsley NHS Foundation Trust between 2007 and 2019 were systematically searched using the Clinical Record Interactive Search data system. RESULTS 298 patients diagnosed with BDD between age 12 and 65 years were identified. 206 (69 %) had experienced lifetime suicidal ideation. 149 (50 %) had recorded lifetime acts of self-harm or suicide attempts, most commonly involving cutting and self-poisoning. Rates of self-harm/suicide attempts were similar in those diagnosed before or after 18 years. Comorbid depression was associated with suicidal ideation (OR: 4.26 95% CI 2.07-9.72). Additionally, comorbid depression, OCD and anxiety were all associated with self-harm/suicide attempts (OR: 1.94 95% CI 1.15-3.31, OR: 1.99 95% CI 1.09-3.73, and OR: 1.93 95% CI 1.09-3.45, respectively). The presence of two or more psychiatric comorbidities was associated with a significantly elevated likelihood of suicidal ideation (OR: 7.06 95% CI 2.80-21.7) and self-harm/suicide attempts (OR: 4.62 95% CI 2.32-9.62). LIMITATIONS It is likely that BDD was under-diagnosed in the cohort, and those identified may not be representative. Additionally, the frequency and detail with which suicidal thoughts and behaviours were assessed varied and may also represent underestimates. CONCLUSIONS Suicidal ideation and self-harm/suicide attempts are common among individuals with BDD accessing mental health services. Psychiatric comorbidity and suicidal ideation should be assessed in all BDD patients.
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Affiliation(s)
- Mark Addison
- Oxford Health NHS Foundation Trust, United Kingdom of Great Britain and Northern Ireland
| | - Anthony James
- Oxford Health NHS Foundation Trust, United Kingdom of Great Britain and Northern Ireland; Department of Psychiatry, University of Oxford, United Kingdom of Great Britain and Northern Ireland
| | - Rohan Borschmann
- Department of Psychiatry, University of Oxford, United Kingdom of Great Britain and Northern Ireland; Centre for Mental Health and Community Wellbeing, University of Melbourne, Australia; Centre for Adolescent Health, Murdoch Children's Research Institute, Melbourne, Australia; Justice Health Group, School of Population Health, Curtin University, Perth, Australia
| | - Marta Costa
- Oxford Health NHS Foundation Trust, United Kingdom of Great Britain and Northern Ireland
| | - Amita Jassi
- National and Specialist OCD and Related Disorders Clinic for Young People, South London and Maudsley NHS Foundation Trust, United Kingdom of Great Britain and Northern Ireland
| | - Georgina Krebs
- National and Specialist OCD and Related Disorders Clinic for Young People, South London and Maudsley NHS Foundation Trust, United Kingdom of Great Britain and Northern Ireland; Research Department of Clinical, Educational and Health Psychology, University College London, United Kingdom of Great Britain and Northern Ireland.
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Wairauch Y, Siev J, Hasdai U, Dar R. Compulsive rituals in Obsessive-Compulsive Disorder - A qualitative exploration of thoughts, feelings and behavioral patterns. J Behav Ther Exp Psychiatry 2024; 84:101960. [PMID: 38513433 DOI: 10.1016/j.jbtep.2024.101960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 02/01/2024] [Accepted: 03/04/2024] [Indexed: 03/23/2024]
Abstract
BACKGROUND AND OBJECTIVES Rituals are common among healthy individuals and across cultures and often serve adaptive purposes. In individuals with obsessive-compulsive disorder (OCD), rituals become compulsive, time-consuming and distressing, and may lead to functional impairment. Previous research has examined the functions and characteristics of compulsive rituals, but there is paucity of in-depth, first-person reports about this topic. METHOD We used a qualitative approach to explore thoughts, feelings, and behavioral patterns that characterize OCD rituals. Ten individuals with OCD participated in a semi-structured interview that focused on their most prominent compulsive ritual. The interviews were subjected to a thematic analysis. RESULTS Eight themes emerged from the analysis and were organized in two main categories: Micro Level perspective, comprising triggers, attention, emotional changes, and stopping criteria; and Macro Level perspective, comprising feelings and perceptions, change over time, motives, and inhibitors. The findings shed light on the role of fixed rules and feelings of "completeness" in OCD rituals, the nature of emotional and attentional characteristics during rituals performance, and the evolution of compulsive rituals over time. LIMITATIONS This study used a qualitative approach based on a small number of participants, which limits the generalizability of the findings. CONCLUSION Our results, if replicated, may have clinical implications. The reported patterns of anxiety reduction during ritual performance may contribute to the fine-tuning of CBT for OCD. The findings concerning the nature of attention during ritual performance and the development of rituals over time may be important for understanding the mechanisms that maintain compulsive rituals.
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Affiliation(s)
- Yair Wairauch
- School of Psychological Sciences, Tel Aviv University, Israel
| | | | - Udi Hasdai
- School of Psychological Sciences, Tel Aviv University, Israel
| | - Reuven Dar
- School of Psychological Sciences, Tel Aviv University, Israel.
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Sampogna F, Samela T, Abeni D, Schut C, Kupfer J, Bewley AP, Finlay AY, Gieler U, Thompson AR, Gracia-Cazaña T, Balieva F, Ferreira BR, Jemec GB, Lien L, Misery L, Marron SE, Ständer S, Zeidler C, Szabó C, Szepietowski JC, Reich A, Svensson A, Altunay IK, Legat FJ, Grivcheva-Panovska V, Romanov DV, Lvov AN, Titeca G, Vulink NC, Tomás-Aragones L, van Beugen S, Evers AWM, Dalgard FJ. A cross-sectional study on gender differences in body dysmorphic concerns in patients with skin conditions in relation to sociodemographic, clinical and psychological variables. J Eur Acad Dermatol Venereol 2024. [PMID: 39051499 DOI: 10.1111/jdv.20247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 06/12/2024] [Indexed: 07/27/2024]
Abstract
BACKGROUND Dysmorphic concern is an overconcern with an imagined or slight defect in physical appearance that can be a symptom of body dysmorphic disorder (BDD). Appearance-related concerns are frequently reported by people with dermatological conditions. However, relatively little remains known about the relationship between dysmorphic concern and other variables within persons with different skin conditions. OBJECTIVES The aim of this multicentre, cross-sectional study was to investigate gender differences regarding dysmorphic concern and the prevalence of BDD in a large sample of patients with skin conditions, in relation to sociodemographic, clinical and psychological variables. METHODS Participants aged ≥18 years with skin conditions were consecutively enrolled in dermatological clinics of 22 European centres. Dysmorphic concern and the possible presence of BDD were measured using the Dysmorphic Concern Questionnaire (DCQ) and compared between men and women in relation to sociodemographic, clinical and psychological variables, and separately for each skin condition. RESULTS The DCQ questionnaire was completed by 5290 dermatological patients. In all categories, mean scores were significantly higher in women than in men. Mean DCQ scores were also higher in women for most skin conditions, with the highest effect size in vitiligo. The percentage of patients who screened positive for BDD on the DCQ was 10.5%, 7.7% of men and 12.7% of women. The prevalence of BDD positive was 6.9% in patients with mild clinical severity, 11.1% for moderate and 19.1% for severe condition. In the multivariate model in patients with mild skin condition, the presence of BDD was positively associated with stress and stigma both in men and in women. CONCLUSIONS Dysmorphic concern and BDD were more frequent in women than in men with skin conditions. Both received and actual stigmatization might have an impact on body-related concerns, in particular in women, who may be more at risk for sociocultural reasons.
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Affiliation(s)
- F Sampogna
- Clinical Epidemiology Unit, IDI-IRCCS, Rome, Italy
| | - T Samela
- Clinical Epidemiology Unit, IDI-IRCCS, Rome, Italy
| | - D Abeni
- Clinical Epidemiology Unit, IDI-IRCCS, Rome, Italy
| | - C Schut
- Institute of Medical Psychology, Justus-Liebig-University Gießen, Gießen, Germany
| | - J Kupfer
- Institute of Medical Psychology, Justus-Liebig-University Gießen, Gießen, Germany
| | - A P Bewley
- Barts Health NHS Trust & Queen Mary University, London, UK
| | - A Y Finlay
- Institute of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, UK
| | - U Gieler
- Department of Dermatology, Justus-Liebig- University Giessen and Vitos Klinik, Giessen, Germany
| | - A R Thompson
- South Wales Clinical Psychology Programme, Cardiff & Vale University Health Board, & School of Psychology, Cardiff University, Cardiff, UK
| | - T Gracia-Cazaña
- Miguel Servet University Hospital, IIS Aragón, Universidad de Zaragoza, Zaragoza, Spain
| | - F Balieva
- Department of Dermatology, Stavanger University Hospital, Stavanger, Norway
- Department of Public Health, Faculty of Health Sciences, University of Stavanger, Norway
| | - B R Ferreira
- Department of Dermatology, Coimbra University Hospital, Coimbra, Portugal
| | - G B Jemec
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - L Lien
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Brumunddal, Norway
- Faculty of Social and Health Sciences, Inland Norway University of Applied Sciences, Elverum, Norway
| | - L Misery
- Department of Dermatology, University Hospital of Brest, Brest, France
| | - S E Marron
- Department of Dermatology, University Hospital Miguel Servet, Aragon Psychodermatology Research Group (GAI+PD), Zaragoza, Spain
| | - S Ständer
- Department of Dermatology, University Clinic Münster, Münster, Germany
| | - C Zeidler
- Department of Dermatology, University Clinic Münster, Münster, Germany
| | - C Szabó
- Institute of Psychology, University of Szeged, Szeged, Hungary
| | - J C Szepietowski
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw, Poland
| | - A Reich
- Department of Dermatology, Institute of Medical Sciences, Medical College of Rzeszow University, Rzeszów, Poland
| | - A Svensson
- Department of Dermatology and Venereology, Skåne University Hospital, Malmo, Sweden
| | - I K Altunay
- Şişli Hamidiiye Etfal Research and Training Hospital, Department of Dermatology and Venereology, University of Health Sciences, Istanbul, Turkey
| | - F J Legat
- Department of Dermatology, Medical University of Graz, Graz, Austria
| | - V Grivcheva-Panovska
- School of Medicine, PHI University Clinic of Dermatology Skopje, University St Cyril and Methodius, Skopje, North Macedonia
| | - D V 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 Center, Moscow, Russia
| | - A N Lvov
- Department of Dermatovenereology and Cosmetology, Central State Medical Academy of Department of Presidential Affairs, Moscow, Russia
- Medical Research and Educational Center, Lomonosov Moscow State University, Moscow, Russia
| | - G Titeca
- Department of Dermatology/Clinique Notre Dame de Grâce, Gosselies, Belgium
| | - N C Vulink
- Department of Psychiatry, Amsterdam UMC, Location Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - L Tomás-Aragones
- Department of Psychology, University of Zaragoza, Zaragoza, Spain
| | - S van Beugen
- Institute of Psychology, Health, Medical and Neuropsychology Unit, Leiden University, Leiden, the Netherlands
| | - A W M Evers
- Institute of Psychology, Health, Medical and Neuropsychology Unit, Leiden University, Leiden, the Netherlands
| | - F J Dalgard
- Department of Dermatology and Venereology, Skåne University Hospital, Malmo, Sweden
- Division of Mental Health and Addiction, Vestfold Hospital Trust, Tønsborg, Norway
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Zhao F, Guo Z, Bo Y, Feng L, Zhao J. Is cognitive behavioral therapy an efficacious treatment for psychological interventions in body dysmorphic disorders? A meta-analysis based on current evidence from randomized controlled trials. J Affect Disord 2024; 352:237-249. [PMID: 38369262 DOI: 10.1016/j.jad.2024.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 01/27/2024] [Accepted: 02/06/2024] [Indexed: 02/20/2024]
Abstract
BACKGROUND Clinical guidelines and some studies recommend cognitive-behavioral therapy (CBT) as the most effective treatment for body dysmorphic disorder (BDD). However, owing to the lack of randomized controlled trials (RCTs), the research evidence is insufficient. This study aimed to explore the effectiveness of CBT in the treatment of BDD using RCTs. This meta-analysis was registered in PROSPERO (CRD42023410577). METHODS After a literature search and screening, 11 RCTs with 667 patients were included. The ROB 2.0 tool, funnel plots, sensitivity analysis, and meta-regression analysis were used to assess the quality, publication bias, and sources of heterogeneity. RESULTS After CBT intervention, the severity of BDD (SMD = -1.73, 95 % CI (confidence interval) = [-2.90; -0.57]), depression symptoms (SMD = -1.72, 95 % CI = [-3.16; -0.28]), and anxiety levels were all reduced in the patients of the experimental group; the remission of BDD (OR = 7.37, 95 % CI = [2.17; 24.98]) and the response of BDD (OR = 8.86, 95 % CI = [4.85; 16.18]) were all increased; incorrect beliefs such as disability and BABS were also reduced; the quality of life was improved. The difference between the groups was statistically significant (p < 0.01). Meta-regression analysis showed that age and sample size were the predictive factors of the effectiveness of CBT. LIMITATIONS The heterogeneity of most meta-analyses was high (I2 > 75 %). CONCLUSIONS Although CBT is effective in treating BDD, there is insufficient evidence to suggest that it is the best psychological intervention for BDD. More high-quality evidence is still needed in the future.
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Affiliation(s)
- Fei Zhao
- Key Laboratory of Environmental Ecology and Population Health in Northwest Minority Areas, Medical College of Northwest Minzu University, Lanzhou, China
| | - Zhong Guo
- Key Laboratory of Environmental Ecology and Population Health in Northwest Minority Areas, Medical College of Northwest Minzu University, Lanzhou, China
| | - Yan Bo
- Key Laboratory of Environmental Ecology and Population Health in Northwest Minority Areas, Medical College of Northwest Minzu University, Lanzhou, China
| | - LiJuan Feng
- Students' Counseling and Psychological Education Center, Northwest Minzu University, Lanzhou, China.
| | - Jin Zhao
- Key Laboratory of Environmental Ecology and Population Health in Northwest Minority Areas, Medical College of Northwest Minzu University, Lanzhou, China.
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Mavrogiorgou P, Becker S, Juckel G. Guilt and Shame in Patients with Obsessive-Compulsive Disorders. Psychopathology 2024:1-11. [PMID: 38657572 DOI: 10.1159/000537996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 02/21/2024] [Indexed: 04/26/2024]
Abstract
INTRODUCTION Obsessive-compulsive disorder (OCD) is a tremendous psychiatric illness with a variety of severe symptoms. Feelings of shame and guilt are universal social emotions that fundamentally shape the way people interact with each other. Mental illness is therefore often related to pronounced feelings of shame and guilt in a maladaptive form. METHODS A total of 62 participants (38 women and 24 men) were clinically and psychometrically investigated. RESULTS The OCD patients (n = 31) showed a maladaptive guilt and shame profile, characterized by increased interpersonal feelings of guilt accompanied by a stronger tendency to self-criticism and increased punitive sense of guilt with a simultaneous prevailing tendency to perfectionism, as well as an increased concern for the suffering of others. The proneness to profuse shame in OCD patients seems to be in the context of the violation of inner values and a negative self-image with persistent self-criticism. CONCLUSION Although there are limitations with a small sample size in this monocentric approach, our study underlines the importance of an individual consideration of the leading obsessive-compulsive symptomatology, especially in the context of very personal feelings of guilt and shame. Further multidimensional studies on guilt and shame could contribute to their implementation more strongly in individualized psychotherapy.
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Affiliation(s)
- Paraskevi Mavrogiorgou
- Department of Psychiatry, Psychotherapy and Preventive Medicine, LWL University Hospital of Ruhr, University Bochum, Bochum, Germany
| | - Sarah Becker
- Department of Psychiatry, Psychotherapy and Preventive Medicine, LWL University Hospital of Ruhr, University Bochum, Bochum, Germany
| | - Georg Juckel
- Department of Psychiatry, Psychotherapy and Preventive Medicine, LWL University Hospital of Ruhr, University Bochum, Bochum, Germany
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Farías-Yapur A. Are face transplant candidates choosing autonomously? A preliminary method to evaluate autonomous choosing in psychosocial and bioethical assessments. FRONTIERS IN TRANSPLANTATION 2024; 3:1346667. [PMID: 38993750 PMCID: PMC11235316 DOI: 10.3389/frtra.2024.1346667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 01/24/2024] [Indexed: 07/13/2024]
Abstract
This report proposes a framework for evaluating the validity of informed consent and autonomy in face transplant candidates, taking into account the risk of depression and non-compliance. Traditional factors like decisional capacity, disclosure, comprehension, voluntariness, and agreement are insufficient for assessing valid informed consent in individuals whose self-worth relies on public perception, potentially leading to self-harm if societal worth is undermined. Reliance on self-esteem, rather than inherent personal value, poses risks of depression, poor treatment adherence, and deferential vulnerability. We suggest a qualitative analysis of self-worth, self-esteem, self-trust, and self-respect to better assess the autonomy of face transplant candidates in their decision-making process.
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Affiliation(s)
- Anneke Farías-Yapur
- Interdisciplinary Center for Bioethics, Universidad Panamericana, Mexico City, Mexico
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Berjaoui A, Chahine B. Body dysmorphic disorder among Lebanese females: A cross-sectional study. J Cosmet Dermatol 2024; 23:591-599. [PMID: 37743744 DOI: 10.1111/jocd.16003] [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: 05/19/2023] [Revised: 08/09/2023] [Accepted: 09/11/2023] [Indexed: 09/26/2023]
Abstract
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.
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Affiliation(s)
- Aya Berjaoui
- Lebanese International University, School of Pharmacy, Beirut, Lebanon
| | - Bahia Chahine
- Lebanese International University, School of Pharmacy, Beirut, Lebanon
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Jalalifar E, Arad A, Rastkar M, Beheshti R. The COVID-19 pandemic and obsessive-compulsive disorder: a systematic review of comparisons between males and females. Acta Neuropsychiatr 2023; 35:270-291. [PMID: 36861432 DOI: 10.1017/neu.2023.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
Coronavirus disease, one of the most disastrous epidemics, has caused a worldwide crisis, and the containment measures applied to decelerate the progression of the pandemic can increase the risk of obsessive-compulsive disorder (OCD). Identifying vulnerable groups in this area can lead us to better resource expenditure, and therefore, this systematic review aims to make a comparison between males and females to determine which of the two groups was most affected by the COVID-19 pandemic regarding OCD. Also, a meta-analysis was designed to investigate the prevalence of OCD during the COVID-19 pandemic. A comprehensive search was conducted among three databases (Medline, Scopus, Web of Science) until August 2021 which resulted in 197 articles, and 24 articles met our inclusion criteria. Overall, more than half of the articles stated the role of gender in OCD during the COVID-19 pandemic. Several articles emphasized the role of the female gender, and some others the role of the male gender. The meta-analysis revealed a 41.2% overall prevalence of OCD during the COVID pandemic and 47.1% and 39.1% OCD prevalence for female and male genders respectively. However, the difference between the two genders was not statistically significant. Generally, it seems that females are at greater risk of OCD during the COVID-19 pandemic. In the following groups, the female gender may have acted as a risk factor: under-18 years students, hospital staff, and the studies in the Middle East. In none of the categories, male gender was clearly identified as a risk factor.
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Affiliation(s)
- Erfan Jalalifar
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Amirreza Arad
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mohsen Rastkar
- Students' Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Rasa Beheshti
- Research Center for Evidence-Based Medicine, Iranian EBM Centre: A Joanna Briggs Institute Affiliated Group, Tabriz University of Medical Sciences, Tabriz, Iran
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Laving M, Foroni F, Ferrari M, Turner C, Yap K. The association between OCD and Shame: A systematic review and meta-analysis. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2023; 62:28-52. [PMID: 36300990 PMCID: PMC10091722 DOI: 10.1111/bjc.12392] [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: 06/01/2022] [Revised: 08/24/2022] [Accepted: 09/13/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Due to rumination and self-criticism over unwanted obsessions and repetitive rituals, shame is a common emotion experienced by individuals with obsessive-compulsive disorder (OCD). Shame is also theorized to have relevance to unacceptable thoughts in OCD. However, empirical research looking at the relationship between OCD and shame is still emerging and findings have been mixed. OBJECTIVES Our review systematically examines the association of shame with OCD and unacceptable thoughts. METHODS The last updated search was conducted across five databases between 27 and 29 February 2022. The final selection included 20 papers, 18 of which were used in the primary meta-analysis to calculate pooled effect sizes between OCD and shame measures using a random effects model. In a separate analysis, three papers were used to calculate pooled effect sizes between shame and OCD symptom dimensions also using a random effects model. RESULTS The meta-analyses identified a significant, moderate and positive correlation between total OCD and shame scores r = .352, 95% CI [0.260, 0.438]. In addition, significant, weak and positive relationships were found between shame and three OCD symptom dimensions: unacceptable thoughts r = .252, 95% CI [-0.467, 0.9708], harm obsessions r = .224, CI [-0.190, 0.638] and symmetry concerns r = .200, CI [-0.108, 0.509]. LIMITATIONS Shame measures in the reviewed studies were not specific to OCD, and between-study variance in the analyses examining unacceptable thoughts was significant. CONCLUSIONS Our findings support a medium positive relationship between shame and OCD. As shame in OCD can be a barrier to seeking treatment and impair quality of life, it is imperative to address this emotion through psychoeducation, assessment and treatment.
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Affiliation(s)
- Michelle Laving
- School of Behavioural and Health Sciences, Faculty of Health Sciences, Strathfield, New South Wales, Australia
| | - Francesco Foroni
- School of Behavioural and Health Sciences, Faculty of Health Sciences, Strathfield, New South Wales, Australia
| | - Madeleine Ferrari
- School of Behavioural and Health Sciences, Faculty of Health Sciences, Strathfield, New South Wales, Australia
| | | | - Keong Yap
- School of Behavioural and Health Sciences, Faculty of Health Sciences, Strathfield, New South Wales, Australia
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10
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Bernstein EE, Weingarden H, Greenberg JL, Williams J, Hoeppner SS, Snorrason I, Phillips KA, Harrison O, Wilhelm S. Credibility and expectancy of smartphone-based cognitive behavioral therapy among adults with body dysmorphic disorder. J Obsessive Compuls Relat Disord 2023; 36:100781. [PMID: 38313683 PMCID: PMC10835574 DOI: 10.1016/j.jocrd.2023.100781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Few patients receive cognitive behavioral therapy, the gold-standard for body dysmorphic disorder (CBT-BDD). Smartphones can make evidence-based interventions, like CBT-BDD, more accessible and scalable. A key question is: how do patients view it? Low credibility and expectancy would likely translate to low uptake and engagement outside of research settings, diminishing the impact. Thus, it is important to understand patients' beliefs about digital CBT-BDD. METHODS We compared credibility and expectancy in a coach-guided app-based CBT-BDD trial (N=75) to a previous in-person CBT-BDD trial (N = 55). We further examined the relationship of perceptions of digital CBT-BDD to baseline clinical and demographic factors and dropout. RESULTS Credibility did not differ between the in-person (M=19.3) and digital (M=18.3) trials, p=.24. Expectancy for improvement was moderately higher for in-person (M=58.4) than digital (M=48.3) treatment, p=.005. In the digital trial, no demographic variables were associated with credibility or expectancy. Better BDD-related insight and past non-CBT BDD therapy were associated with greater expectancy. Credibility was associated with lower likelihood of dropout. DISCUSSION Digital CBT-BDD was regarded as similarly credible to in-person CBT-BDD but with lower expectancy. Tailored expectancy-enhancing strategies could strengthen this novel approach, particularly among those with poorer insight and without prior BDD treatment.
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Affiliation(s)
| | | | | | | | | | | | - Katharine A. Phillips
- Rhode Island Hospital and Alpert Medical School of Brown University
- New York-Presbyterian Hospital and Weill Cornell Medical College
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Ritter V, Schüller J, Berkmann EM, von Soosten-Höllings-Lilge L, Stangier U. Efficacy of Cognitive Therapy for Body Dysmorphic Disorder: A Randomized Controlled Pilot Trial. Behav Ther 2023; 54:65-76. [PMID: 36608978 DOI: 10.1016/j.beth.2022.07.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 07/04/2022] [Accepted: 07/10/2022] [Indexed: 01/11/2023]
Abstract
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.
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12
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Benster LL, Weissman CR, Daskalakis ZJ. Suicidal Ideation and Obsessive-Compulsive Disorder: Links and Knowledge. Psychol Res Behav Manag 2022; 15:3793-3807. [PMID: 36573087 PMCID: PMC9789712 DOI: 10.2147/prbm.s368585] [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: 09/11/2022] [Accepted: 12/15/2022] [Indexed: 12/24/2022] Open
Abstract
Suicidal ideation (SI) is understudied in obsessive-compulsive disorder (OCD). Nonetheless, evidence suggests increased risk for SI in individuals with OCD compared to the general population. Understanding the relationship between SI and OCD involves investigating risk factors associated with SI. Furthering knowledge of links is essential for enhancing outcomes and decreasing experiences of SI through improving treatment interventions. Additionally, increasing awareness of factors that lead SI to suicide attempts (SA) is vital. To best illustrate the current state of knowledge, this scoping review examines risk factors for SI, including symptom profiles or phenotypes, comorbid diagnoses, sociodemographic and lifestyle factors, childhood trauma, and genetic and familial contributions. Important treatment considerations for targeting SI within the context of OCD are detailed with respect to the current evidence for psychotherapy, pharmacology, brain stimulation, and neurosurgery. Gaps in the literature and future directions are identified, broadly with respect to studies examining the treatment of SI within the context of OCD, particular OCD phenotypes, and factors influencing SI in pediatric OCD. Due to the relative novelty of this area of exploration, many unknowns persist regarding onset of SI in OCD, factors contributing to the maintenance of SI in OCD, and relevant treatment protocols. Findings suggest that individuals with previous SI or SA, history of childhood trauma, significant life stress, and psychiatric comorbidities, particularly depression, should be closely monitored and screened for SI.
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Affiliation(s)
- Lindsay L Benster
- Joint Doctoral Program in Clinical Psychology, SDSU/UC San Diego, San Diego, CA, USA,Correspondence: Lindsay L Benster, Joint Doctoral Program in Clinical Psychology, SDSU/UC San Diego, 6363 Alvarado Ct, San Diego, CA, 92120, USA, Tel +1206 230 0707, Email
| | - Cory R Weissman
- Department of Psychiatry, UC San Diego School of Medicine, San Diego, CA, USA
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13
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Linde J, Luoma JB, Rück C, Ramnerö J, Lundgren T. Acceptance and Compassion-Based Therapy Targeting Shame in Body Dysmorphic Disorder: A Multiple Baseline Study. Behav Modif 2022; 47:693-718. [PMID: 36373413 PMCID: PMC10150257 DOI: 10.1177/01454455221129989] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Shame is considered central in body dysmorphic disorder (BDD) and empirical accounts highlight the link between shame and BDD symptoms as well as common negative psychosocial effects of the disorder, yet there is a lack of interventions addressing shame in this context. In the past decade, Acceptance and commitment therapy (ACT) and interventions that foster self-compassion have shown promise for reducing the negative effects of shame in a range of clinical problems. The aim of the present study was to develop and evaluate an acceptance and compassion-based treatment specifically targeting shame in BDD. Using a randomized nonconcurrent multiple baseline design, the 12-session intervention, ACT with Compassion (ACTwC), was examined in a psychiatric outpatient sample of five adults diagnosed with BDD. The daily ratings showed marked reductions in BDD-behaviors and self-criticism at posttreatment for four of five participants, while three participants demonstrated decreases in body shame compared to baseline. Improvements were maintained at 6-months follow-up. The intervention also led to reliable long-term improvements in general shame, overall BDD-symptoms, depressive symptoms, and quality of life for four of five participants. All treatment responders showed significant gains in psychological flexibility and self-compassion. Participants reported high credibility and satisfaction with the treatment. These preliminary results suggest that ACTwC may be a promising approach to treating shame in BDD, worthy of further investigation.
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Affiliation(s)
- Johanna Linde
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Jason B. Luoma
- Portland Psychotherapy Clinic, Research, & Training Center, OR, USA
| | - Christian Rück
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Jonas Ramnerö
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Tobias Lundgren
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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Wilhelm S, Weingarden H, Greenberg JL, Hoeppner SS, Snorrason I, Bernstein EE, McCoy TH, Harrison OT. Efficacy of App-Based Cognitive Behavioral Therapy for Body Dysmorphic Disorder with Coach Support: Initial Randomized Controlled Clinical Trial. PSYCHOTHERAPY AND PSYCHOSOMATICS 2022; 91:277-285. [PMID: 35588706 PMCID: PMC9394457 DOI: 10.1159/000524628] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 04/10/2022] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Body dysmorphic disorder (BDD) is severe, chronic, and undertreated. Apps could substantially improve treatment access. OBJECTIVE We provide an initial test of the usability and efficacy of coach-supported app-based cognitive behavioral therapy (CBT) for BDD. The Perspectives app covers core treatment components: psychoeducation, cognitive restructuring, exposure with response prevention, mindfulness, attention retraining, and relapse prevention. METHODS A randomized waitlist-controlled trial was conducted. Adults (N = 80) with primary BDD were assigned to 12 weeks of Perspectives or waitlist. Coaches promoted engagement and answered questions via in-app messaging and phone calls. BDD severity was measured at baseline, mid-treatment, and end of treatment by blinded independent evaluators (Yale-Brown Obsessive Compulsive Scale Modified for BDD; BDD-YBOCS). Secondary outcomes included BDD-related insight, depression, quality of life, and functioning. RESULTS App uptake and satisfaction were high. In intent-to-treat analyses, Perspectives app-based CBT was associated with significantly lower BDD-YBOCS severity at end of treatment (M [SD]: 16.8 [7.5]) compared to the waitlist (26.7 [6.2]; p < 0.001, d = 1.44). App-based CBT was associated with greater improvements across all secondary measures, with medium to large effects. CONCLUSIONS Perspectives, supported by a bachelor's-level coach, is an efficacious, scalable treatment for adults with BDD.
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Affiliation(s)
- Sabine Wilhelm
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts, USA
| | - Hilary Weingarden
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts, USA
| | - Jennifer L Greenberg
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts, USA
| | - Susanne S Hoeppner
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts, USA
| | - Ivar Snorrason
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts, USA
| | - Emily E Bernstein
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts, USA,
| | - Thomas H McCoy
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts, USA
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15
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Sunavsky A, Moreau J, Tripp DA. Understanding Perceived Stress in Adolescent Inflammatory Bowel Disease. J Can Assoc Gastroenterol 2022; 5:79-85. [PMID: 35368321 PMCID: PMC8972323 DOI: 10.1093/jcag/gwab036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Accepted: 08/28/2021] [Indexed: 12/12/2022] Open
Abstract
Background Inflammatory bowel disease (IBD) is a chronic and debilitating illness associated with psychosocial comorbidities. Adolescents are vulnerable to the additive stress of managing IBD and navigating developmental milestones. Psychosocial factors, such as catastrophizing, illness stigma, illness uncertainty, and illness-related shame, often contribute to perceived stress in chronic illnesses. However, the combination of these variables on perceived stress in adolescents with IBD has not been examined. Methods Participants completed a cross-sectional online self-report survey. Model 4 of PROCESS Macro in SPSS was used to test the parallel mediation model of the relationship between disease severity and perceived stress using catastrophizing, stigma, uncertainty, and shame as mediators using 10,000 bootstrap samples. T-tests were run to assess systematic differences in the dependent variable between subjects. Results One hundred and thirty-one adolescents (Mage = 18.95 years; 100 females) completed the survey. Females had higher stress scores than males (P =0.002), and there were no difference in stress between younger and older participants (P = 0.085), location (P = 0.484), or IBD type (P = 0.515). The total effect of disease stress on perceived stress operating through the mediators was significant, b = 0.168, SE = 0.028, 95% CI [0.112, 0.224]. Helplessness catastrophizing, illness uncertainty, and illness-related shame, but not illness stigma, were equally strong, positive mediators. Conclusions The present results suggest that helplessness catastrophizing, illness uncertainty, and illness-related shame are central elements to target in stress interventions for adolescents with IBD.
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Affiliation(s)
- Adam Sunavsky
- Department of Psychology, Queen's University, Kingston, Ontario, Canada
| | - Julia Moreau
- Department of Psychology, Queen's University, Kingston, Ontario, Canada
| | - Dean A Tripp
- Departments of Psychology, Anesthesiology and Urology, Queen's University, Kingston, Ontario, Canada
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Alghamdi WA, Subki AH, Khatib HA, Butt NS, Alghamdi RA, Alsallum MS, Alharbi AA, Almatrafi MN, Alobisi AA, Al-Zaben F, Koenig HG. Body Dysmorphic Disorder Symptoms: Prevalence and Risk Factors in an Arab Middle Eastern Population. Int J Gen Med 2022; 15:2905-2912. [PMID: 35300125 PMCID: PMC8923679 DOI: 10.2147/ijgm.s329942] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Accepted: 12/29/2021] [Indexed: 11/23/2022] Open
Abstract
Background Methods Results Conclusion
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Affiliation(s)
- Waleed Ahmed Alghamdi
- Department of Psychiatry, King Abdulaziz University, Jeddah, Saudi Arabia
- Correspondence: Waleed Ahmed Alghamdi; Harold G Koenig, Email ;
| | - Ahmed Hussein Subki
- Department of Internal Medicine, King Faisal Specialist Hospital & Research center, Jeddah, Saudi Arabia
| | | | - Nadeem Shafique Butt
- Department of Community Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Rahaf Ali Alghamdi
- Department of Psychiatry, King Abdulaziz University, Jeddah, Saudi Arabia
| | | | - Ahmed A Alharbi
- Department of Psychiatry, King Abdulaziz University, Jeddah, Saudi Arabia
| | | | | | - Faten Al-Zaben
- Department of Psychiatry, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Harold G Koenig
- Department of Psychiatry, King Abdulaziz University, Jeddah, Saudi Arabia
- School of Public Health, Ningxia Medical University, Yinchuan, People’s Republic of China
- Duke University Medical Center, Durham, NC, USA
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Nikolić M, Hannigan LJ, Krebs G, Sterne A, Gregory AM, Eley TC. Aetiology of shame and its association with adolescent depression and anxiety: results from a prospective twin and sibling study. J Child Psychol Psychiatry 2022; 63:99-108. [PMID: 34132398 PMCID: PMC9292396 DOI: 10.1111/jcpp.13465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/24/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Shame is considered a maladaptive self-conscious emotion that commonly co-occurs alongside depression and anxiety. Little is known, however, about the aetiology of shame and its associations with depression and anxiety. We estimated, for the first time, genetic and environmental influences on shame and on its associations with depression and anxiety in adolescence. METHODS The sample was twin and sibling pairs from the Genesis 1219 Study (Time 1, N = 2,685; males 42.8%, Mage = 14.95, SD = 1.67, age range: 12-21; Time 2, N = 1618; males 39.7%, Mage = 16.97, SD = 1.64, age range: 14-23). Participants completed validated questionnaires to measure shame (at Time 1), depression and anxiety (at Times 1 and 2). RESULTS Shame was moderately to strongly associated with concurrent depression and anxiety. Prospectively, shame was significantly associated with an increase in depression, but not anxiety. Genetic analyses revealed that shame was moderately heritable with substantial nonshared environmental influence. The associations between shame and concurrent depression and anxiety were primarily accounted for by overlapping genetic influences. Prospectively, the association between shame and later depression was primarily accounted for by genetic and nonshared environmental influences shared with earlier depression. The unique association between shame and later depression was mostly explained by common nonshared environmental influences. CONCLUSIONS The findings offer novel evidence regarding aetiology of shame-although moderately heritable, shame in adolescents may also result from nonshared environmental factors. Genetic and nonshared environmental influences contribute to the co-occurrence of shame with depression and anxiety.
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Affiliation(s)
| | | | - Georgina Krebs
- King’s College LondonLondonUK,National and Specialist OCD and Related Disorders Clinic for Young PeopleSouth London and Maudsley NHS Foundation TrustLondonUK
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18
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The Prevalence of Adverse Childhood Experiences, Body Shame, and Revision Request Rate in 218 Plastic Surgery Patients: What Drives Postoperative Dissatisfaction? Plast Reconstr Surg 2021; 148:1233-1246. [PMID: 34644275 DOI: 10.1097/prs.0000000000008567] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND What drives patients who are unhappy despite good results? Adverse childhood experiences are common, can impair adult health, and can cause body shame. Neither adverse childhood experiences nor body shame has been studied in surgical patients. The authors report adverse childhood experience prevalences in a plastic surgical population and investigate associations from adverse childhood experiences to body shame and to postoperative dissatisfaction. METHODS Two hundred eighteen consecutive patients (86 percent aesthetic and 14 percent reconstructive) completed the Adverse Childhood Experiences Survey and the Experience of Shame Scale. A one-sample test of proportions, logistic regression, and mediation analysis assessed outcomes. RESULTS Compared to the Kaiser/Centers for Disease Control and Prevention medical population, our patients had higher overall adverse childhood experience prevalences (79.8 percent versus 64 percent), emotional abuse (41 percent versus 11 percent), emotional neglect (38 percent versus 15 percent), family substance abuse (36 percent versus 27 percent), and family mental illness (29 percent versus 19 percent, all p < 0.001). Fifty-two percent of our patients had body shame. Adverse Childhood Experiences score predicted body shame (OR, 1.22; p = 0.003). Compared to unshamed patients, body shame was associated with more adverse childhood experiences (85 percent versus 72 percent), higher median Adverse Childhood Experiences score (3.5 versus 2), more cosmetic operations (three versus zero), more health problems (three versus two), higher antidepressant use (39 percent versus 19 percent), substance abuse history (16 percent versus 5 percent), and demands for additional pain medication (18 percent versus 5 percent). Body shame predicted requests for surgical revision (49 percent versus 17 percent; OR, 4.61; all p ≤ 0.0001). CONCLUSIONS Adverse childhood experience were common in our patients. Adverse Childhood Experiences score predicted body shame, which predicted revision requests. If body shame preceded and drove surgery, revision requests were likely. Patients desiring revisions had recognizable characteristics. CLINICAL QUESTION/LEVEL OF EVIDENCE Risk, III.
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19
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Association of body dysmorphic disorder with anxiety, depression, and stress among university students. J Taibah Univ Med Sci 2021; 16:689-694. [PMID: 34690648 PMCID: PMC8498710 DOI: 10.1016/j.jtumed.2021.05.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 04/28/2021] [Accepted: 05/01/2021] [Indexed: 11/21/2022] Open
Abstract
Objectives This study aims to estimate the prevalence of body dysmorphic disorder (BDD) and identify its association with depression, anxiety, and stress. Method We conducted a cross-sectional study in Jeddah, KSA. In 2019, a validated questionnaire with items on sociodemographic characteristics and body dysmorphic disorder, as well as the Depression, Anxiety, and Stress Scale – 21 items (DASS 21) was distributed to 1,112 students of King Abdulaziz University. SPSS version 23 was used for data analysis, which included descriptive statistics, chi-square tests, and binary logistic regression models. The association was presented as an odds ratio (OR) along with its 95% confidence Interval (CI). Results The overall prevalence of BDD was 13.9% (95% CI of 11.8–16.2.) with the highest reported sites being the skin (81.6%) and waist (68.8%). BDD was found to be a significant predictor of depression with an OR of 4.2 (95% CI 2.9–6.1), anxiety OR of 2.2 (95%1.6–3.2), and stress OR of 3.2 (2.2–4.7). Females were significantly associated with anxiety, OR of 1.4 (95% CI 1.1–1.9) and stress, OR of 1.5 (1.1–2). Affiliation to the administration, arts, humanities, and social colleges was also a significant predictor of anxiety as reflected by an OR of 1.4 (95% CI 1.1–1.8). Conclusions Our study shows that BDD is relatively common among university students in Jeddah and associated with depression, anxiety, and stress. BDD is common among university students. Skin and Waist circumference were the most reported sites among students. BDD is a significant predictor of depression, anxiety, and stress affecting both male and female university student.
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Snorrason I, Beard C, Christensen K, Bjornsson AS, Björgvinsson T. Body Dysmorphic Disorder and Major Depressive Episode Have Comorbidity-Independent Associations With Suicidality in an Acute Psychiatric Setting. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2021; 19:490-495. [PMID: 35747305 PMCID: PMC9063574 DOI: 10.1176/appi.focus.19405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
(Appeared originally in Journal of Affective Disorders 2019; 259:266-270).
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Affiliation(s)
- Ivar Snorrason
- Department of Psychiatry, McLean Hospital, Belmont, MA, USA (Snorrason, Beard, Christensen, Björgvinsson); Department of Psychiatry, Harvard Medical School, Boston, MA, USA (Snorrason, Beard, Christensen, Björgvinsson); Department of Psychology, University of Iceland, Reykjavik, Iceland (Bjornsson)
| | - Courtney Beard
- Department of Psychiatry, McLean Hospital, Belmont, MA, USA (Snorrason, Beard, Christensen, Björgvinsson); Department of Psychiatry, Harvard Medical School, Boston, MA, USA (Snorrason, Beard, Christensen, Björgvinsson); Department of Psychology, University of Iceland, Reykjavik, Iceland (Bjornsson)
| | - Kirsten Christensen
- Department of Psychiatry, McLean Hospital, Belmont, MA, USA (Snorrason, Beard, Christensen, Björgvinsson); Department of Psychiatry, Harvard Medical School, Boston, MA, USA (Snorrason, Beard, Christensen, Björgvinsson); Department of Psychology, University of Iceland, Reykjavik, Iceland (Bjornsson)
| | - Andri S Bjornsson
- Department of Psychiatry, McLean Hospital, Belmont, MA, USA (Snorrason, Beard, Christensen, Björgvinsson); Department of Psychiatry, Harvard Medical School, Boston, MA, USA (Snorrason, Beard, Christensen, Björgvinsson); Department of Psychology, University of Iceland, Reykjavik, Iceland (Bjornsson)
| | - Thröstur Björgvinsson
- Department of Psychiatry, McLean Hospital, Belmont, MA, USA (Snorrason, Beard, Christensen, Björgvinsson); Department of Psychiatry, Harvard Medical School, Boston, MA, USA (Snorrason, Beard, Christensen, Björgvinsson); Department of Psychology, University of Iceland, Reykjavik, Iceland (Bjornsson)
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González-Rodríguez A, Seeman MV. Two Case Studies of Delusions Leading to Suicide, a Selective Review. Psychiatr Q 2020; 91:1061-1073. [PMID: 32761556 DOI: 10.1007/s11126-020-09802-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Many questions pertaining to delusional disorder (DD) remain unanswered. It is unclear what syndromes to include under this category of psychotic illness and when to treat with antidepressants, cognitive therapy, or antipsychotic medication. DD is associated with psychiatric comorbidity, especially depression, and rates of suicidal behavior are high when the two conditions co-exist. In this selective review, we present two instances of suicide in the context of DD, one illustrating risks for the somatic subtype and the second, risks for the persecutory subtype. The frequency of suicidal behaviour in these two subtypes of DD is estimated at 8-21%. The literature suggests a prominent role for social emotions (shame, humiliation) in the pathway leading to suicide. In addition, risk factors found in our two patients point to factors such as poverty, living alone, vulnerable risk periods, stigma, and lack of trust in mental health services. Building trust may be the most effective preventive measure.
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Affiliation(s)
- Alexandre González-Rodríguez
- Department of Mental Health, Parc Tauli University Hospital. I3PT. Autonomous University of Barcelona (UAB), Sabadell, Barcelona, Spain
| | - Mary V Seeman
- Department of Psychiatry, University of Toronto, 260 Heath Street West, Suite #605, Toronto, ON, M5P 3L6, Canada.
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Snorrason I, Beard C, Christensen K, Bjornsson AS, Björgvinsson T. Body dysmorphic disorder is associated with risk for suicidality and inpatient hospitalization: A replication study. Psychiatry Res 2020; 293:113478. [PMID: 33198049 DOI: 10.1016/j.psychres.2020.113478] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 09/21/2020] [Indexed: 11/24/2022]
Abstract
In a previous study, body dysmorphic disorder (BDD) was shown to have comorbidity-independent associations with suicidality among patients in a partial hospital program. Here, we replicated and extended this study in an independent cohort (N = 1612) from the same program using a different measure of suicidality. Semi-structured interviews were used to assess psychiatric diagnoses and suicide risk. We also documented inpatient hospitalization during treatment. BDD was associated with suicide risk and inpatient hospitalization even after adjusting for age, gender and other psychiatric disorders. The results suggest that BDD is associated with risk for suicidality and clinical deterioration in acute psychiatric settings.
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Affiliation(s)
- Ivar Snorrason
- Department of Psychiatry, McLean Hospital, Belmont, Massachusetts, USA; Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA.
| | - Courtney Beard
- Department of Psychiatry, McLean Hospital, Belmont, Massachusetts, USA; Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Kirsten Christensen
- Department of Psychiatry, McLean Hospital, Belmont, Massachusetts, USA; Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Thröstur Björgvinsson
- Department of Psychiatry, McLean Hospital, Belmont, Massachusetts, USA; Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
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Abstract
Body dysmorphic disorder and borderline personality disorder are common in esthetic practices and occur in up to 15% of patients. Operating on these patients may not only lead to dissatisfaction but may also worsen their premorbid condition and can induce negative behavior toward the practice. Preventing surgery and referring patients for cognitive therapy is essential. An adequate understanding of these conditions and the available screening tools is indispensable for all esthetic practitioners. Unrealistic emotional attribution to a facial shape, multiple procedures, a near-normal nose at the outset, childhood trauma, multiple comorbid mental conditions, and social dysfunction are red-flags to consider.
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Zhao J, Chi Y, Ju Y, Liu X, Wang J, Liu X, Lew B, Siau CS, Jia C. Shame and Suicidal Ideation among Undergraduates in China: The Mediating Effect of Thwarted Belongingness and Perceived Burdensomeness. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17072360. [PMID: 32244371 PMCID: PMC7178018 DOI: 10.3390/ijerph17072360] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 03/27/2020] [Indexed: 01/26/2023]
Abstract
Undergraduate students with shame are more likely to experience suicidal ideation, but there remains a lack of research investigating the factors underlying this relationship. The interpersonal theory of suicide posits that suicidal ideation is influenced by the simultaneous presence of thwarted belongingness and perceived burdensomeness. We examined the prevalence of suicidal ideation among undergraduate students in China and examined the association between shame and suicidal ideation mediated by perceived burdensomeness and thwarted belongingness. A survey was conducted in July 2018 involving 2320 undergraduate students, and the twelve-month prevalence of suicidal ideation was 8.95%. Shame played a crucial role in predicting suicidal ideation, and the mediating effects of perceived burdensomeness and thwarted belongingness between shame and suicidal ideation were significant. Suicidal ideation is common among undergraduate students in China and merits greater attention. Shame, perceived burdensomeness, and thwarted belongingness may be important factors to assess among undergraduate students in suicide risk assessment and psychological intervention.
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Affiliation(s)
- Jingjing Zhao
- School of Marxism, Shandong University, Jinan 250012, China
| | - Yanna Chi
- School of Public Health, Shandong University, Jinan 250012, China
| | - Yanli Ju
- School of Public Health, Shandong University, Jinan 250012, China
| | - Xiyao Liu
- School of Public Health, Shandong University, Jinan 250012, China
| | - Jingjing Wang
- School of Public Health, Shandong University, Jinan 250012, China
| | - Xinglai Liu
- School of Public Health, Shandong University, Jinan 250012, China
| | - Bob Lew
- Department of Social Psychology, Putra University of Malaysia, Serdang 43400, Selangor Malaysia
| | - Ching Sin Siau
- Faculty of Social Sciences and Liberal Arts, UCSI University, Kuala Lumpur 56000, Malaysia
| | - Cunxian Jia
- School of Public Health, Shandong University, Jinan 250012, China
- Correspondence: ; Tel.: +86-0531-8838-2141-8803
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Abstract
PURPOSE OF REVIEW Studies on the relations between shame and anxiety and obsessive-compulsive and related disorders (OCRDs) are reviewed, with a focus on recent work. RECENT FINDINGS Medium-sized positive correlations have been consistently found across anxiety disorders and OCRDs, suggesting that this relation is transdiagnostic. Most studies focused on shame-proneness and found similar relations across multiple types (e.g. internal, external) and domains (e.g. bodily, characterological, behavioural) of shame, with little variation between clinical and non-clinical populations and different age categories. However, most studies are cross-sectional and correlational and by separately studying clinical and non-clinical populations, they do not give a unitary dimensional view of the relation between shame and symptoms. Emerging findings suggest that shame may be a marker of the response to treatment in these disorders, and its relation with symptoms may be bidirectional. The consistent but medium-sized associations between shame and symptoms of anxiety and OCRDs warrant the future search for mediators and moderators.
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Affiliation(s)
- Aurora Szentágotai-Tătar
- Department of Clinical Psychology and Psychotherapy, Babeş-Bolyai University, Cluj-Napoca, Romania. .,The Institute for Research, Development and Innovation in Applied Natural Sciences, Babeş-Bolyai University, Cluj-Napoca, Romania.
| | - Diana-Mirela Nechita
- Department of Clinical Psychology and Psychotherapy, Babeş-Bolyai University, Cluj-Napoca, Romania.,International Institute for the Advanced Studies of Psychotherapy and Applied Mental Health, Babeş-Bolyai University, Cluj-Napoca, Romania
| | - Andrei C Miu
- Department of Psychology, Babeș-Bolyai University, Cluj-Napoca, Romania.,Cognitive Neuroscience Laboratory, Babeș-Bolyai University, Cluj-Napoca, Romania
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Albert U, De Ronchi D, Maina G, Pompili M. Suicide Risk in Obsessive-Compulsive Disorder and Exploration of Risk Factors: A Systematic Review. Curr Neuropharmacol 2020; 17:681-696. [PMID: 29929465 PMCID: PMC7059158 DOI: 10.2174/1570159x16666180620155941] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Revised: 05/16/2018] [Accepted: 06/20/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Historically, OCD has been considered to be associated with a relatively low risk of suicide. Recent studies, on the contrary, revealed a significant association between OCD and suicide attempts and ideation. A huge variation in prevalence rates, however, is reported. OBJECTIVE To estimate prevalence rates of suicide attempts and suicidal ideation in individuals with OCD, and to identify predictors of suicide risk among subjects with OCD. METHODS We systematically reviewed the literature on suicide risk (ideation and/or attempts) and OCD. We included studies with appropriate definition of OCD, cross-sectional or prospective design, separating clinical samples from epidemiological studies, that employed a quantitative measure of suicidality and/or reported an outcome measure of the association between suicidality and OCD or examined factors associated with suicidality. RESULTS In clinical samples, the mean rate of lifetime suicide attempts is 14.2% (31 studies: range 6- 51.7%). Suicidal ideation is referred by 26.3-73.5% of individuals (17 studies, mean 44.1%); current suicidal ideation rate ranges between 6.4 and 75% (13 studies, mean 25.9). Epidemiological studies found that OCD increases significantly the odds of having a lifetime suicidal ideation as compared to the general population (OR: 1.9-10.3) and a history of lifetime suicide attempts (OR: 1.6- 9.9). Predictors of greater suicide risk are severity of OCD, the symptom dimension of unacceptable thoughts, comorbid Axis I disorders, severity of comorbid depressive and anxiety symptoms, past history of suicidality and some emotion-cognitive factors such as alexithymia and hopelessness. CONCLUSION Overall, suicidality appears a relevant phenomenon in OCD.
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Affiliation(s)
- Umberto Albert
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Diana De Ronchi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Giuseppe Maina
- Rita Levi Montalcini Department of Neuroscience, University of Torino, Torino, Italy
| | - Maurizio Pompili
- Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Center, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
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AlShahwan MA. Prevalence and characteristics of body dysmorphic disorder in Arab dermatology patients. Saudi Med J 2020; 41:73-78. [PMID: 31915798 PMCID: PMC7001078 DOI: 10.15537/smj.2020.1.24784] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 11/24/2019] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To explore how prevalent body dysmorphic disorder (BDD) is among Arab dermatology patients and what characteristics of patients are associated with it. METHODS A total of 497 patients from the dermatology outpatient clinic at King Khalid University Hospital, Riyadh, Saudi Arabia, participated in this cross-sectional study conducted between October and December 2018. We asked the patients about their demographic and clinical characteristics, and then asked them to complete a dermatology-based self-report BDD questionnaire. Following this, we appointed 2 independent researchers to evaluate the dermatological flaws highlighted in the patient questionnaires and rate them using a severity scale. RESULTS Body dysmorphic disorder was found in 14.1% of Arab dermatology patients. There were significant links between female with BDD (odds ration [OR]: 2.93; 95% CI 1.24, 6.9]), having 2 or more skin conditions with BDD (OR: 4.67; 95% CI 1.33, 16.49) and having a certain skin condition such as hyperpigmentation with BDD (OR: 5.86; 95% CI 1.46, 23.61). The biggest BDD concerns were hyperpigmentation, acne, and hair loss. Conclusion: Body dysmorphic disorder was common among Arab dermatology patients, especially among women and those who have hyperpigmentation or more than one skin condition.
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Affiliation(s)
- Mohammed A AlShahwan
- Dermatology Department, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia. E-mail.
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Body dysmorphic disorder and major depressive episode have comorbidity-independent associations with suicidality in an acute psychiatric setting. J Affect Disord 2019; 259:266-270. [PMID: 31450136 DOI: 10.1016/j.jad.2019.08.059] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Revised: 08/08/2019] [Accepted: 08/18/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND This study sought to examine whether mood, anxiety, and obsessive-compulsive spectrum disorders have unique (comorbidity-independent) associations with suicidal thoughts and behaviors in an acute psychiatric population. METHODS Patients (N = 498) were evaluated during admission to a partial hospital. Semi-structured interviews were used to assess current psychiatric diagnoses and past-month suicidal ideation and suicidal behaviors (e.g., suicide attempts). RESULTS After adjusting for age, gender and other psychiatric disorders, body dysmorphic disorder (BDD) had a significant association with suicidal ideation (odds ratio [OR] = 6.62; 95% CI, 1.92-22.79) and suicidal behaviors (OR = 2.45; 95% CI, 1.05-5.71). Similarly, major depressive episode was associated with suicidal ideation (OR = 3.00; 95% CI, 1.95-4.63) and suicidal behaviors (OR = 2.11; 95% CI, 1.12-3.98). When unipolar and bipolar depression were analyzed separately, unipolar depression was associated with suicidal ideation (OR = 1.82; 95% CI, 1.20-2.74), but not suicidal behaviors, whereas, bipolar depression was associated with suicidal ideation (OR = 2.71; 95% CI, 1.36-5.40) and marginally with suicidal behaviors (OR = 2.02; 95% CI, 0.99-4.13). Anxiety disorders, obsessive-compulsive disorder, and posttraumatic stress disorder were unrelated to suicidality in this sample after controlling for comorbid disorders. LIMITATIONS Cross-sectional design and a relatively small sample for analyses of low base-rate conditions. CONCLUSIONS Major depressive episode and BDD are unique markers of suicidality in an acute psychiatric setting. BDD is a common but often underdiagnosed condition, and clinicians should be aware of high rates of suicidality among these patients.
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Sheehy K, Noureen A, Khaliq A, Dhingra K, Husain N, Pontin EE, Cawley R, Taylor PJ. An examination of the relationship between shame, guilt and self-harm: A systematic review and meta-analysis. Clin Psychol Rev 2019; 73:101779. [PMID: 31707184 PMCID: PMC6891258 DOI: 10.1016/j.cpr.2019.101779] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 07/12/2019] [Accepted: 09/14/2019] [Indexed: 01/29/2023]
Abstract
Self-harm is a major public health concern associated with suicide risk and significant psychological distress. Theories suggest that aversive emotional states are an important process that drives self-harm. Shame and guilt may, in particular, be important emotions in self-harm. This review therefore sought to provide a systematic review and meta-analysis of the relationship between shame, guilt, and self-harm. A systematic search of electronic databases (PsycINFO; Medline; CINAHL Plus; Web of Science and ProQuest) was undertaken to identify studies measuring shame, guilt and self-harm (including suicidal and non-suicidal behaviour). Meta-analysis was undertaken where papers focused on the same subtype of shame or guilt and shared a common outcome. Thirty studies were identified for inclusion. Most forms of shame were associated with non-suicidal self-injury (NSSI), but research was sparse concerning suicidal behaviour. Fewer studies examined guilt and findings were more varied. Methodological issues included a paucity of longitudinal designs and lack of justification for sample sizes. Results of this review support the link between shame and self-harm, particularly NSSI. The direction of this relationship is yet to be established. Clinically, consideration should be given to the role of shame amongst individuals who present with NSSI. This review was pre-registered on PROSPERO (CRD42017056165).
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Affiliation(s)
- Kate Sheehy
- Institute of Psychology, Health and Society, University of Liverpool, United Kingdom.
| | - Amna Noureen
- Pakistan Institute of Living & Learning, Karachi, Pakistan.
| | - Ayesha Khaliq
- Pakistan Institute of Living & Learning, Karachi, Pakistan.
| | - Katie Dhingra
- School of Social Sciences, Leeds Beckett University, LS1 3HE England, United Kingdom
| | - Nusrat Husain
- Division of Psychology & Mental Health, School of Health Sciences, University of Manchester, Manchester Academic Health Sciences Centre, Manchester, United Kingdom.
| | - Eleanor E Pontin
- Institute of Psychology, Health and Society, University of Liverpool, United Kingdom.
| | - Rosanne Cawley
- Institute of Psychology, Health and Society, University of Liverpool, United Kingdom.
| | - Peter J Taylor
- Division of Psychology & Mental Health, School of Health Sciences, University of Manchester, Manchester Academic Health Sciences Centre, Manchester, United Kingdom.
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30
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Del Casale A, Kotzalidis GD, Rapinesi C, Girardi P. Current Psychopharmacology of Obsessive-Compulsive Spectrum Disorders. Curr Neuropharmacol 2019; 17:668-671. [PMID: 31393238 PMCID: PMC7059163 DOI: 10.2174/1570159x1708190709144820] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Affiliation(s)
- Antonio Del Casale
- Department of Neuroscience, Mental Health, and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Sapienza University; Unit of Psychiatry, Sant'Andrea University Hospital, Rome, Italy
| | - Georgios D. Kotzalidis
- Department of Neuroscience, Mental Health, and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Sapienza University; Unit of Psychiatry, Sant'Andrea University Hospital, Rome, Italy
| | - Chiara Rapinesi
- Department of Neuroscience, Mental Health, and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Sapienza University; Unit of Psychiatry, Sant'Andrea University Hospital, Rome, Italy
| | - Paolo Girardi
- Department of Neuroscience, Mental Health, and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Sapienza University; Unit of Psychiatry, Sant'Andrea University Hospital, Rome, Italy
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31
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Body dysmorphic disorder and its relationship to sexuality, impulsivity, and addiction. Psychiatry Res 2019; 273:260-265. [PMID: 30658211 PMCID: PMC6420059 DOI: 10.1016/j.psychres.2019.01.036] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 12/13/2018] [Accepted: 01/10/2019] [Indexed: 01/22/2023]
Abstract
This study sought to examine the prevalence of probable body dysmorphic disorder (BDD) in a university sample and its associated physical and mental health correlates. A 156-item anonymous online survey was distributed via email to a randomly chosen subset of 10,000 university students, at a large public university. The survey queried current use of alcohol and drugs, psychological and physical status, academic performance, sexual behaviors, and questionnaire-based measures of impulsivity and compulsivity. A total of 3,459 participants (59.1% female) completed the survey and were included in the analysis. The overall prevalence of BDD was 1.7% (n = 59). Compared to students without BDD, those with BDD were significantly more likely to endorse symptoms of compulsive sexual behavior, depression, PTSD, and anxiety. Questionnaire-based measures revealed higher levels of both compulsivity and impulsivity associated with BDD. BDD appears to be common in young adults, and is associated with specific mental health comorbidities, as well as both impulsive and compulsive traits. Clinicians should be aware of the presentation of BDD and screen for it in primary care and mental health settings.
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The Role of Facial Gender Confirmation Surgery in the Treatment of Gender Dysphoria. J Craniofac Surg 2019; 30:1387-1392. [DOI: 10.1097/scs.0000000000005499] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Wilver NL, Summers BJ, Garratt GH, Carlton CN, Cougle JR. An initial investigation of the unique relationship between disgust propensity and body dysmorphic disorder. Psychiatry Res 2018; 269:237-243. [PMID: 30153602 DOI: 10.1016/j.psychres.2018.08.056] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 06/19/2018] [Accepted: 08/16/2018] [Indexed: 10/28/2022]
Abstract
Disgust is a universal emotion that has received recent empirical attention for its potential role in various forms of psychopathology. We conducted two studies using varying methods to explore the relationship between disgust propensity, a construct related to obsessive-compulsive symptomatology, and symptoms of body dysmorphic disorder (BDD). Study 1 found a significant and unique (i.e., above and beyond co-occurring depression and anxiety) relationship between higher disgust propensity and more severe BDD symptoms, as measured by a standardized self-report and via an in-vivo task aimed at eliciting BDD-related concerns (N = 200). In Study 2, a clinical sample of individuals with BDD (N = 50) reported higher disgust propensity compared to mentally healthy controls (N = 36). This finding remained significant when controlling for depression and anxiety. Findings are the first to our knowledge to demonstrate a relationship between disgust propensity and BDD symptoms and provide directions for future research exploring the role of disgust in BDD.
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Affiliation(s)
- Natalie L Wilver
- Department of Psychology, Florida State University, 1107 W. Call Street, Tallahassee, FL 32306, USA.
| | - Berta J Summers
- Department of Psychology, Florida State University, 1107 W. Call Street, Tallahassee, FL 32306, USA; Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, 185 Cambridge Street, Suite 2000, Boston, MA 02114, USA.
| | - Grace H Garratt
- Department of Psychology, Florida State University, 1107 W. Call Street, Tallahassee, FL 32306, USA.
| | - Corinne N Carlton
- Department of Psychology, Florida State University, 1107 W. Call Street, Tallahassee, FL 32306, USA.
| | - Jesse R Cougle
- Department of Psychology, Florida State University, 1107 W. Call Street, Tallahassee, FL 32306, USA.
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34
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Prevalence of bullying in a pediatric sample of body dysmorphic disorder. Compr Psychiatry 2018; 87:12-16. [PMID: 30193152 DOI: 10.1016/j.comppsych.2018.08.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 08/08/2018] [Accepted: 08/13/2018] [Indexed: 02/07/2023] Open
Abstract
Little is known about etiological factors in Body dysmorphic disorder (BDD). Cognitive behavioral and diathesis-stress models have implicated teasing and bullying as significant early environmental stressful triggers. Due to these implications, this study aimed to assess the emergence of BDD in children during early development, and to see if bullying experiences played a role in its development. A total of 219 children ages 7 to 10 were screened for psychopathology. Children were separated into four groups including a BDD group, an OCD group, a clinical control group (consisting of depressive disorders, attention deficit hyperactivity disorder, oppositional defiant disorder, and anxiety disorders not otherwise specified), and a non-clinical control group. Children were given questionnaires to evaluate their bullying and victimization experiences. It was hypothesized that children with BDD would experience more instances of victimization than children with OCD, clinical controls, and non-clinical controls. Contrary to the hypothesis, results indicated that children with BDD symptoms were significantly more likely to be perpetrators of bullying than the other groups [F (3, 27.082) = 17.892, p < .001]. In addition to scoring high on the bullying questionnaires, children with BDD scored high on victim questionnaires as well, suggesting a link between these two peer interpersonal conflicts. The results of this study suggest that bullying behavior might be an unknown characteristic in young children with emerging BDD pathology.
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Abstract
Shame is a distressing emotion experienced when individuals judge themselves in a broadly negative and critical manner. Clinical descriptions of body dysmorphic disorder (BDD) emphasize the centrality of shame, yet research on shame in BDD remains scarce. This study is the largest investigation of shame in clinically diagnosed individuals with BDD, and it is the first to examine whether shame changes with treatment. Eighty-three adults with BDD were treated with 14 weeks of open-label escitalopram. Shame was measured using the Young Schema Questionnaire-Short Form. Shame was significantly higher in individuals with BDD than in previously reported healthy control and psychiatric outpatient samples. Shame was significantly, moderately correlated with greater suicidal thoughts and hopelessness and marginally significantly correlated with greater BDD severity. Shame decreased significantly with treatment. Reductions in shame with escitalopram were significantly associated with reductions in suicidal thoughts and hopelessness, even when accounting for reductions in BDD and depression severity.
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36
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Hong K, Nezgovorova V, Uzunova G, Schlussel D, Hollander E. Pharmacological Treatment of Body Dysmorphic Disorder. Curr Neuropharmacol 2018; 17:697-702. [PMID: 29701157 PMCID: PMC7059151 DOI: 10.2174/1570159x16666180426153940] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 03/15/2018] [Accepted: 04/24/2018] [Indexed: 11/29/2022] Open
Abstract
Body dysmorphic disorder is a challenging disorder that manifests as erroneously perceived flaws in one’s physical appearance and repetitive behaviors in response to appearance concerns. This disorder is also frequently comorbid with other psychiatric disorders, including major depressive disorder and autism spectrum disorder. It is currently understood to arise from a combination of biological, psychological, and environmental factors. Treatment of body dysmorphic disorder typically consists of a combination of pharmacotherapy and cognitive behavioral therapy. However, not all patients respond to treatment, and BDD symptoms remain even in those who do respond. This review outlines current pharmacological and neuromodulation treatments for body dysmorphic disorder and suggests directions for future studies of novel treatments such as augmentation with atypical antipsychotics and the use of intranasal oxytocin in cases of body dysmorphic disorder that show residual symptomatology even with tailored monotherapy. There is emerging evidence suggesting that non-invasive neurostimulatory techniques, such as repetitive transcranial magnetic stimulation, may be of value in treatment-resistant cases.
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Affiliation(s)
- Kevin Hong
- Department of Psychiatry and Behavioral Sciences, Autism and Obsessive-Compulsive Spectrum Program, Anxiety and Depression Program, Albert Einstein College of Medicine, Montefiore Medical Center, NY, United States
| | - Vera Nezgovorova
- Department of Psychiatry and Behavioral Sciences, Autism and Obsessive-Compulsive Spectrum Program, Anxiety and Depression Program, Albert Einstein College of Medicine, Montefiore Medical Center, NY, United States
| | - Genoveva Uzunova
- Department of Psychiatry and Behavioral Sciences, Autism and Obsessive-Compulsive Spectrum Program, Anxiety and Depression Program, Albert Einstein College of Medicine, Montefiore Medical Center, NY, United States
| | - Danya Schlussel
- Department of Psychiatry and Behavioral Sciences, Autism and Obsessive-Compulsive Spectrum Program, Anxiety and Depression Program, Albert Einstein College of Medicine, Montefiore Medical Center, NY, United States
| | - Eric Hollander
- Department of Psychiatry and Behavioral Sciences, Autism and Obsessive-Compulsive Spectrum Program, Anxiety and Depression Program, Albert Einstein College of Medicine, Montefiore Medical Center, NY, United States
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Kealy D, Spidel A, Ogrodniczuk JS. Self-conscious emotions and suicidal ideation among women with and without history of childhood sexual abuse. COUNSELLING & PSYCHOTHERAPY RESEARCH 2017. [DOI: 10.1002/capr.12140] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- David Kealy
- Department of Psychiatry; University of British Columbia; Vancouver BC Canada
| | - Alicia Spidel
- Mental Health & Substance Use Services; Fraser Health Authority; White Rock BC Canada
| | - John S. Ogrodniczuk
- Department of Psychiatry; University of British Columbia; Vancouver BC Canada
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Weingarden H, Renshaw KD, Davidson E, Wilhelm S. Relative relationships of general shame and body shame with body dysmorphic phenomenology and psychosocial outcomes. J Obsessive Compuls Relat Disord 2017; 14:1-6. [PMID: 29057211 PMCID: PMC5648067 DOI: 10.1016/j.jocrd.2017.04.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Body Dysmorphic Disorder (BDD) is characterized by a preoccupation with a perceived flaw in appearance and repetitive avoidance behaviors. BDD involves severe psychosocial outcomes (e.g., depression, suicidality, functional impairment). Identifying correlates of BDD symptoms and outcomes can inform treatment. Shame, a painful emotion felt in response to critical self-judgment, may be one key correlate. However, research on shame in BDD is scarce and previous studies have not distinguished general shame from body shame. This study examines the relative relationships between body shame and general shame with body dysmorphic phenomenology and psychosocial outcomes. Participants (N = 184) were recruited online via BDD organizations and completed a survey. Path analysis was used to examine associations between body and general shame with 1) body dysmorphic phenomenology and 2) depression severity, suicide risk, and functional impairment. Both types of shame were differentially related to outcomes. Body shame was more strongly related to phenomenology, whereas general shame was more strongly related to psychosocial outcomes. Thus, it may be important for BDD treatment to focus on reducing both general and body shame. Further research should evaluate whether current treatments adequately address and reduce general and body shame, and whether addressing shame promotes better treatment outcomes.
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Affiliation(s)
- Hilary Weingarden
- Department of Psychiatry, Massachusetts General Hospital & Harvard Medical School, 185 Cambridge Street, Suite 2000, Boston, MA, USA, 02114
| | - Keith D Renshaw
- Department of Psychology, George Mason University, 4400 University Drive, Fairfax, VA, USA 22030
| | - Eliza Davidson
- Department of Psychiatry, Massachusetts General Hospital & Harvard Medical School, 185 Cambridge Street, Suite 2000, Boston, MA, USA, 02114
| | - Sabine Wilhelm
- Department of Psychiatry, Massachusetts General Hospital & Harvard Medical School, 185 Cambridge Street, Suite 2000, Boston, MA, USA, 02114
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Weingarden H, Curley EE, Renshaw KD, Wilhelm S. Patient-identified events implicated in the development of body dysmorphic disorder. Body Image 2017; 21:19-25. [PMID: 28285175 PMCID: PMC5440192 DOI: 10.1016/j.bodyim.2017.02.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Revised: 01/23/2017] [Accepted: 02/10/2017] [Indexed: 01/18/2023]
Abstract
Little is known about the causes of body dysmorphic disorder (BDD), but researchers have proposed a diathesis-stress model. This study uses a patient-centered approach to identify stressful events to which patients attribute the development of their BDD symptoms. An Internet-recruited sample of 165 adults with BDD participated. A large minority of participants attributed the development of their BDD to a triggering event. Bullying experiences were the most commonly described type of event. Additionally, most events were interpersonal and occurred during grade school or middle school. There were no differences in severity of psychosocial outcomes between participants who did or did not attribute their BDD to a specific triggering event. However, participants who specifically attributed their BDD development to a bullying experience had poorer psychosocial outcomes (i.e., perceived social support, depression severity, functional impairment, quality of life) compared to those who attributed their BDD development to another type of triggering event.
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Affiliation(s)
- Hilary Weingarden
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, 185 Cambridge Street, Suite 2000, Boston, MA 02114, United States.
| | - Erin E Curley
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, 185 Cambridge Street, Suite 2000, Boston, MA 02114, United States
| | - Keith D Renshaw
- Psychology Department, David King Hall, George Mason University, 4400 University Drive, Fairfax, VA 22030, United States
| | - Sabine Wilhelm
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, 185 Cambridge Street, Suite 2000, Boston, MA 02114, United States
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