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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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Hohenberger R, Baumann I, Riedel F, Plinkert PK, Bulut OC. Impact of Psychiatric Symptoms on Nasal Perception in Septorhinoplasty Patients. Facial Plast Surg 2024. [PMID: 38196074 DOI: 10.1055/a-2240-8943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2024] Open
Abstract
Psychological assessment plays a crucial role in the preoperative phase of septorhinoplasty (SRPL), exerting potential influence on both pre- and postoperative aspects of quality of life (QoL). In this prospective study, SRPL patients were systematically screened using two validated questionnaires for body dysmorphic disorder (BDD) and one each for anxiety, depression, and somatic symptom disorder (SSD). Nasal perception was evaluated utilizing two disease-specific, self-report instruments: The Rhinoplasty Outcomes Evaluation (ROE) and the Functional Rhinoplasty Outcome Inventory-17 (FROI-17). A total of 95 patients were enrolled. Positive screening rates were 40.4 and 28.3% for BDD, 37.3% for elevated anxiety, 16.4% for depression, and 22.4% for SSD. Mean scores on the ROE and FROI indicated lower QoL in all positive screening groups. Statistically significant differences were observed for anxiety (FROI total score: 47.1 ± 14.6 to 37.8 ± 16.2; p = 0.021) and BDD (ROE: 43.7 ± 15.7 to 32.5 ± 15.5; p = 0.003 and FROI total score: 47.4 ± 15.3 to 37.8 ± 17.1; p = 0.014). The Hospital Anxiety and Depression Scale exhibited a significant correlation with the preoperative FROI score (r = 0.34, p = 0.005). Patients with positive screenings for depression, anxiety, BDD, and SSD demonstrated compromised QoL during preoperative assessments compared with their negative counterparts, reflecting diminished nasal perception in both esthetic and functional dimensions. Surgeons must be cognizant of these psychological aspects during preoperative evaluations.
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Affiliation(s)
- Ralph Hohenberger
- Department of Otorhinolaryngology, Head and Neck Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Ingo Baumann
- Department of Otorhinolaryngology, Head and Neck Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | | | - Peter K Plinkert
- Department of Otorhinolaryngology, Head and Neck Surgery, Heidelberg University Hospital, Heidelberg, Germany
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Braren-von Stülpnagel C, Augustin M, Sommer R, Westphal L. Psychosocial Burden in People with Atopic Dermatitis: Effects of a Substance-Free Basic Skincare in a Randomized Health Care Study. Skin Pharmacol Physiol 2024; 36:296-301. [PMID: 38325354 DOI: 10.1159/000536671] [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: 08/17/2023] [Accepted: 02/01/2024] [Indexed: 02/09/2024]
Abstract
INTRODUCTION Atopic dermatitis (AD) is a physical, emotional, and social burden for patients. Most suffer from itching, pain, and dry skin as well as sleep disturbances, experienced stigmatization, anxiety, or depression. Therefore, it is important to consider the psychosocial well-being and also stigmatization in the treatment of people with AD. The aims of this study were to compare clinical and psychosocial parameters between patients with a different severity of AD and to analyse the effect of an omega-6-fatty-acid-skin therapy. METHODS Adult patients with clinically confirmed AD were asked about quality of life, stigmatization, and well-being after dermatological diagnosis. A second examination took place after 2-5 weeks. Meanwhile, after randomization, half of the patients used an omega-6-fatty-acid-skin therapy. RESULTS Seventy-nine patients were included in the study. The use of omega-6-fatty-acid-skin therapy resulted in a significant reduction in the severity of xerosis cutis compared to patients using another basic therapy. In addition, the health-related quality of life of all patients improved significantly in both groups (F = 7.56; p = 0.008), and no significant difference was found between the groups over time in the patient-reported outcomes. CONCLUSION Basic therapy for AD leads to relevant improvements in clinical status as well as quality of life. Patients using omega-6-fatty-acid-skin therapy experience greater improvement in xerosis cutis compared to free-choice basic therapy.
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Affiliation(s)
- Catharina Braren-von Stülpnagel
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Matthias Augustin
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Rachel Sommer
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Lukas Westphal
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
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Toh WL, Lam S, Mangano M, Rossell SL. Multidimensional Perfectionism and Facial Symmetry, Attractiveness and Approachability: Comparing Those With High Versus Low Dysmorphic Concerns. Psychol Rep 2023:332941231205274. [PMID: 37788829 DOI: 10.1177/00332941231205274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
Concerns pertaining to one's physical appearance or specific body parts is not uncommon in the community. Whether such dissatisfaction is related to superior (or inferior) face perception abilities, or interacts with related constructs, such as perfectionism, is unknown. The current study aimed to investigate whether multidimensional perfectionism (e.g. involving concern over mistakes or doubts over actions) and facial ratings differed in those with high versus low dysmorphic concerns (i.e. excessive preoccupation about perceived physical flaws). Respondents (N = 343) from the community took part in an online study, comprising questionnaires assessing dysmorphic concerns and perfectionism. They also completed a face perception task involving symmetry, attractiveness and approachability ratings for a series of faces, some of which had been digitally manipulated to yield differing degrees of symmetry. Respondents were divided into those with high (n = 147) versus low (n = 196) dysmorphic concerns. Group comparisons using analyses of variance were conducted. Those with high dysmorphic concerns exhibited significantly elevated overall perfectionism (as well as on facets involving concern over mistakes, personal standards, parental perceptions and doubts over actions). No significant group differences were uncovered for the face perception task, involving ratings of symmetry, attractiveness and approachability. Perfectionism differences existed in a non-clinical sample with high dysmorphic concerns, though further work is needed to elucidate consistent patterns regarding perfectionism facets. More research examining face perception deficits on the clinical end of the body image spectrum, such as in those with body dysmorphic disorder, as well as utilising alternate task versions involving self-referential stimuli, are recommended.
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Affiliation(s)
- Wei Lin Toh
- Centre for Mental Health and Brain Sciences, Swinburne University of Technology, Melbourne, VIC, Australia
- Department of Psychiatry, St Vincent's Hospital, Melbourne, VIC, Australia
- Department of Psychology, Alfred Hospital, Melbourne, VIC, Australia
| | - Sandy Lam
- Centre for Mental Health and Brain Sciences, Swinburne University of Technology, Melbourne, VIC, Australia
| | - Madeleine Mangano
- Centre for Mental Health and Brain Sciences, Swinburne University of Technology, Melbourne, VIC, Australia
| | - Susan L Rossell
- Centre for Mental Health and Brain Sciences, Swinburne University of Technology, Melbourne, VIC, Australia
- Department of Psychiatry, St Vincent's Hospital, Melbourne, VIC, Australia
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Matos M, Coimbra M, Ferreira C. When body dysmorphia symptomatology meets disordered eating: The role of shame and self-criticism. Appetite 2023; 186:106552. [PMID: 37024054 DOI: 10.1016/j.appet.2023.106552] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 02/06/2023] [Accepted: 03/31/2023] [Indexed: 04/08/2023]
Abstract
Body Dysmorphic Disorder (BDD) is a serious psychiatric condition that has long been identified as an important risk factor for the development of eating-related difficulties. However, little is known about the mechanisms that might explain this association. Therefore, the current study aimed to explore the link between body dysmorphic symptomatology and disordered eating, and test whether this relationship is mediated by higher levels of shame and self-criticism. This cross-sectional study included 291 women from the community, aged between 18 and 62 years old, who completed self-report measures. Path analysis revealed that BDD symptomatology has not only a direct effect on disordered eating, but also an indirect effect, mediated by shame and self-criticism. The path model revealed a very good fit, accounting for 38% and 31% of internal and external shames' variances, respectively, for 69% of self-criticism variance, and 58% of the variance of disordered eating. These findings seem to suggest that in women with BDD symptomatology, disordered eating may emerge as a compensatory strategy to cope with general feelings of inferiority/defectiveness, particularly in the presence of shame experiences and self-critical attitudes/behaviours. Moreover, this study emphasizes the importance to invest in innovative treatment and prevention approaches for BDD that specifically target shame and self-criticism, such as compassion-based therapies. LEVEL OF EVIDENCE: IV, cross-sectional study.
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Affiliation(s)
- Maria Matos
- University of Coimbra, Portugal; Faculty of Psychology and Educational Sciences of the University of Coimbra, Portugal
| | - Maria Coimbra
- CINEICC - Center for Research in Neuropsychology and Cognitive Behavioral Intervention, Portugal.
| | - Claudia Ferreira
- University of Coimbra, Portugal; CINEICC - Center for Research in Neuropsychology and Cognitive Behavioral Intervention, Portugal; Faculty of Psychology and Educational Sciences of the University of Coimbra, Portugal
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Pereira IN, Chattopadhyay R, Fitzpatrick S, Nguyen S, Hassan H. Evidence-based review: Screening body dysmorphic disorder in aesthetic clinical settings. J Cosmet Dermatol 2023. [PMID: 36847707 DOI: 10.1111/jocd.15685] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 10/26/2022] [Accepted: 02/02/2023] [Indexed: 03/01/2023]
Abstract
BACKGROUND Body dysmorphic disorder (BDD) is a psychiatric disturbance with high incidence in aesthetic clinical settings. Early recognition may avoid unnecessary elective procedures with ethical and medicolegal consequences. AIMS To identify validated BDD screening tools and critically appraise current literature regarding its implementation and efficacy in aesthetic medicine and surgery scenarios, with the purpose of transposing the findings to the broad clinical settings in the field. METHODS Data was collected using advanced search from PubMed (MEDLINE). Having satisfied the search parameters, 12 studies referring BDD definition according to Diagnostic and Statistical Manual of Mental Disorder (DSM-5) criteria and including a BDD screening tool in clinical aesthetic settings were selected. RESULTS While BDD screening enables the recognition of at-risk individuals, further work is required to uncover the best screening tool for general aesthetic clinical practice. Level III evidence favored BDD Questionnaire (BDDQ)/BDDQ-Dermatology Version (DV), and The Dysmorphic Concern Questionnaire (DCQ) among the limited available validated screening instruments to be used outside the psychiatric environment. Based on level II self-classification, one study selected BDDQ-Aesthetic Surgery (AS) version for rhinoplasty patients. The validation process of both BDDQ-AS and Cosmetic Procedure Screening Questionnaire (COPS) had limitations. For BDD screening potential in avoiding postoperative complications, the limited studies found evaluating the outcomes following aesthetic treatments using validated BDD screening measures showed a trend toward less satisfaction with aesthetic treatment outcome among positive screening population against non-BDD counterparts. CONCLUSION Further research is necessary to establish more effective methods to identify BDD and evaluate the impact of positive findings on aesthetic intervention outcomes. Future studies may elucidate which BDD characteristics best predict a favorable outcome and provide high-quality evidence for standardized protocols in research and clinical practice.
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Affiliation(s)
| | - Rashmi Chattopadhyay
- Barts & The London School of Medicine & Dentistry, Centre for Cutaneous Research, Blizard Institute of Cell and Molecular Science, Queen Mary University, London, UK
| | - Sean Fitzpatrick
- Barts & The London School of Medicine & Dentistry, Centre for Cutaneous Research, Blizard Institute of Cell and Molecular Science, Queen Mary University, London, UK
| | - Sheila Nguyen
- Barts & The London School of Medicine & Dentistry, Centre for Cutaneous Research, Blizard Institute of Cell and Molecular Science, Queen Mary University, London, UK
| | - Haidar Hassan
- Barts & The London School of Medicine & Dentistry, Centre for Cutaneous Research, Blizard Institute of Cell and Molecular Science, Queen Mary University, London, UK
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Schmidt J, Gallinat C, Martin A. Appearance-related concerns in individuals with pathological skin picking-a comparison with individuals with dermatological conditions and skin-healthy controls. Front Med (Lausanne) 2023; 10:1075743. [PMID: 37206477 PMCID: PMC10189119 DOI: 10.3389/fmed.2023.1075743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 04/04/2023] [Indexed: 05/21/2023] Open
Abstract
Introduction Pathological skin picking (PSP) is an excessive behavior which characterizes Skin Picking Disorder. Individuals repeatedly pick their skin and cause skin lesions, but are unable to control the behavior, which can cause severe distress. Visible self-inflicted skin lesions can additionally affect individuals with PSP due to emerging appearance-related concerns. However, these concerns and their role in PSP have hardly been studied, especially not in comparison with individuals with dermatological conditions and skin-healthy controls. Methods The present cross-sectional study (n = 453, 83.9% female, 15.9% male, 0.2% diverse) aimed at analyzing appearance-related concerns and mental health outcomes between four groups: Individuals with PSP and dermatological conditions (SP/DC; n = 83), PSP without dermatological conditions (SP; n = 56), dermatological conditions without PSP (DC; n = 176) and skin-healthy controls (SH, n = 138). We compared questionnaire data on dysmorphic concerns, appearance-based rejection sensitivity, and body dysmorphic symptoms, as well as PSP-symptoms and mental health outcomes (depression, anxiety, and self-esteem) between groups. Results The analyses showed a significant multivariate group effect in the appearance-related variables, F(6, 896) = 19.92, Wilks' Λ = 0.78, p < 0.001, and mental health outcomes, F(6, 896) = 16.24, Wilks' Λ = 0.81, p < 0.001. The SP/DC group had the strongest appearance-related concerns and mental health impairments, followed by the SP group, the DC group and the SH group. The SP/DC group and SP group only differed significantly with regard to dysmorphic concerns, but not in other variables. The DC group was less affected but still showed higher dysmorphic concerns and mental health impairments than skin-healthy controls. In contrast to the PSP groups, the other two groups did not exceed clinically relevant cut-off scores. Discussion The present study shows that individuals with PSP exhibit strong appearance-related concerns, regardless of the presence or absence of underlying or comorbid dermatological conditions. These findings shed new light on the importance of appearance-related concerns in Skin Picking Disorder and the role of PSP as a potentially overlooked risk factor in dermatological patients. Therefore, appearance-related concerns should be explicitly addressed in dermatological and psychotherapeutic settings. Future studies should also include longitudinal and experimental analyses to more clearly classify the role of appearance-related concerns in the etiology of PSP and Skin Picking Disorder.
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Affiliation(s)
- Jennifer Schmidt
- Münster Department of Health, FH Münster—University of Applied Sciences, Münster, Germany
- *Correspondence: Jennifer Schmidt,
| | - Christina Gallinat
- Center for Psychotherapy Research, University Hospital Heidelberg, Heidelberg, Germany
| | - Alexandra Martin
- Clinical Psychology and Psychotherapy, School of Human and Social Sciences, University of Wuppertal, Wuppertal, Germany
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Schoenenberg K, Martin A. Cognitive-affective reactions to a non-judgmental and judgmental mirror gazing task in individuals with body dysmorphic concerns. J Behav Ther Exp Psychiatry 2022; 77:101779. [PMID: 36113914 DOI: 10.1016/j.jbtep.2022.101779] [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: 09/20/2021] [Revised: 07/08/2022] [Accepted: 08/26/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND AND OBJECTIVES The look into the mirror represents a typical trigger situation for people with body dysmorphic concerns. Mirror exposure on the other hand is commonly used in the treatment of Body Dysmorphic Disorder even though little is known about its precise effects. This study aimed to investigate cognitive-affective processes related to mirror gazing. METHODS A total of 125 individuals (screening for body dysmorphic concerns: NBDD+ = 56, negative NBDD- = 69) participated in a laboratory study using a guided 10-min mirror gazing task. Participants were randomized to one of two experimental conditions, a non-judgmental and judgmental description of the own body during mirror gazing. Distress, self-hostile cognitions and post-event processing were assessed after the task and at follow-up. RESULTS Participants with body dysmorphic concerns showed higher values regarding subjective appearance distortion, stress induced by the exposure, distress, self-hostile cognitions and post-event processing compared to the symptom negative group. The two conditions did not yield differential effects. LIMITATIONS The short duration of the mirror gazing and the only internal description of the body may have contributed to a missing effect for the approach. CONCLUSIONS The results indicate the importance of cognitive and affective processes in reaction to mirror exposure. They support the cognitive model of BDD and suggest post-event processing as a relevant factor requiring further investigation in future research.
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Affiliation(s)
- Katrin Schoenenberg
- Department for Clinical Psychology and Psychotherapy, University Wuppertal, Germany.
| | - Alexandra Martin
- Department for Clinical Psychology and Psychotherapy, University Wuppertal, Germany
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da Silva N, Augustin M, Hilbring C, Braren-von Stülpnagel CC, Sommer R. Psychological (co)morbidity in patients with psoriasis: the impact of pruritus and anogenital involvement on symptoms of depression and anxiety and on body dysmorphic concerns - a cross-sectional study. BMJ Open 2022; 12:e055477. [PMID: 36153012 PMCID: PMC9511542 DOI: 10.1136/bmjopen-2021-055477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES While stress plays a paramount role on the onset/exacerbation of psoriasis, via overactivation of the hypothalamic-pituitary-adrenal axis and increased release of pro-inflammatory cytokines, cutaneous inflammatory response induces, in turn, anxiety/depression symptoms, via body disfigurement and stigmatisation. The intensity of pruritus and anogenital involvement are additional risk factors for psychological comorbidity.Aims were to (1) examine the effects of intensity of pruritus and anogenital psoriasis on disease burden and psychological comorbidity and (2) identify the variables associated with the presence of clinically significant depression, anxiety, and dysmorphic concerns. DESIGN Cross-sectional study. SETTING Conducted at the University Medical Center Hamburg-Eppendorf (UKE). PARTICIPANTS 107 patients with psoriasis (mean age = 46.3, SD = 14.6 years; 53.3% male): 64 with none/mild pruritus; 43 with moderate/severe pruritus; 31 with anogenital psoriasis; 76 not affected in the anogenital area. PRIMARY/SECONDARY OUTCOMES MEASURES Disease severity was assessed with Psoriasis Area and Severity Index and intensity of pruritus was rated by patients. Patient-reported outcomes included the Dermatology Life Quality Index, ItchyQoL, Patient Benefit Index, Perceived Stigmatisation Questionnaire, and Relationship and Sexuality Scale. Psychological morbidity was assessed with the Patient Health Questionnaire, Generalised Anxiety Disorder, and Dysmorphic Concern Questionnaire. RESULTS Patients with moderate/severe pruritus reported more quality of life impairments, depression, anxiety and dysmorphic concerns, and less treatment benefits than those with none/mild pruritus. Moderate/severe pruritus had a deleterious effect on depression and stigmatisation for patients without anogenital involvement. Less patient benefits were associated with a higher likelihood of clinically significant depression/anxiety. CONCLUSION Pruritus induces significant burden and psychological morbidity, particularly for patients without anogenital involvement. However, coping strategies used by patients with anogenital psoriasis might be dysfunctional for overall psychosocial adaptation. Patient-centred healthcare might be the best way to prevent psychological comorbidity. ETHICS APPROVAL Ethics Committee of the Medical Association of Hamburg (process number PV6083, 28 May 2019).
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Affiliation(s)
- Neuza da Silva
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Matthias Augustin
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Caroline Hilbring
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Catharina C Braren-von Stülpnagel
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Rachel Sommer
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
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Davies KL, Hanley SM, Bhullar N, Wootton BM. A psychometric validation of the Dysmorphic Concerns Questionnaire (DCQ) in adolescents and young adults. AUSTRALIAN PSYCHOLOGIST 2022. [DOI: 10.1080/00050067.2022.2093625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Affiliation(s)
- Katey L. Davies
- Discipline of Clinical Psychology, Graduate School of Health, University of Technology, Sydney, Australia
| | - Sarah M. Hanley
- School of Psychology, University of New England, Armidale, Australia
| | - Navjot Bhullar
- School of Psychology, University of New England, Armidale, Australia
- Discipline of Psychology, Edith Cowan University, Perth, Australia
| | - Bethany M. Wootton
- Discipline of Clinical Psychology, Graduate School of Health, University of Technology, Sydney, Australia
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Miller ML, Roche AI, Lemon E, O'Hara MW. Obsessive-compulsive and related disorder symptoms in the perinatal period: prevalence and associations with postpartum functioning. Arch Womens Ment Health 2022; 25:771-780. [PMID: 35614279 PMCID: PMC11131363 DOI: 10.1007/s00737-022-01239-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 05/16/2022] [Indexed: 11/02/2022]
Abstract
Obsessive-compulsive disorder (OCD) symptoms are more likely to develop or be exacerbated during pregnancy and the postpartum period, which can cause significant distress and impairment. However, the disorders grouped with OCD in the DSM-5, obsessive-compulsive and related disorders (OCRD; e.g., hoarding disorder (HD), body dysmorphic disorder (BDD), trichotillomania (TTM), excoriation disorder (ED)), have rarely been examined in the perinatal period. This study aimed to explore (1) the prevalence of all clinically significant OCRD symptoms in pregnancy and the postpartum period and (2) the correlations between OCRD psychopathology and postpartum functioning. Participants were recruited during their second trimester of pregnancy from a Midwestern medical center. Participants completed an online questionnaire and a semi-structured clinical interview during pregnancy (28-32 weeks' gestation, N = 276) and the postpartum period (6-8 weeks, N = 221). BDD and OCD symptoms were the most prevalent. In pregnancy, 14.9% (N = 41) of participants endorsed clinically significant BDD symptoms and 6.2% (N = 17) endorsed clinically significant OCD symptoms. In the postpartum period, 11.8% (N = 26) endorsed clinically significant BDD symptoms and 14% (N = 31) endorsed clinically significant OCD symptoms. Poorer postpartum functioning was associated with elevated OCRD symptoms in pregnancy and postpartum. OCRD symptoms occur during pregnancy and the postpartum period at rates similar or higher than other life periods. Elevated OCRD symptoms are associated with poorer postpartum functioning across domains. Future research should explore how all OCRD symptoms may affect functioning in the perinatal period, not only OCD symptoms.
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Affiliation(s)
- Michelle L Miller
- University of Iowa, Iowa City, USA.
- Indiana University School of Medicine/IU Health Physicians, Goodman Hall/IU Health Neuroscience Center, Suite 2800, 355 W. 16th St, Indianapolis, IN, 46202, USA.
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12
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Schut C, Dalgard FJ, Bewley A, Evers AWM, Gieler U, Lien L, Sampogna F, Ständer S, Tomas-Aragones L, Vulink N, Finlay AY, Legat FJ, Titeca G, Jemec GB, Misery L, Szabó C, Grivcheva-Panovska V, Spillekom-van Koulil S, Balieva F, Szepietowski JC, Reich A, Roque Ferreira B, Lvov A, Romanov D, Marron SE, Gracia-Cazaña T, Svensson Å, Altunay IK, Thompson A, Zeidler C, Kupfer J. Body dysmorphia in common skin diseases: Results of an observational, cross-sectional multi-centre study among dermatological out-patients in 17 European countries. Br J Dermatol 2022; 187:115-125. [PMID: 35041211 DOI: 10.1111/bjd.21021] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 12/20/2021] [Accepted: 01/15/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Body dysmorphic disorder (BDD) is a common psychiatric disorder associated with high costs for healthcare systems as patients may repeatedly ask for different, often not effective interventions. BDD symptoms are more prevalent in patients with dermatological conditions than the general population, but there are no large sample studies comparing the prevalence of BDD symptoms between patients with dermatological conditions and healthy skin controls. OBJECTIVES To compare the prevalence of BDD symptoms between patients with different dermatological conditions and healthy skin controls and to describe sociodemographic, physical and psychological factors associated with BDD symptoms to identify patients who may have a particularly high chance of having this condition. METHODS This observational cross-sectional, comparative multi-centre study included 8295 participants: 5487 consecutive patients with different skin diseases (56% female) recruited among dermatological out-patients at 22 clinics in 17 European countries and 2808 healthy skin controls (66% female). All patients were examined by a dermatologist. BDD symptoms were assessed by the Dysmorphic Concern Questionnaire (DCQ). Sociodemographic data, information on psychological factors and physical conditions were collected. Each patient was given a dermatological diagnosis according to ICD-10 by a dermatologist. RESULTS The participation rate of invited dermatological patients was 82.4% on average across all centres. BDD symptoms were five times more prevalent in patients with dermatological conditions than in healthy skin controls (10.5% vs. 2.1%). Patients with hyperhidrosis, alopecia and vitiligo had a more than eleven-fold increased chance (adjusted Odds Ratio (OR) > 11) of having BDD symptoms compared to healthy skin controls, and patients with atopic dermatitis, psoriasis, acne, hidradenitis suppurativa, prurigo and bullous diseases had a more than six-fold increased chance (adjusted OR > 6) of having BDD symptoms. Using a logistic regression model, BDD symptoms were significantly related to lower age, female sex, higher psychological stress and feelings of stigmatisation. CONCLUSIONS This study reveals that clinical BDD symptoms are significantly associated with common dermatological diseases. As such symptoms are associated with higher levels of psychological distress and multiple unhelpful consultations, general practitioners and dermatologists should consider BDD and refer patients when identified to an appropriate service for BDD screening and management.
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Affiliation(s)
- Christina Schut
- Institute of Medical Psychology, Justus-Liebig-University, Gießen, Germany
| | - Florence J Dalgard
- Division of Mental Health and Addiction, Vestfold Hospital Trust, Tønsberg, Norway.,Department of Dermatology and Venereology, Skåne University Hospital, Malmo, Sweden
| | - Anthony Bewley
- Barts Health NHS Trust & Queen Mary University of London, UK
| | - Andrea W M Evers
- Health, Medical and Neuropsychology Department, Leiden University, The Netherlands
| | | | - Lars Lien
- Faculty of Social and Health Sciences, Inland Norway University of Applied Sciences, Elverum, Norway.,Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Brumunddal, Norway
| | | | - Sonja Ständer
- Department of Dermatology and Centre for Chronic Pruritus, University Hospital Münster, Münster, Germany
| | - Lucia Tomas-Aragones
- Department of Psychology, University of Zaragoza, Spain.,Aragon Psychodermatology Research Group Zaragoza, Spain
| | - Nienke Vulink
- Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Andrew Y Finlay
- Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, UK
| | - Franz J Legat
- Department of Dermatology, Medical University of Graz, Graz, Austria
| | | | - Gregor B Jemec
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Laurent Misery
- Department of Dermatology, University Hospital of Brest, Brest, France
| | - Csanád Szabó
- Department of Dermatology and Allergology, University of Szeged, Hungary
| | - Vesna Grivcheva-Panovska
- University St. Cyril and Methodius, School of Medicine, PHI University Clinic of Dermatology Skopje, N. Macedonia
| | - Saskia Spillekom-van Koulil
- Radbout Institute for Health Sciences, Department of Medical Psychology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Flora Balieva
- Department of Dermatology, Stavanger University Hospital, Stavanger, Norway.,Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Jacek C Szepietowski
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Poland
| | - Adam Reich
- Department of Dermatology, Institute of Medical Sciences, Medical College of Rzeszow University, Poland
| | - Bárbara Roque Ferreira
- Centre for Philosophy of Science of the University of Lisbon, Portugal.,Department of Dermatology, Centre Hospitalier de Mouscron, Belgium.,University of Brest, Lien, France
| | - Andrey Lvov
- Central State Medical Academy of Department of Presidential Affairs, Moscow, Russia.,Medical Research and Educational Centre, Lomonosov Moscow State University, Moscow, Russia
| | - Dmitry Romanov
- Department of Psychiatry and Psychosomatics, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia.,Department of Boundary Mental Conditions and Psychosomatic Disorders, Mental Health Research Centre, Moscow, Russia.,Moscow Scientific and Practical Centre of Dermatology, Venereology and Cosmetology of Moscow City Health Department, Moscow, Russia
| | - S E Marron
- Aragon Psychodermatology Research Group Zaragoza, Spain.,Department of Dermatology, University Hospital Miguel Servet, Zaragoza, Spain
| | | | - Å Svensson
- Department of Dermatology, Skane University Hospital, Malmö, Sweden
| | - Ilknur K Altunay
- University of Health Sciences, Şişli Hamidiye Etfal Training and Research Hospital, Dermatology and Venereology Clinic, Istanbul, Turkey
| | - Andrew Thompson
- South Wales Clinical Psychology Training Programme, Cardiff & Vale University Health Board & School of Psychology, Cardiff University, Cardiff, UK
| | - Claudia Zeidler
- Department of Dermatology and Centre for Chronic Pruritus, University Hospital Münster, Münster, Germany
| | - Joerg Kupfer
- Institute of Medical Psychology, Justus-Liebig-University, Gießen, Germany
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13
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Toh WL, Mangano M, Lam S, Rossell SL. The contribution of multidimensional perfectionism and aesthetic sensitivity to the prediction of dysmorphic and symmetry concerns in a community sample. CURRENT RESEARCH IN BEHAVIORAL SCIENCES 2022. [DOI: 10.1016/j.crbeha.2022.100079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022] Open
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14
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Psychosocial issues and body dysmorphic disorder in aesthetics: Review and debate. Clin Dermatol 2022; 40:4-10. [DOI: 10.1016/j.clindermatol.2021.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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15
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Pikoos TD, Buzwell S, Sharp G, Rossell SL. The Zoom Effect: Exploring the Impact of Video Calling on Appearance Dissatisfaction and Interest in Aesthetic Treatment During the COVID-19 Pandemic. Aesthet Surg J 2021; 41:NP2066-NP2075. [PMID: 34146086 DOI: 10.1093/asj/sjab257] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The popularity of videoconferencing platforms has skyrocketed during the COVID-19 pandemic; however, concerns have been expressed regarding the potential for video calls to promote appearance dissatisfaction because individuals are exposed to an image of themselves on camera for extended periods. OBJECTIVES The aim of the current study was to characterize current video usage behaviors and their relation to appearance dissatisfaction and interest in aesthetic procedures in the general population. METHODS An online survey was completed by 335 adults currently living in Australia. Multiple aspects of video usage were assessed, including engagement in video-manipulation techniques to enhance appearance and the focus of visual attention (ie, on self or others) while on video calls. The Dysmorphic Concern Questionnaire was administered to determine if video-use behaviors were associated with greater body image disturbance. RESULTS Over one-third of participants had identified new appearance concerns while on video. Dysmorphic concern was associated with self-focused attention, greater engagement in video-manipulation behaviors, and increasing appearance concerns due to their time on video calls. Individuals who identified new video-based appearance concerns reported greater interest in obtaining future beauty treatments (eg, waxing) and aesthetic procedures (eg, nonsurgical procedures such as antiwrinkle injections). CONCLUSIONS This is one of first empirical studies to report the potential consequences of video-call usage for increasing appearance dissatisfaction and dysmorphic concern, and to demonstrate a link between the use of video calls and interest in cosmetic procedures.
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Affiliation(s)
- Toni D Pikoos
- Centre for Mental Health, Swinburne University of Technology, Melbourne, Australia
| | - Simone Buzwell
- Centre for Mental Health, Swinburne University of Technology, Melbourne, Australia
| | - Gemma Sharp
- Monash Alfred Psychiatry Research Centre, Melbourne, Australia
| | - Susan L Rossell
- Centre for Mental Health, Swinburne University of Technology, Melbourne, Australia
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16
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Personality functioning as a mediator of adult mental health following child maltreatment. J Affect Disord 2021; 291:126-134. [PMID: 34034217 DOI: 10.1016/j.jad.2021.05.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 05/02/2021] [Accepted: 05/05/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND The broad range of adverse health outcomes following child maltreatment (child maltreatment) underscores the need to investigate shared trajectories that contribute to associated physical and mental health problems. Previous research focused on different mechanisms, such as emotion regulation or attachment. In the present study, we propose personality functioning, comprising self- and interpersonal regulation and perception, to mediate between child maltreatment and mental and physical health. METHODS In a German representative sample (N = 2,508), we assessed remembered child maltreatment, levels of personality functioning, and different health outcomes in adulthood, namely somatic symptoms, general mental distress, and body dysmorphic concern. We conducted path analyses to investigate mediation effects in the total sample as well as in female and male subsamples. RESULTS Child maltreatment significantly predicted the assessed health outcomes and showed significant associations with lower levels of personality functioning. Personality functioning partially mediated all health outcomes assessed by significant indirect effects and lowered direct effects of child maltreatment on health outcomes. An exploratory analysis of different facets of personality functioning revealed a pronounced impact of identity perception and self-reflective capacities in mediating between child maltreatment and physical and mental health. Comparable results were found in female and male participants. LIMITATIONS Major limitations of the study are the reliance on cross-sectional data and the use of a screening measure to assess experienced child maltreatment. CONCLUSION Personality functioning may represent a transdiagnostic link to different somatic and psychological symptoms in the aftermath of child maltreatment.
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17
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Schmidt J, Martin A. Smartphone-Apps zur Verbesserung der Körperzufriedenheit? PSYCHOTHERAPEUT 2021. [DOI: 10.1007/s00278-021-00517-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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18
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Hater L, Schulte J, Geukes K, Buhlmann U, Back MD. Disentangling the contributions of agentic, antagonistic, and neurotic narcissism to drive for thinness and drive for muscularity. PLoS One 2021; 16:e0253187. [PMID: 34129626 PMCID: PMC8205145 DOI: 10.1371/journal.pone.0253187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 05/31/2021] [Indexed: 11/22/2022] Open
Abstract
Body image concerns revolving around body ideals (thin ideal, muscular ideal) are widespread among women. Whereas a stronger preoccupation with ideal physical appearance is often assumed for narcissistic women, previous empirical findings have been mixed. Following a tripartite structure of agentic, antagonistic, and neurotic narcissism facets, we reexamined whether trait narcissism predicted drive for thinness and drive for muscularity. We further explored the role of importance of appearance as a mediator and moderator of the relation between narcissism and body image concerns. Latent structural equation modeling was applied to self-report data from two independent nonclinical female samples (NSample1 = 224, NSample2 = 342). Results underlined the importance of distinguishing between narcissism facets: Neurotic (but not agentic or antagonistic) narcissism uniquely predicted drive for thinness and drive for muscularity. Importance of appearance mediated but did not robustly moderate these relations. Hence, neurotic narcissistic women (characterized by hypersensitivity, shame, and a fragile self-esteem) are particularly prone to body image concerns. This vulnerability seems partly driven by how much importance they ascribe to their appearance. Future work might build on these insights to further unravel the processes linking neurotic narcissism to body image concerns and how these can be targeted in practical interventions.
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Affiliation(s)
- Leonie Hater
- Institute of Psychology, University of Münster, Münster, Germany
| | - Johanna Schulte
- Institute of Psychology, University of Münster, Münster, Germany
| | - Katharina Geukes
- Institute of Psychology, University of Münster, Münster, Germany
| | - Ulrike Buhlmann
- Institute of Psychology, University of Münster, Münster, Germany
| | - Mitja D. Back
- Institute of Psychology, University of Münster, Münster, Germany
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19
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Sommer R, Augustin M, Hilbring C, Ständer S, Hubo M, Hutt H, Stülpnagel C, Silva N. Significance of chronic pruritus for intrapersonal burden and interpersonal experiences of stigmatization and sexuality in patients with psoriasis. J Eur Acad Dermatol Venereol 2021; 35:1553-1561. [DOI: 10.1111/jdv.17188] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 01/14/2021] [Indexed: 01/07/2023]
Affiliation(s)
- R. Sommer
- German Center for Health Services Research in Dermatology (CVderm) Institute for Health Services Research in Dermatology and Nursing (IVDP) University Medical Center Hamburg‐Eppendorf (UKE) Hamburg Germany
| | - M. Augustin
- German Center for Health Services Research in Dermatology (CVderm) Institute for Health Services Research in Dermatology and Nursing (IVDP) University Medical Center Hamburg‐Eppendorf (UKE) Hamburg Germany
| | - C. Hilbring
- German Center for Health Services Research in Dermatology (CVderm) Institute for Health Services Research in Dermatology and Nursing (IVDP) University Medical Center Hamburg‐Eppendorf (UKE) Hamburg Germany
| | - S. Ständer
- Kompetenzzentrum Chronischer PruritusUniversitätsklinikum Münster (UKM) Münster Germany
| | - M. Hubo
- LEO Pharma GmbH Neu‐Isenburg Germany
| | - H.J. Hutt
- LEO Pharma GmbH Neu‐Isenburg Germany
| | - C.C. Stülpnagel
- German Center for Health Services Research in Dermatology (CVderm) Institute for Health Services Research in Dermatology and Nursing (IVDP) University Medical Center Hamburg‐Eppendorf (UKE) Hamburg Germany
| | - N. Silva
- German Center for Health Services Research in Dermatology (CVderm) Institute for Health Services Research in Dermatology and Nursing (IVDP) University Medical Center Hamburg‐Eppendorf (UKE) Hamburg Germany
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20
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Rozzell KN, Carter C, Convertino AD, Gonzales M, Blashill AJ. The Dysmorphic Concern Questionnaire: Measurement invariance by gender and race/ethnicity among sexual minority adults. Body Image 2020; 35:201-206. [PMID: 33049457 DOI: 10.1016/j.bodyim.2020.08.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 08/22/2020] [Accepted: 08/25/2020] [Indexed: 11/26/2022]
Abstract
Sexual minority adults report heightened body image disturbances, and may be more likely to meet criteria for body dysmorphic disorder (BDD) than their heterosexual counterparts. Given the poor outcomes associated with BDD, it is important to validate measures assessing dysmorphic symptoms among this at-risk group. The Dysmorphic Concern Questionnaire (DCQ) is a seven-item self-report measure intended to assess dysmorphic symptoms. The present study investigated racial, ethnic, and gender measurement invariance properties of the DCQ in a racially and ethnically diverse sample of sexual minority adults. The current results lend initial support for use of the DCQ to potentially detect BDD symptoms among White, Black, Latino, and Asian sexual minority men and women. This may inform future studies that wish to utilize the DCQ, such as investigations of mean level differences in dysmorphic concern. These findings may have important clinical applications, given the heightened risk of appearance-related concerns among diverse sexual minority adults.
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Affiliation(s)
- Kaitlin N Rozzell
- Psychology Department, San Diego State University, San Diego, CA, United States
| | - Chelsea Carter
- Psychology Department, San Diego State University, San Diego, CA, United States
| | - Alexandra D Convertino
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, United States
| | - Manuel Gonzales
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, United States
| | - Aaron J Blashill
- Psychology Department, San Diego State University, San Diego, CA, United States; San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, United States.
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21
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Pikoos TD, Buzwell S, Sharp G, Rossell SL. The COVID-19 pandemic: Psychological and behavioral responses to the shutdown of the beauty industry. Int J Eat Disord 2020; 53:1993-2002. [PMID: 32936467 DOI: 10.1002/eat.23385] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 09/02/2020] [Accepted: 09/02/2020] [Indexed: 01/14/2023]
Abstract
OBJECTIVE During the COVID-19 pandemic, Australia implemented widespread closure of beauty and cosmetic services to control the virus spread. The effect of these restrictions is unknown, given that beauty services are widely used for stress relief or to enhance confidence. The current study explored the relationship between engagement in appearance-focused behaviors and distress regarding beauty service closure. Participants with high and low levels of dysmorphic concern were compared to determine whether COVID-19 restrictions may affect these groups differently. METHOD An online survey was completed by 216 participants living in Australia. Questions addressed engagement in appearance-focused behaviors during the COVID-19 pandemic and attitudes toward beauty service closure. The Dysmorphic Concern Questionnaire (DCQ) was used to group participants by low and high dysmorphic concern. RESULTS Appearance-focused behaviors decreased in the low DCQ group (n = 163) during the COVID-19 pandemic, while such behaviors in the high DCQ group (n = 53) remained unchanged. Individuals who were living alone, younger, reported higher dysmorphic concern and greater distress over beauty service closure engaged in more frequent appearance-focused behaviors (R2 = .57, p < .001). The high DCQ group reported greater distress over beauty service closure and increased desire to obtain future beauty treatments. DISCUSSION While COVID-19 restrictions may have provided a break from societal appearance pressure for those with low dysmorphic concern, appearance-focused behaviors persisted in individuals with high dysmorphic concern. A greater understanding of the long-term impacts on appearance-related distress is needed to determine mental health priorities emerging from the COVID-19 pandemic.
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Affiliation(s)
- Toni D Pikoos
- Centre for Mental Health, Swinburne University of Technology, Melbourne, Australia
| | - Simone Buzwell
- Centre for Mental Health, Swinburne University of Technology, Melbourne, Australia
| | - Gemma Sharp
- Monash Alfred Psychiatry Research Centre, Melbourne, Australia
| | - Susan L Rossell
- Centre for Mental Health, Swinburne University of Technology, Melbourne, Australia.,Department of Psychiatry, St Vincent's Hospital, Melbourne, Australia
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22
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Body Dysmorphic Disorder in the Perspective of the Alternative DSM-5 Model for Personality Disorder: A Study on Italian Community-Dwelling Women. J Nerv Ment Dis 2020; 208:974-981. [PMID: 32947452 DOI: 10.1097/nmd.0000000000001239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
To evaluate the relationships between body dysmorphic disorder (BDD) and Alternative DSM-5 Model for Personality Disorder (AMPD) criterion A and dysfunctional personality trait (i.e., criterion B) measures, 420 Italian community-dwelling women were administered three measures of BDD (i.e., the Body Dysmorphic Disorder Questionnaire, the Body Dysmorphic Disorder-Dimensional Scale, and the Appearance Anxiety Inventory), as well as the Level of Personality Functioning Scale-Brief Form (LPFS-BF) and the Personality Inventory for DSM-5-Short Form (PID-5-SF). The three BDD measures showed substantial convergent validity correlations and could be reliably cumulated to obtain the BDD Cumulative Index (BDDCI). Several significant, nonnegligible correlations were observed between the BDDCI as well as the LPFS-BF scale scores and PID-5-SF personality trait scale scores. Relative importance weight analysis results showed that LPFS-BF scale scores and PID-5-SF trait scale scores were substantial predictors of the BDDCI scores (R = 0.42, f = 0.72). In particular, AMPD criterion A impairment in self-functioning and AMPD criterion B depressivity, anhedonia, perseveration, separation insecurity, and cognitive and perceptual dysregulation were core components of the dysfunctional personality profile associated with BDD.
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23
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Arkenau R, Waldorf M, Cordes M, Vocks S. [The German-Language Version of the Muscle Dysmorphia Inventory: Evaluation of the Psychometric Properties in Male Samples]. Psychother Psychosom Med Psychol 2020; 71:42-48. [PMID: 32650348 DOI: 10.1055/a-1197-6068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
To assess central aspects of muscle dysmorphia, classified as a subtype of body dysmorphic disorder, the Muscle Dysmorphia Inventory (MDI) is available for the English-speaking areas. The aim of the present study was to evaluate the psychometric properties of the German-language version of the MDI. Therefore, male participants from two separate samples (sample 1: n=143; sample 2: n=71; N=214) completed a questionnaire battery, including the MDI. Using confirmatory factor analysis, the factor structure postulated by the authors of the English-language original version could not be replicated. However, the fit indices were broadly adequate when the model was altered based on the modification indices. The MDI subscales showed acceptable to excellent internal consistencies. The test-retest reliability of approximately 14 days was high. Significant positive correlations of the MDI subscales with other body image and psychopathology measures, and the weight-training frequency per week indicated good convergent and criterion validity. Furthermore, the MDI differentiated between subgroups of men with muscle dysmorphia, weight-training, and non-weight-training men. With the exception of the subscale Pharmacological Use (PU), which showed lower reliability and validity, and the insufficient model fit, the German-language version of the MDI generally displayed adequate psychometric properties. Hence, with restrictions concerning the subscale PU, the administration in clinical-psychological research and a psychotherapeutic context seems to be recommendable.
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Affiliation(s)
- Rike Arkenau
- Fachgebiet Klinische Psychologie und Psychotherapie, Universität Osnabrück
| | - Manuel Waldorf
- Fachgebiet Klinische Psychologie und Psychotherapie, Universität Osnabrück
| | - Martin Cordes
- Fachgebiet Klinische Psychologie und Psychotherapie, Universität Osnabrück
| | - Silja Vocks
- Fachgebiet Klinische Psychologie und Psychotherapie, Universität Osnabrück
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24
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Arkenau R, Vocks S, Taube CO, Waldorf M, Hartmann AS. The Body Image Matrix of Thinness and Muscularity—Male Bodies: Development and validation of a new figure rating scale for body image in men. J Clin Psychol 2020; 76:1283-1292. [DOI: 10.1002/jclp.22933] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Affiliation(s)
- Rike Arkenau
- Department of Clinical Psychology and Psychotherapy Osnabrück University Osnabrück Germany
| | - Silja Vocks
- Department of Clinical Psychology and Psychotherapy Osnabrück University Osnabrück Germany
| | - Christoph O. Taube
- Department of Clinical Psychology and Psychotherapy Osnabrück University Osnabrück Germany
| | - Manuel Waldorf
- Department of Clinical Psychology and Psychotherapy Osnabrück University Osnabrück Germany
| | - Andrea S. Hartmann
- Department of Clinical Psychology and Psychotherapy Osnabrück University Osnabrück Germany
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25
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Grünherz L, Wang A, Lindenblatt N. [Body Dysmorphic Disorder - Balance between Beauty Mania and Illness]. PRAXIS 2020; 109:499-503. [PMID: 32456576 DOI: 10.1024/1661-8157/a003463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Body Dysmorphic Disorder - Balance between Beauty Mania and Illness Abstract. The body dysmorphic disorder (BDD) belongs to the somatoform disorders and is characterized by an excessive concern about a slight or not apparent defect in appearance. Typical areas of concern include the face, for example the skin texture or form and symmetry of a particular feature. Besides behavioral pecularities such as excessive checking of the defect in a mirror, the preoccupation causes clinically significant distress and impairment in social functioning. Given a prevalence of up to 20 % among patients seeking plastic surgery, it is perhaps the most relevant psychiatric condition for plastic surgeons. Moreover, aesthetic treatments might even lead to a worsening of symptoms. Thus, we recommend close observation of all patients seeking aesthetic operations cautiously with regard to typical symptoms and behavior. Particular questions from well-known screening questionnaires might further help to identify patients with BDD.
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Affiliation(s)
- Lisanne Grünherz
- Klinik für Plastische Chirurgie und Handchirurgie, Universitätsspital Zürich
| | - Anna Wang
- Klinik für Plastische Chirurgie und Handchirurgie, Universitätsspital Zürich
| | - Nicole Lindenblatt
- Klinik für Plastische Chirurgie und Handchirurgie, Universitätsspital Zürich
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Johnson S, Egan SJ, Andersson G, Carlbring P, Shafran R, Wade TD. Internet-delivered cognitive behavioural therapy for perfectionism: Targeting dysmorphic concern. Body Image 2019; 30:44-55. [PMID: 31128427 DOI: 10.1016/j.bodyim.2019.05.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 05/04/2019] [Accepted: 05/04/2019] [Indexed: 02/06/2023]
Abstract
Perfectionism is an important transdiagnostic risk factor for several psychopathologies. As such, treatments targeting perfectionism have gained increased attention over recent years. While perfectionism is postulated to be an important underlying mechanism for dysmorphic concern, no research has explored the benefits of targeting perfectionism to reduce dysmorphic concern. The current study evaluated the use of Internet-delivered cognitive behavioural therapy for perfectionism (ICBT-P) with 31 participants (28 women) with high levels of dysmorphic concern to examine the impact on perfectionism, dysmorphic concern, body image disturbance, negative affect, and selective attention towards appearance-based stimuli. Using a case series design, observations were collected at baseline, at the end of a 4-week pre-treatment phase, after the 8-week ICBT-P, and 1-month post-treatment. Intent-to-treat analyses showed significant improvement from baseline to end-of-treatment and follow-up on most of the variables, with a large effect size decrease in dysmorphic concern, and decreased selective attention to BDD-body, BDD-positive, and BDD-negative words. The results of this study support the use of ICBT-P as an efficacious treatment worthy of further examination in populations who experience high levels of dysmorphic concern.
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Affiliation(s)
| | - Sarah J Egan
- School of Psychology and Speech Pathology, Curtin University, Perth, Australia
| | - Gerhard Andersson
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden; Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Per Carlbring
- Department of Psychology, Stockholm University, Stockholm, Sweden; Department of Psychology, University of Southern Denmark, Denmark
| | - Roz Shafran
- Institute of Child Health, University College of London, London, England, United Kingdom
| | - Tracey D Wade
- School of Psychology, Flinders University, Adelaide, Australia
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Abstract
Zusammenfassung. Eine Körperbildstörung ist ein Symptom unterschiedlicher psychischer Störungen. Im deutschen Sprachraum fehlt ein Instrument, das die Körperbildstörung transdiagnostisch, global und unter Einbezug des Ausmaßes des Leidens und der Beeinträchtigung erfasst. Der aus dem Englischen übersetzte Body Image Disturbance Questionnaire (BIDQ) wurde in mehreren Teilstudien zusammen mit inhaltlich verwandten Instrumenten bei erwachsenen Männern und Frauen eingesetzt ( N = 997). In einer Studie wurde der BIDQ erneut nach 4 Wochen von einem Anteil der Teilnehmenden ( n = 68) ausgefüllt. Die bestätigte einfaktorielle Struktur des BIDQ zeigte eine exzellente interne Konsistenz (α = .92) und kurzfristige Stabilität ( r = .89, p < .001). Er korrelierte signifikant mit spezifischen Körperbildkomponenten, körperbildassoziierter Psychopathologie und psychosozialem Wohlbefinden (BMI: .16 ≤ r ≤ .70; Essstörungspsychopathologie: alle p < .001). Der deutsche BIDQ erfasst erfolgreich transdiagnostisch die Schwere einer Körperbildstörung. Nach erwiesener Veränderungssensitivität kann er auch im Rahmen der Verlaufsdiagnostik bei der Behandlung unterschiedlicher psychischer Störungen eingesetzt werden.
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Schmidt J, Martin A. Appearance Teasing and Mental Health: Gender Differences and Mediation Effects of Appearance-Based Rejection Sensitivity and Dysmorphic Concerns. Front Psychol 2019; 10:579. [PMID: 30949099 PMCID: PMC6435521 DOI: 10.3389/fpsyg.2019.00579] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 03/01/2019] [Indexed: 01/03/2023] Open
Abstract
Appearance teasing is a common phenomenon in social interactions, especially in adolescence. Several studies have shown its negative impact on mental health as well as on body image. While these findings prove stable in various contexts, less evidence is available for possible gender differences in these relationships. In particular, the role of two important body image variables - appearance-based rejection sensitivity (ARS) and dysmorphic concerns - and their contribution to mental health impairments has not been assessed in gender-specific process models. In a cross-sectional survey-study (N = 501; 407 f, 94 m), we retrospectively assessed early appearance teasing experiences, as well as current ARS, dysmorphic concerns, depression, anxiety, and self-esteem. We analyzed gender differences in these variables and their interrelations. We then examined the mediating role of ARS and dysmorphic concerns in explaining mental health variables in adulthood due to early appearance teasing in gender-specific serial-mediation models. The results show high ratios of early teasing experiences, but no significant gender difference regarding the frequency of early appearance teasing. While teasing experiences were significantly related to body image variables in adulthood in both genders (rs > 0.32; ps < 0.010), we observed significant relations with mental health outcomes in women (rs > 0.30; ps < 0.001) but not in men (rs < 0.20; ps > 0.250). Serial mediation models show that ARS and dysmorphic concerns mediate the effects of appearance teasing on mental health in all outcomes in women (ΔR2 > 0.17), but not in men (ΔR2 < 0.03). Findings remained stable when controlling for Body-Mass-Index, age, and relationship-status. The findings show similar frequencies of appearance teasing and associated negative effects on body image in men and women. Specifically, in women, the effects of teasing on mental health were stronger and mediated by ARS and dysmorphic concerns. Overall, the results point to the relevance of ARS for etiological models of body image disorders and female mental health. However, men did not show the same relationships of teasing and mental health. Differential resilience factors regarding the negative effects of early appearance teasing could be an important target for future research.
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Affiliation(s)
- Jennifer Schmidt
- Clinical Psychology and Psychotherapy, School of Human and Social Sciences, University of Wuppertal, Wuppertal, Germany
- Department of Psychology, HSD Hochschule Döpfer University of Applied Sciences, Cologne, Germany
| | - Alexandra Martin
- Clinical Psychology and Psychotherapy, School of Human and Social Sciences, University of Wuppertal, Wuppertal, Germany
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Beilharz F, Phillipou A, Castle D, Jenkins Z, Cistullo L, Rossell S. Dysmorphic concern in anorexia nervosa: Implications for recovery. Psychiatry Res 2019; 273:657-661. [PMID: 31207849 DOI: 10.1016/j.psychres.2019.01.102] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 01/28/2019] [Accepted: 01/30/2019] [Indexed: 10/27/2022]
Abstract
Body image disturbance ('dysmorphic concern') is a key diagnostic criterion for anorexia nervosa (AN). While dysmorphic concern has been described as a relapse predictor, relatively little is understood about the prevalence in AN, and the consequences upon wellbeing. The present study examined the rates of dysmorphic concern in a sample of treatment-seeking adults with AN (N = 39), and explored the associations with general mental health, disability and eating disorder symptoms. The majority of participants (61.5%) had clinically significant levels of dysmorphic concern. Furthermore, higher dysmorphic concern scores were associated with increased symptoms of anxiety, depression and eating disorder symptomatology. There was also a trend towards associations between dysmorphic concern and age of onset and stages of change (pre-contemplation, contemplation, preparation, action, maintenance), although replication is required. These findings suggest that strategies which specifically address body image distortions should be a key feature of treatment for anorexia nervosa to support long-term recovery and wellbeing.
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Affiliation(s)
- Francesca Beilharz
- Centre for Mental Health, Swinburne University of Technology, Melbourne, VIC, Australia.
| | - Andrea Phillipou
- Centre for Mental Health, Swinburne University of Technology, Melbourne, VIC, Australia; Department of Psychiatry, St Vincent's Hospital, Melbourne, VIC, Australia; Department of Psychiatry, The University of Melbourne, Melbourne, VIC, Australia; Department of Mental Health, The Austin Hospital, Melbourne, VIC, Australia
| | - David Castle
- Department of Psychiatry, St Vincent's Hospital, Melbourne, VIC, Australia; Department of Psychiatry, The University of Melbourne, Melbourne, VIC, Australia
| | - Zoe Jenkins
- Department of Psychiatry, St Vincent's Hospital, Melbourne, VIC, Australia; Department of Psychiatry, The University of Melbourne, Melbourne, VIC, Australia
| | - Leonardo Cistullo
- Department of Psychiatry, St Vincent's Hospital, Melbourne, VIC, Australia
| | - Susan Rossell
- Centre for Mental Health, Swinburne University of Technology, Melbourne, VIC, Australia; Department of Psychiatry, St Vincent's Hospital, Melbourne, VIC, Australia
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Abstract
People with a body dysmorphic disorder (BDD) suffer from excessive preoccupation and anxiety about an imagined or to others a negligible defect in their appearance. They cannot bear to look at themselves, feel ugly, are convinced that their nose, their physique and their skin are disfiguring. The more concerned they become about their appearance, the more their attention is drawn to the ostensible blemishes and reinforces the impression of their own unattractiveness. Those affected do not consider themselves to be ill, but are convinced that it is a real physical defect which forces them again and again to stand in front of the mirror. Such patients may consult a dermatologist, some even a plastic surgeon, in order to get closer to their ideal of beauty, which perforce remains unattainable for patients because of a distorted perception of their body.
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Henn AT, Taube CO, Vocks S, Hartmann AS. Body Image as Well as Eating Disorder and Body Dysmorphic Disorder Symptoms in Heterosexual, Homosexual, and Bisexual Women. Front Psychiatry 2019; 10:531. [PMID: 31427996 PMCID: PMC6689822 DOI: 10.3389/fpsyt.2019.00531] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 07/08/2019] [Indexed: 12/26/2022] Open
Abstract
Body image disturbance is a core symptom of eating disorders (EDs) and body dysmorphic disorder (BDD). There is first evidence that females' body image differs depending on sexual orientation, with heterosexual women (HEW) appearing to show more body image disturbance symptoms than homosexual women (HOW). Such disparities might be moderated by everyday discrimination experiences and involvement with the lesbian community. However, to date, there has been no comprehensive assessment of a broad range of body image facets such as drive for thinness, leanness, and muscularity; body avoidance; body checking and body dissatisfaction; and ED and BDD pathology as well as moderating factors. Moreover, studies have often neglected bisexual women (BIW). A total of N = 617 women (n = 180 HOW, n = 322 HEW, n = 115 BIW) completed an online survey assessing the various facets of body image, ED and BDD pathology, discrimination experiences, and involvement with the lesbian community. Significant group differences were found regarding drive for leanness and thinness, body checking, investment behavior, and body ideal (all p<.05). BIW showed significantly more body checking than HOW. Compared to HEW, HOW reported a significantly lower drive for leanness and thinness as well as compared to HEW and BIW less investment behavior. HOW preferred a body ideal with significantly more body fat than did HEW (all p<.05). In contrast, no differences emerged in body dissatisfaction, drive for muscularity, body-related avoidance, ED and BDD pathology, and body image disturbance (all p>.05). In all groups, discrimination experiences were positively related to ED and BDD pathology and to body image disturbance (all p < .05); however, discrimination was significantly correlated with more body image facets in HEW than in HOW or BIW. Involvement with the lesbian community was positively correlated with a larger ideal body size in HOW (p < .05) and negatively correlated with drive for muscularity in BIW (p < .05). Despite the group differences in several body image facets, we found no consistent evidence of increased vulnerability to body image disturbance or associated pathology depending on sexual orientation. However, in HEW, discrimination experience might pose a risk factor for the development of body image-related pathology and single facets of body image disturbance.
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Affiliation(s)
- Alina T Henn
- Department of Clinical Psychology and Psychotherapy, Osnabrück University, Osnabrück, Germany
| | - Christoph O Taube
- Department of Clinical Psychology and Psychotherapy, Osnabrück University, Osnabrück, Germany
| | - Silja Vocks
- Department of Clinical Psychology and Psychotherapy, Osnabrück University, Osnabrück, Germany
| | - Andrea S Hartmann
- Department of Clinical Psychology and Psychotherapy, Osnabrück University, Osnabrück, Germany
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Pérez Rodríguez C, Judge RB, Castle D, Phillipou A. Body dysmorphia in dentistry and prosthodontics: A practice based study. J Dent 2018; 81:33-38. [PMID: 30579858 DOI: 10.1016/j.jdent.2018.12.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 12/10/2018] [Accepted: 12/12/2018] [Indexed: 11/27/2022] Open
Abstract
The prevalence of Body Dysmorphic Disorder (BDD) and dysmorphic concern in dentistry and prosthodontics have not been properly assessed, yet the mouth and the teeth are amongst the top preoccupation for these individuals. OBJECTIVES To evaluate the prevalence of dysmorphic symptoms and BDD using validated tools in patients presenting to general and specialist prosthodontic practice. METHODS Patients were recruited by two prosthodontics practices and three general dentist practices. Patients were given a Dysmorphic Concern Questionnaire (DCQ) integrated into a medical history form. Treating clinicians also completed a Baseline Rating Form assessing the patients´ reason for presentation. Two DCQ score cut-offs were used (9 and 12). RESULTS Two hundred and thirteen patients were recruited, the majority of patients showed DCQ scores below 9 (84%). The prevalence of BDD was 7% (cut-off ≥ 9) or 4% (cut-off ≥12). Women were more likely to present with high DCQ scores as well as people with a history of mental health problems. The cosmetic practice, the implant clinic, and the prosthodontic practice received a higher proportion of patients with high DCQ scores when compared with the general family practice. The type of procedure was not related to DCQ scores. The defect severity assessment and whether this was amenable to correction was moderately correlated with DCQ scores. CONCLUSIONS The DCQ seems to be a suitable tool to be used by dentists as part of history taking and patient examination due to its brevity, simplicity and the good sensitivity/specificity reported in the literature. CLINICAL SIGNIFICANCE Identifying patients with dysmorphia is important before irreversible treatment is carried out due to high levels of dissatisfaction, poor patient centred outcomes and the question of whether these individuals have the capacity to consent.
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Affiliation(s)
- Carolina Pérez Rodríguez
- Melbourne Dental School, The University of Melbourne, Melbourne, 720 Swanston Street, Carlton, VIC, 3010, Australia.
| | - Roy B Judge
- Melbourne Dental School, The University of Melbourne, Melbourne, 720 Swanston Street, Carlton, VIC, 3010, Australia.
| | - David Castle
- St Vincent's Hospital and The University of Melbourne, St Vincent´s Mental Health Research Unit. 46 Nicholson St, Fitzroy VIC 3065, Australia.
| | - Andrea Phillipou
- Centre for Mental Health, Swinburne University of Technology, Hawthorn VIC 3122, Australia.
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Enander J, Ivanov VZ, Mataix-Cols D, Kuja-Halkola R, Ljótsson B, Lundström S, Pérez-Vigil A, Monzani B, Lichtenstein P, Rück C. Prevalence and heritability of body dysmorphic symptoms in adolescents and young adults: a population-based nationwide twin study. Psychol Med 2018; 48:2740-2747. [PMID: 29486813 PMCID: PMC6236441 DOI: 10.1017/s0033291718000375] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 01/21/2018] [Accepted: 01/30/2018] [Indexed: 11/15/2022]
Abstract
BACKGROUND Body dysmorphic disorder (BDD) usually begins during adolescence but little is known about the prevalence, etiology, and patterns of comorbidity in this age group. We investigated the prevalence of BDD symptoms in adolescents and young adults. We also report on the relative importance of genetic and environmental influences on BDD symptoms, and the risk for co-existing psychopathology. METHODS Prevalence of BDD symptoms was determined by a validated cut-off on the Dysmorphic Concerns Questionnaire (DCQ) in three population-based twin cohorts at ages 15 (n = 6968), 18 (n = 3738), and 20-28 (n = 4671). Heritability analysis was performed using univariate model-fitting for the DCQ. The risk for co-existing psychopathology was expressed as odds ratios (OR). RESULTS The prevalence of clinically significant BDD symptoms was estimated to be between 1 and 2% in the different cohorts, with a significantly higher prevalence in females (1.3-3.3%) than in males (0.2-0.6%). The heritability of body dysmorphic concerns was estimated to be 49% (95% CI 38-54%) at age 15, 39% (95% CI 30-46) at age 18, and 37% (95% CI 29-42) at ages 20-28, with the remaining variance being due to non-shared environment. ORs for co-existing neuropsychiatric and alcohol-related problems ranged from 2.3 to 13.2. CONCLUSIONS Clinically significant BDD symptoms are relatively common in adolescence and young adulthood, particularly in females. The low occurrence of BDD symptoms in adolescent boys may indicate sex differences in age of onset and/or etiological mechanisms. BDD symptoms are moderately heritable in young people and associated with an increased risk for co-existing neuropsychiatric and alcohol-related problems.
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Affiliation(s)
- Jesper Enander
- Department of Clinical Neuroscience, Karolinska Institutet, Centre for Psychiatry Research, Stockholm, Sweden
- Stockholm Health Care Services, Stockholm County Council
| | - Volen Z. Ivanov
- Department of Clinical Neuroscience, Karolinska Institutet, Centre for Psychiatry Research, Stockholm, Sweden
- Stockholm Health Care Services, Stockholm County Council
| | - David Mataix-Cols
- Department of Clinical Neuroscience, Karolinska Institutet, Centre for Psychiatry Research, Stockholm, Sweden
- Stockholm Health Care Services, Stockholm County Council
| | - Ralf Kuja-Halkola
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Brjánn Ljótsson
- Department of Clinical Neuroscience, Karolinska Institutet, Centre for Psychiatry Research, Stockholm, Sweden
| | - Sebastian Lundström
- Centre for Ethics Law and Mental Health, University of Gothenburg, Gothenburg, Sweden
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - Ana Pérez-Vigil
- Department of Clinical Neuroscience, Karolinska Institutet, Centre for Psychiatry Research, Stockholm, Sweden
| | - Benedetta Monzani
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Paul Lichtenstein
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Christian Rück
- Department of Clinical Neuroscience, Karolinska Institutet, Centre for Psychiatry Research, Stockholm, Sweden
- Stockholm Health Care Services, Stockholm County Council
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Parameters of visual processing abnormalities in adults with body image concerns. PLoS One 2018; 13:e0207585. [PMID: 30475860 PMCID: PMC6261110 DOI: 10.1371/journal.pone.0207585] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Accepted: 11/03/2018] [Indexed: 11/24/2022] Open
Abstract
Body dysmorphic disorder (BDD), at the extreme end of the body image concern (BIC) spectrum, is thought to be associated with a local (detail-focussed) visual processing bias. Given that the inversion of a stimulus disrupts holistic processing and demands detail-specific attention, this perceptual bias is characterised by superior processing of such inverted stimuli. This study examined the processing bias, via a body-inversion discrimination task, of 26 participants with non-clinical, high-BIC (Dysmophic Concern Questionnaire (DCQ) scores between 11–19) and 26 participants with low-BIC (DCQ scores between 0–4). This study also explored the impact of varying stimuli presentation durations and discrimination difficulties during the inversion task on visual processing. As hypothesised, compared to those with low-BIC, participants with high-BIC demonstrated superior accuracy when discriminating between images of inverted bodies, indicating a local processing bias. Also as hypothesised, this local processing bias selectively manifested only when stimuli were presented for longer durations and at higher discrimination difficulties, revealing the parameters of this, potentially conscious, processing tendency. Consistent with previous research, this study identified a local processing bias in those with high BIC, which may be a predisposing factor for developing BDD. In turn, identifying the parameters (stimulus exposure and stimulus complexity) in which the local bias manifests has implications for future interventions aiming to reverse this perceptual abnormality.
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Schieber K, Kollei I, de Zwaan M, Martin A. The Dysmorphic Concern Questionnaire in the German General Population: Psychometric Properties and Normative Data. Aesthetic Plast Surg 2018; 42:1412-1420. [PMID: 29946895 DOI: 10.1007/s00266-018-1183-1] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 06/13/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND The Dysmorphic Concern Questionnaire (DCQ) is a widely used screening instrument assessing dysmorphic concerns ranging from a mild to an excessive level. It is often used in the setting of plastic and aesthetic surgery. The present study aimed at examining the psychometric properties of the DCQ in a random general population sample. METHODS A representative sample of the German general population (N = 2053, aged between 18 and 65 years, 54% females) completed the DCQ as well as questionnaires on depression and appearance concerns. RESULTS The DCQ showed a good internal consistency with Cronbach's α = 0.81. Its one-factor model structure was confirmed. Normative data were stratified according to gender and age. Women reported more dysmorphic concerns than men, but also within females the DCQ scores differed between age classes. Overall, 4.0% of the sample reported excessive dysmorphic concerns based on a previously defined cutoff sum score ≥ 11. CONCLUSION The DCQ is a valid and reliable screening tool to identify individuals with excessive dysmorphic concerns. Excessive concerns may indicate also the presence of body dysmorphic disorder, but for verifying a final diagnosis the use of a structured clinical interview is necessary. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Scar satisfaction and body image in thyroidectomy patients: prospective study in a tertiary referral centre. The Journal of Laryngology & Otology 2017; 132:60-67. [DOI: 10.1017/s0022215117002158] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractBackground:This study is the first to evaluate scar satisfaction and body image in thyroidectomy patients using validated assessment tools.Methods:A total of 123 thyroidectomy patients were recruited over 8 months. Both patients and clinicians completed assessment tools that included: the Manchester Scar Scale (to measure scar perception), Dysmorphic Concern Questionnaire (to assess body image), Body Dysmorphic Concern Questionnaire (to screen for body dysmorphic disorder) and EQ-5D (to measure life quality). A separate image panel comprising experts and non-experts assessed 15 scar photographs. The results were analysed using non-parametric descriptive statistics.Results:Poor body image was associated with poor scar perception (ρ = 0.178,p= 0.05). Poor life quality correlated with poor scar perception (ρ = −0.292,p= 0.001). Scar length did not affect scar perception. Prevalence of body dysmorphic disorder among patients was found to be 8.94 per cent, which is higher than general population rates.Conclusion:Negative body image and life quality impact negatively upon scar perception.
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Erratum zu: Diagnostik der Körperbildstörung. PSYCHOTHERAPEUT 2017. [DOI: 10.1007/s00278-017-0231-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Schmidt J, Martin A. Du magst mich nicht, weil ich hässlich bin! ZEITSCHRIFT FUR KLINISCHE PSYCHOLOGIE UND PSYCHOTHERAPIE 2017. [DOI: 10.1026/1616-3443/a000433] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Zusammenfassung. Theoretischer Hintergrund: Viele Personen befürchten Zurückweisungen aufgrund ihres Aussehens. Übermäßige „aussehensbezogene Zurückweisungssensitivität“ (ARS) kann jedoch zur Entstehung und Aufrechterhaltung von – insbesondere körperfokussierter – Psychopathologie beitragen. Fragestellung: ARS ist im deutschsprachigen Raum wenig untersucht, da Erhebungsinstrumente fehlen. Daher war die Validierung einer deutschen „Appearance-based-Rejection-Sensitivity-Scale“ (ARS-D; Park, 2007 ) Ziel der Studie. Methode: Nach Übersetzung des englischen Originals wurde die psychometrische Güte der ARS-D in einer Online-Befragung getestet (n = 391). Ermittelt wurden Itemcharakteristika, Faktorstruktur, Reliabilität und Konstruktvalidität. Ergebnisse: Die ARS-D zeigte bei einfaktorieller Struktur sehr gute Reliabilitätsindizes. Die psychometrischen Eigenschaften ließen sich bei einer auf 12 Items gekürzten Skalenvariante (Original: 15 Items) weiter verbessern. Signifikante Korrelationen mit körperdysmorpher Besorgnis, Essstörungssymptomatik und Depressivität (rs > .30) indizieren Konstruktvalidität. Schlussfolgerungen: Die ARS-D ist zur Erfassung und weiteren Erforschung der Rolle aussehensbezogener Zurückweisungssensitivität bei verschiedenen Störungsbildern geeignet.
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Affiliation(s)
- Jennifer Schmidt
- Klinische Psychologie und Psychotherapie, Bergische Universität Wuppertal
| | - Alexandra Martin
- Klinische Psychologie und Psychotherapie, Bergische Universität Wuppertal
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Senín-Calderón C, Valdés-Díaz M, Benítez-Hernández MM, Núñez-Gaitán MC, Perona-Garcelán S, Martínez-Cervantes R, Rodríguez-Testal JF. Validation of Spanish Language Evaluation Instruments for Body Dysmorphic Disorder and the Dysmorphic Concern Construct. Front Psychol 2017; 8:1107. [PMID: 28713311 PMCID: PMC5492913 DOI: 10.3389/fpsyg.2017.01107] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 06/15/2017] [Indexed: 11/17/2022] Open
Abstract
Dysmorphic concern (DC) refers to excessive preoccupation with a slight or imagined defect in physical appearance with social avoidance and behavior directed at controlling the defect in appearance. This study attempted to adapt the factor structure of two instruments that cover the DC construct, the Dysmorphic Concern Questionnaire (DCQ) and the Body Dysmorphic Disorder Examination Self-Report (BDDE-SR), to Spanish and establish their psychometric properties. A total of 920 subjects (62.7% women, Mage = 32.44 years) participated. Exploratory and Confirmatory Factor Analysis of both scales found adequate goodness of fit indices. A one-dimensional structure was found for the DCQ and two first-order factors (dissatisfaction/preoccupation with body image (BI) and BI avoidance behavior) were identified for the BDDE-SR. The psychometric test–retest reliability and validity properties (content, convergent, and discriminant) were satisfactory. It is suggested that the DC construct includes both cognitive and behavioral aspects and may represent a continuum of severity with Body Dysmorphic Disorder at the end.
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Affiliation(s)
| | - María Valdés-Díaz
- Personality, Evaluation and Psychological Treatment Department, University of SevilleSeville, Spain
| | - Ma M Benítez-Hernández
- Personality, Evaluation and Psychological Treatment Department, University of SevilleSeville, Spain
| | - Ma C Núñez-Gaitán
- Personality, Evaluation and Psychological Treatment Department, University of SevilleSeville, Spain
| | - Salvador Perona-Garcelán
- Personality, Evaluation and Psychological Treatment Department, University of SevilleSeville, Spain.,Virgen del Rocío Outpatient Mental Hospital, Andalusian Health-CareSeville, Spain
| | | | - Juan F Rodríguez-Testal
- Personality, Evaluation and Psychological Treatment Department, University of SevilleSeville, Spain
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Steinfeld B, Bauer A, Waldorf M, Hartmann AS, Vocks S. Diagnostik der Körperbildstörung. PSYCHOTHERAPEUT 2017. [DOI: 10.1007/s00278-017-0188-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Ritter V, Fluhr JW, Schliemann-Willers S, Elsner P, Strauß B, Stangier U. Body dysmorphic concerns, social adaptation, and motivation for psychotherapeutic support in dermatological outpatients. J Dtsch Dermatol Ges 2016; 14:901-8. [PMID: 27607031 DOI: 10.1111/ddg.12908] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND OBJECTIVES Dermatologists are increasingly confronted with patients affected by body dysmorphic disorder (BDD). BDD is characterized by excessive preoccupation with one or more perceived defect(s) or flaw(s) in physical appearance which are not observable or appear slight to others. So far, there have been only few studies examining the prevalence of BDD in dermatological outpatients. In addition, the need for psychotherapeutic support in dermatological outpatients with body dysmorphic concerns has not yet been systematically examined. The objective of the present study was therefore to investigate the frequency of body dysmorphic concerns as well as social adaptation and the need for psychotherapeutic support in the aforementioned patient group. PATIENTS AND METHODS A total of 252 dermatological outpatients seen at a German university hospital were consecutively enrolled, and examined using the Dysmorphic Concerns Questionnaire, the Social Adaptation Self-Evaluation Scale, and the German version of the University of Rhode Island Change Assessment Scale. RESULTS 7.9 % of all outpatients (unselected sample) showed positive test results, suggesting clinically relevant body dysmorphic concerns. Patients with clinically relevant body dysmorphic concerns exhibited poor social adaptation. Contrary to expectations, these patients revealed a high motivation for change, indicating the necessity for psychotherapeutic support. CONCLUSIONS Our findings confirm previous prevalence rates of BDD in dermatological outpatients, and highlight the need for providing psychotherapeutic support to dermatological patients.
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Affiliation(s)
- Viktoria Ritter
- Institute for Psychology, Clinical Psychology and Psychotherapy, Goethe University, Frankfurt am Main, Germany.
| | - Joachim W Fluhr
- Department of Dermatology and Allergology, Charité - University Medicine, Berlin, Germany.,Department of Dermatology and Allergology, University Hospital, Jena, Germany
| | | | - Peter Elsner
- Department of Dermatology and Allergology, University Hospital, Jena, Germany
| | - Bernhard Strauß
- Institute for Psychosocial Medicine and Psychotherapy, University Hospital, Jena, Germany
| | - Ulrich Stangier
- Institute for Psychology, Clinical Psychology and Psychotherapy, Goethe University, Frankfurt am Main, Germany
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Ritter V, Fluhr JW, Schliemann-Willers S, Elsner P, Strauß B, Stangier U. Körperdysmorphe Symptome, soziale Anpassung und Motivation zu psychotherapeutischer Beratung bei ambulanten dermatologischen Patienten. J Dtsch Dermatol Ges 2016; 14:901-9. [DOI: 10.1111/ddg.12908_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Viktoria Ritter
- Institut für Psychologie, Klinische Psychologie und Psychotherapie; Goethe-Universität Frankfurt am Main
| | - Joachim W. Fluhr
- Klinik für Dermatologie und Allergologie; Charité - Universitätsmedizin Berlin
- Klinik für Dermatologie und Allergologie; Universitätsklinikum Jena
| | | | - Peter Elsner
- Klinik für Dermatologie und Allergologie; Universitätsklinikum Jena
| | - Bernhard Strauß
- Institut für Psychosoziale Medizin und Psychotherapie; Universitätsklinikum Jena
| | - Ulrich Stangier
- Institut für Psychologie, Klinische Psychologie und Psychotherapie; Goethe-Universität Frankfurt am Main
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Body dysmorphic disorder in different settings: A systematic review and estimated weighted prevalence. Body Image 2016; 18:168-86. [PMID: 27498379 DOI: 10.1016/j.bodyim.2016.07.003] [Citation(s) in RCA: 168] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2015] [Revised: 06/30/2016] [Accepted: 07/18/2016] [Indexed: 11/24/2022]
Abstract
Our aim was to systematically review the prevalence of body dysmorphic disorder (BDD) in a variety of settings. Weighted prevalence estimate and 95% confidence intervals in each study were calculated. The weighted prevalence of BDD in adults in the community was estimated to be 1.9%; in adolescents 2.2%; in student populations 3.3%; in adult psychiatric inpatients 7.4%; in adolescent psychiatric inpatients 7.4%; in adult psychiatric outpatients 5.8%; in general cosmetic surgery 13.2%; in rhinoplasty surgery 20.1%; in orthognathic surgery 11.2%; in orthodontics/cosmetic dentistry settings 5.2%; in dermatology outpatients 11.3%; in cosmetic dermatology outpatients 9.2%; and in acne dermatology clinics 11.1%. Women outnumbered men in the majority of settings but not in cosmetic or dermatological settings. BDD is common in some psychiatric and cosmetic settings but is poorly identified.
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Facial discrimination in body dysmorphic, obsessive-compulsive and social anxiety disorders. Psychiatry Res 2016; 236:105-111. [PMID: 26774187 DOI: 10.1016/j.psychres.2015.12.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Revised: 11/24/2015] [Accepted: 12/15/2015] [Indexed: 11/23/2022]
Abstract
Body dysmorphic disorder (BDD) is characterized by preoccupation with perceived flaws in one's own appearance. Several risk factors such as aesthetic perceptual sensitivity have been proposed to explain BDD's unique symptomatology. Although research on facial discrimination is limited so far, the few existing studies have produced mixed results. Thus, the purpose of this study was to further examine facial discrimination in BDD. We administered a facial discrimination paradigm, which allows to assess the ability to identify slight to strong facial changes (e.g., hair loss, acne) when presented with an original (unmodified) facial image, relative to a changed (modified) facial image. The experiment was administered in individuals with BDD, social anxiety disorder, obsessive-compulsive disorder, and mentally healthy controls (32 per group, respectively). Overall, groups did not differ with respect to their ability to correctly identify facial aberrations when presented with other people's faces. Our findings do not support the hypothesis of enhanced general aesthetic perceptual sensitivity in individuals with (vs. without) BDD.
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Woolley AJ, Perry JD. Body dysmorphic disorder: prevalence and outcomes in an oculofacial plastic surgery practice. Am J Ophthalmol 2015; 159:1058-1064.e1. [PMID: 25728858 DOI: 10.1016/j.ajo.2015.02.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Revised: 02/19/2015] [Accepted: 02/24/2015] [Indexed: 11/17/2022]
Abstract
PURPOSE To determine the prevalence, associated factors, and surgical outcomes of patients with body dysmorphic disorder in an oculofacial surgery practice. DESIGN Retrospective cross-sectional analysis of a consecutive case series. METHODS Participants consisted of a consecutive series of 728 patients who completed the Dysmorphic Concern Questionnaire in an oculofacial surgery practice at The Cole Eye Institute between November 2013 and June 2014. A questionnaire score ≥9 was used as a positive screen for body dysmorphic disorder. Three control patients scoring ≤8 in the same month were randomly selected for each positive-screening patient. Main outcome measures included number of reoperations, surgical complications, and follow-up visits; preoperative and postoperative pain scores; and the technician word count. Categorical variables were analyzed with Pearson χ(2) tests or Fisher exact tests, while continuous variables were analyzed with Wilcoxon rank sum tests or t tests. RESULTS A total of 728 patients completed the questionnaire and 50 (6.9%) scored 9 or more. Using a confidence interval of 95%, patients in the positive questionnaire screen group were younger (P = .004), had more eyelid surgeries (P = .007), experienced higher rates of complications after surgery (P = .002), reported higher postoperative pain scores (P = .034), required more reoperations (P = .050), and had a higher technician word count compared to the control group (P = .003). CONCLUSIONS The prevalence of body dysmorphic disorder in an oculofacial surgical setting matches reports from other surgical specialties, and is significantly higher than in the general population. Patients screening positively for body dysmorphic disorder tend to have higher postoperative pain scores and more postoperative complications.
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Affiliation(s)
- Austin J Woolley
- Cole Eye Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Julian D Perry
- Cole Eye Institute, Cleveland Clinic Foundation, Cleveland, Ohio.
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Schieber K, Kollei I, de Zwaan M, Martin A. Classification of body dysmorphic disorder - what is the advantage of the new DSM-5 criteria? J Psychosom Res 2015; 78:223-7. [PMID: 25595027 DOI: 10.1016/j.jpsychores.2015.01.002] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Revised: 01/02/2015] [Accepted: 01/05/2015] [Indexed: 11/25/2022]
Abstract
OBJECTIVE In DSM-5 the diagnosis of body dysmorphic disorder (BDD) has been subjected to two important changes: Firstly, BDD has been assigned to the category of obsessive-compulsive and related disorders. Secondly, a new criterion has been defined requiring the presence of repetitive behaviors or mental acts in response to appearance concerns. The aims of this study were to report the prevalence rates of BDD based on a DSM-5 diagnosis, and to evaluate the impact of the recently introduced DSM-5 criteria for BDD by comparing the prevalence rates (DSM-5 vs. DSM-IV) METHODS BDD-criteria (DSM-IV/DSM-5), dysmorphic concerns, and depressive symptoms, were assessed in a representative sample of the German general population (N=2129, aged 18-65years). RESULTS The association between BDD case identification based on DSM-IV and DSM-5 was strong (Phi=.95, p<.001), although point prevalence of BDD according to DSM-5 was slightly lower (2.9%, n=62 vs. 3.2%, n=68). Approximately one third of the identified BDD (DSM-5) cases reported time-consuming behavioral acts in response to appearance concerns. In detail, 0.8% of the German general population fulfilled the BDD criteria and reported repetitive acts of at least one hour/day. CONCLUSIONS The revised criteria of BDD in DSM-5 do not seem to have an impact on prevalence rates. However, the recently added B-criterion reflects more precisely the clinical symptoms of BDD, and may be useful for distinguishing between various severity levels related to repetitive behaviors/mental acts.
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Affiliation(s)
- Katharina Schieber
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital of Erlangen, University of Erlangen-Nuernberg, Schwabachanlage 6, 91054 Erlangen, Germany.
| | - Ines Kollei
- (b)Department of Clinical Psychology and Psychotherapy, University of Erlangen-Nuernberg, Nägelsbachstr. 25a, 91052 Erlangen, Germany
| | - Martina de Zwaan
- (c)Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Alexandra Martin
- (d)Department of Clinical Psychology and Psychotherapy, University of Wuppertal, Max-Horkheimer-Str. 20, 42097 Wuppertal, Germany
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Waldorf M, Cordes M, Vocks S, McCreary D. „Ich wünschte, ich wäre muskulöser”: Eine teststatistische Überprüfung der deutschsprachigen Fassung der Drive for Muscularity Scale (DMS). DIAGNOSTICA 2014. [DOI: 10.1026/0012-1924/a000106] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Die Drive for Muscularity Scale (DMS) ist der am häufigsten verwendete Fragebogen zur Erfassung des Muskulositätsstrebens. Ziel der Studie war die psychometrische Überprüfung der deutschsprachigen Version der DMS. 601 Männer aus muskel- und kraftorientierten Sportarten wurden am Computer oder mit der Papierversion der DMS und mit weiteren Skalen befragt. Interne Konsistenz und Retest-Reliabilität der DMS liegen im sehr guten Bereich (>.88), ebenso die Korrelation mit einem Alternativtest (Male Body Attitudes Scale: .81). Muskulositäts- und Schlankheitsstreben lassen sich eindeutig differenzieren (Eating Disorder Inventory-2-DT: .11). Die durchgeführten Faktorenanalysen stützen die Einteilung in eine kognitive und eine korrelierte behaviorale Subskala. Es zeigten sich Zusammenhänge mit körperbezogenem Selbstwert und körperdysmorphen Sorgen. Die deutschsprachige DMS ist ein reliables und valides Instrument zur Erfassung des Muskulositätsstrebens in Forschung und klinischer Einzelfallanwendung.
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Monzani B, Rijsdijk F, Anson M, Iervolino AC, Cherkas L, Spector T, Mataix-Cols D. A twin study of body dysmorphic concerns. Psychol Med 2012; 42:1949-1955. [PMID: 22126745 DOI: 10.1017/s0033291711002741] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Dysmorphic concern refers to an excessive preoccupation with a perceived or slight defect in physical appearance. It lies on a continuum of severity from no or minimal concerns to severe concerns over one's appearance. The present study examined the heritability of dysmorphic concerns in a large sample of twins. METHOD Twins from the St Thomas UK twin registry completed a valid and reliable self-report measure of dysmorphic concerns, which also includes questions about perceived body odour and malfunction. Twin modelling methods (female twins only, n=3544) were employed to decompose the variance in the liability to dysmorphic concerns into additive genetic, shared and non-shared environmental factors. RESULTS Model-fitting analyses showed that genetic factors accounted for approximately 44% [95% confidence intervals (CI) 36-50%] of the variance in dysmorphic concerns, with non-shared environmental factors and measurement error accounting for the remaining variance (56%; 95% CI 50-63%). Shared environmental factors were negligible. The results remained unchanged when excluding individuals reporting an objective medical condition/injury accounting for their concern in physical appearance. CONCLUSIONS Over-concern with a perceived or slight defect in physical appearance is a heritable trait, with non-shared environmental factors also playing an important role in its causation. The results are relevant for various psychiatric disorders characterized by excessive concerns in body appearance, odour or function, including but not limited to body dysmorphic disorder.
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Affiliation(s)
- B Monzani
- Department of Psychosis Studies, King's College London, Institute of Psychiatry, London, UK.
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Monzani B, Rijsdijk F, Iervolino AC, Anson M, Cherkas L, Mataix-Cols D. Evidence for a genetic overlap between body dysmorphic concerns and obsessive-compulsive symptoms in an adult female community twin sample. Am J Med Genet B Neuropsychiatr Genet 2012; 159B:376-82. [PMID: 22434544 DOI: 10.1002/ajmg.b.32040] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2011] [Accepted: 02/09/2012] [Indexed: 11/07/2022]
Abstract
Body dysmorphic disorder (BDD) is thought to be etiologically related to obsessive-compulsive disorder (OCD) but the available evidence is incomplete. The current study examined the genetic and environmental sources of covariance between body dysmorphic and obsessive-compulsive symptoms in a community sample of adult twins. A total of 2,148 female twins (1,074 pairs) completed valid and reliable measures of body dysmorphic concerns and obsessive-compulsive symptoms. The data were analyzed using bivariate twin modeling methods and the statistical programme Mx. In the best-fitting model, the covariation between body dysmorphic and obsessive-compulsive traits was largely accounted for by genetic influences common to both phenotypes (64%; 95% CI: 0.50-0.80). This genetic overlap was even higher when specific obsessive-compulsive symptom dimensions were considered, with up to 82% of the phenotypic correlation between the obsessing and symmetry/ordering symptom dimensions and dysmorphic concerns being attributable to common genetic factors. Unique environmental factors, although influencing these traits individually, did not substantially contribute to their covariation. The results remained unchanged when excluding individuals reporting an objective medical condition/injury accounting for their concern in physical appearance. The association between body dysmorphic concerns and obsessive-compulsive symptoms is largely explained by shared genetic factors. Environmental risk factors were largely unique to each phenotype. These results support current recommendations to group BDD together with OCD in the same DSM-5 chapter, although comparison with other phenotypes such as somatoform disorders and social phobia is needed.
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Affiliation(s)
- Benedetta Monzani
- Institute of Psychiatry, Department of Psychosis Studies, King's College London, London, UK.
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Keck T, Kühnemann S, Ehrat J, Meder G, Dahlbender RW. [Functional-aesthetic rhinosurgery patients: psychometric parameters]. HNO 2012; 60:55-62. [PMID: 22282012 DOI: 10.1007/s00106-011-2436-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND The aim of this study was to acquire psychometric parameters in patients desiring functional-aesthetic nasal surgery. MATERIAL AND METHODS Over a 1-year period, 101 patients were consecutively examined at the ENT department of the University of Ulm. Septoplasty or septorhinoplasty was indicated in all cases. The acquisition of psychometric data was performed by means of standardised and validated questionnaires. Data relating to anxiety, depression, private and public self-awareness as well as general satisfaction with oneself and in particular with one's nose was collected. RESULTS Patients demonstrated greater levels of fear, self-awareness in public and dissatisfaction with their nose. The greatest expectation concerning the outcome of the operation was the improvement of nasal obstruction. Altering the outward appearance of the nose was a secondary consideration. CONCLUSION The screening presented here enables ENT surgeons to identify possible "problem" patients before functional-aesthetic nasal surgery.
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Affiliation(s)
- T Keck
- Abteilung für HNO-Heilkunde, Kopf-, Hals- und Plastische Gesichtschirurgie, Elisabethinen-Krankenhaus, Akademisches Lehrkrankenhaus der Medizinischen Universität Graz, Elisabethinergasse 14, 8020, Graz, Österreich.
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