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Applewhite B, Olivola M, Tweed C, Wesemann U, Himmerich H. Body dysmorphic disorder, muscle dysmorphia, weight and shape dissatisfaction and the use of appearance-enhancing drugs in the military: a systematic review. BMJ Mil Health 2024; 170:255-266. [PMID: 35675995 DOI: 10.1136/bmjmilitary-2022-002135] [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: 04/15/2022] [Accepted: 05/16/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND Body dysmorphic disorder (BDD) and muscle dysmorphia (MD) are common but often underdiagnosed disorders. These disorders have rarely been explored in the context of military personnel by mental health researchers despite the emphasis on physical fitness in military populations. We conducted a comprehensive systematic literature review on scientific studies of BDD and MD and the accompanying symptoms within the military. METHODS We used the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines and used PubMed, Web of Science and PsycINFO as databases with "body dysmorphic disorder," "muscle dysmorphia," "body image," "performance and image enhancing drugs," "anabolic steroid," military personnel," "soldiers," "navy," "air force," "army" and "armed forces" as search terms. RESULTS A total of 20 eligible articles reporting data of 42 952 study participants were used. According to the identified literature, prevalence rates of BDD in the military are ~10% in men and ~20% in women, whereas ~15% of men and ~5% of women may suffer from MD. Further identified related problems in military populations were excessive bodybuilding, the use of anabolic drugs, the intake of stimulants, weight and shape concerns, and weight-control behaviours. CONCLUSIONS BDD, MD, as well as the use of anabolic and stimulating drugs, are highly prevalent in military personnel. Despite the importance of these problems in the military, there are no military-specific treatment studies available. A pre-existing focus on physical appearance and fitness might contribute to the decision to pursue a professional military career. The military environment might be a maintaining factor of BDD or MD, but not the ultimate cause of the disorder in an affected individual.
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Affiliation(s)
- Briana Applewhite
- Department of Psychological Medicine, King's College London, London, UK
| | - M Olivola
- Department of Brain and Behavioural Science, University of Pavia, Pavia, Italy
- Department of Mental Health and Dependence, Azienda Socio-Sanitaria Territoriale di Pavia, Pavia, Italy
| | - C Tweed
- Eating Disorders Service, South London and Maudsley NHS Foundation Trust, London, UK
- Institute of Naval Medicine, Royal Navy, Gosport, UK
| | - U Wesemann
- Department of Psychiatry, Psychotherapy and Psychotraumatology, Bundeswehrkrankenhaus Berlin, Berlin, Germany
| | - H Himmerich
- Department of Psychological Medicine, King's College London, London, UK
- Eating Disorders Service, South London and Maudsley NHS Foundation Trust, London, UK
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Goldstein I, Gelbard MK, Lipshultz LI. Clinical Significance of Shortened Penile Length and Alterations in Penile Length Following Treatment for Peyronie's Disease. Sex Med Rev 2022; 10:409-420. [PMID: 35772849 DOI: 10.1016/j.sxmr.2021.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 12/15/2021] [Accepted: 12/20/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Across many cultures, penis size has been associated with virility, and concerns about penile length are commonplace. Peyronie's disease (PD) is a known acquired cause of penile shortening. OBJECTIVES This paper describes the psychosocial impacts of penile length on men and their partners, both generally and in men with PD, and evaluates the effect of PD treatments (eg, collagenase clostridium histolyticum , surgery, mechanical therapy) on this outcome measure. METHODS A PubMed database search was performed for English language articles through July 2021. Main outcome measures were association of penile length with emotional well-being, selfesteem, and relationship satisfaction in men with PD, and change from baseline penile length after treatment. RESULTS Shortened penile length caused by PD can negatively impact patient and partner quality of life, including effects on body image, emotional well-being, sexual function, and interpersonal relationships. In men with PD, studies have demonstrated an association between loss of penile length and emotional problems, reduced satisfaction with sexual performance, poor self-esteem, depression, and relationship difficulties. Loss of penile length can frequently occur after surgery for PD (including plication, plaque incision/excision with grafting, and penile implant). Advanced surgical techniques may preserve/increase penile length, but the increased risks associated with these complex procedures must be carefully considered. Treatment with collagenase clostridium histolyticum does not appear to negatively impact penile length, and 5-year follow-up data suggest potential longterm posttreatment improvements in this outcome measure. Penile traction therapy, either alone or as adjunctive therapy, may increase penile length in men with PD, but nonadherence may limit improvement. CONCLUSION Changes in penile length are important to many men, particularly those with PD, and should be considered during PD treatment selection. Penile length should be measured objectively before and after treatment for PD and should be included as an outcome measure in future studies on treatment effectiveness. Goldstein I, Gelbard MK, Lipshultz LI. Clinical Significance of Shortened Penile Length and Alterations in Penile Length Following Treatment for Peyronie's Disease. Sex Med Rev 2022;10:409-420.
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Johnson S, Letheby C. Psychedelic therapy for body dysmorphic disorder. JOURNAL OF PSYCHEDELIC STUDIES 2022. [DOI: 10.1556/2054.2022.00200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Abstract
In this opinion piece we propose the investigation of psychedelic-assisted psychotherapy for the treatment of body dysmorphic disorder (BDD). BDD is a psychiatric disorder characterised by appearance-based preoccupations and accompanying compulsions. While safe and effective treatments for BDD exist, non-response and relapse rates remain high. Therefore, there is a need to investigate promising new treatment options for this highly debilitating condition. Preliminary evidence suggests safety, feasibility, and potential efficacy of psychedelic treatments in disorders that share similar psychopathological mechanisms with BDD. Drawing on this evidence, as well as on relevant qualitative reports and theoretical proposals, we argue that it would be worthwhile to conduct a phase 2a study aimed at assessing the safety and feasibility of psychedelic-assisted psychotherapy in BDD. We also offer some suggestions for how future research ought to proceed.
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Affiliation(s)
- Shevaugn Johnson
- College of Education, Psychology, and Social Work, Flinders University, Sturt Road, Bedford Park, South Australia, 5042, Australia
| | - Chris Letheby
- Department of Philosophy, The University of Western Australia, 35 Stirling Hwy, Crawley, Western Australia, 6009, Australia
- Department of Philosophy, The University of Adelaide, North Terrace, Adelaide, South Australia, 5005, Australia
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Dobosz M, Rogowska P, Sokołowska E, Szczerkowska-Dobosz A. "Motivations, demography and clinical features of body dysmorphic disorder among people seeking cosmetic treatments: a study of 199 patients.". J Cosmet Dermatol 2022; 21:4646-4650. [PMID: 35243745 DOI: 10.1111/jocd.14890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 01/18/2022] [Accepted: 02/25/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Motivations for getting aesthetic medicine treatments concern not only the improvement of the physical appearance but also internal aspects such as feeling more confident or happier. Body dysmorphic disorder (BDD) is a disorder that affects from 5 to 15% of aesthetic medicine clients and characterizes by an obsessive preoccupation with a non-visible or minimal defect in appearance. AIMS The aim of the study was to assess the main motivations, demography, and clinical features of body dysmorphic disorder among people seeking cosmetic treatments. METHODS A single-center study was performed using an anonymous questionnaire on 199 patients of the private aesthetic medicine clinic in Gdansk, Poland. RESULTS A typical client of an aesthetic clinic is a woman aged 40 to 50, with higher education, who undergoes aesthetic treatments more than twice a year, mainly with botulinum toxin injections. The most common motivations are the desire to achieve a fresh look, the will to reduce the signs of aging, and to invest in oneself. Furthermore, over 38% of patients stated that they were having critical and recurring thoughts about their appearance, which affected their daily functioning and caused a decrease in their well-being. Almost 20% of them performed repetitive activities, such as frequently looking in the mirror or asking others for opinions about their appearance. 15.6% of patients presented at least two characteristic features of BDD. CONCLUSIONS Patients seeking cosmetic treatments may suffer from body dysmorphic disorder, thus the need for aesthetic medicine practitioners to be aware of this disease.
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Affiliation(s)
- Maria Dobosz
- Faculty of Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | - Patrycja Rogowska
- Department of Dermatology, Venereology and Allergology, Faculty of Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | - Ewa Sokołowska
- Faculty of Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | - Aneta Szczerkowska-Dobosz
- Department of Dermatology, Venereology and Allergology, Faculty of Medicine, Medical University of Gdańsk, Gdańsk, Poland
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Mitra S, Bult-Ito A. Bidirectional Behavioral Selection in Mice: A Novel Pre-clinical Approach to Examining Compulsivity. Front Psychiatry 2021; 12:716619. [PMID: 34566718 PMCID: PMC8458042 DOI: 10.3389/fpsyt.2021.716619] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 08/16/2021] [Indexed: 11/17/2022] Open
Abstract
Obsessive-compulsive disorder (OCD) and related disorders (OCRD) is one of the most prevalent neuropsychiatric disorders with no definitive etiology. The pathophysiological attributes of OCD are driven by a multitude of factors that involve polygenic mechanisms, gender, neurochemistry, physiological status, environmental exposures and complex interactions among these factors. Such complex intertwining of contributing factors imparts clinical heterogeneity to the disorder making it challenging for therapeutic intervention. Mouse strains selected for excessive levels of nest- building behavior exhibit a spontaneous, stable and predictable compulsive-like behavioral phenotype. These compulsive-like mice exhibit heterogeneity in expression of compulsive-like and other adjunct behaviors that might serve as a valuable animal equivalent for examining the interactions of genetics, sex and environmental factors in influencing the pathophysiology of OCD. The current review summarizes the existing findings on the compulsive-like mice that bolster their face, construct and predictive validity for studying various dimensions of compulsive and associated behaviors often reported in clinical OCD and OCRD.
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Affiliation(s)
- Swarup Mitra
- Department of Pharmacology and Toxicology, State University of New York at Buffalo, Buffalo, NY, United States
| | - Abel Bult-Ito
- Department of Biology and Wildlife, University of Alaska Fairbanks, Fairbanks, AK, United States
- OCRD Biomed LLC, Fairbanks, AK, United States
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Langsdon PR, Schroeder RJ. Recognizing, Managing, and Guiding the Patient Through Complications in Facial Plastic Surgery. Facial Plast Surg Clin North Am 2021; 28:483-491. [PMID: 33010867 DOI: 10.1016/j.fsc.2020.06.007] [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: 10/23/2022]
Abstract
Complications in facial plastic surgery can occur in both surgical and nonsurgical procedures. Many complications can be prevented through thorough preprocedural evaluation, patient counseling, and close postoperative monitoring. Despite the best efforts complications will happen and identifying them early is critical to prevent long-term sequelae. It is important to know how to both manage the complication and guide the patient through the recovery process.
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Affiliation(s)
- Phillip R Langsdon
- The Langsdon Clinic, 7499 Poplar Pike, Germantown, TN, USA; Department of Otolaryngology-Head and Neck Surgery, University of Tennessee Health Science Center, Memphis, TN, USA.
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Watson C, Ban S. Body dysmorphic disorder in children and young people. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2021; 30:160-164. [PMID: 33565924 DOI: 10.12968/bjon.2021.30.3.160] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The incidence of body dysmorphic disorder (BDD) in young people is increasing. Causes of BDD are related to the prevalence of social media and adolescent development, especially the role that brain neuroplasticity has on influencing perception. There are long-term impacts of BDD, including depression and suicide. Prevention and promotion of positive body image are part of the nurse's role; treatment can prevent unnecessary aesthetic surgical interventions.
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Affiliation(s)
- Chloe Watson
- BSc Student Nurse (Child), Northumbria University/Great North Children's Hospital, Newcastle
| | - Sasha Ban
- Senior Lecturer, Nursing, Midwifery and Health Department, Northumbria University, Newcastle
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Bascarane S, Kuppili PP, Menon V. Psychiatric Assessment and Management of Clients Undergoing Cosmetic Surgery: Overview and Need for an Integrated Approach. Indian J Plast Surg 2021; 54:8-19. [PMID: 33854274 PMCID: PMC8034989 DOI: 10.1055/s-0040-1721868] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Background Psychiatric disorders are more common among people undergoing cosmetic procedures than the general population and evaluating mental health can be cumbersome for plastic surgeons. We aim to summarize the available literature in this regard and propose an integrated approach to psychiatric assessment and management of mental health issues among this group. Methods Electronic search of MEDLINE, Google Scholar, and PsycINFO databases was done to identify relevant peer-reviewed English language articles from inception till April 2020. Generated abstracts were screened for their eligibility. Included articles were grouped according to their thematic focus under the following headings; prevalence of psychiatric morbidity among clients posted for cosmetic surgery, assessment tools, and management of psychiatric morbidity in relation to undergoing cosmetic surgery. Results A total of 120 articles were reviewed. The prevalence of psychiatric disorder in patients undergoing cosmetic surgery was 4 to 57% for body dysmorphic disorder (BDD); the corresponding figures for depression, anxiety, and personality disorder were 4.8 to 25.8, 10.8 to 22, and 0 to 53%, respectively. A range of tools have been used to assess these disorders and specific measures are also available to assess clinical outcomes following surgery. Screening for these disorders is essential to prevent unnecessary surgical procedures, as well as to ensure timely management of the psychiatric comorbidity. Conclusion Psychiatric morbidity is a common concomitant in cosmetic surgery. A structured and integrated approach to evaluation and management of psychiatric morbidity will help to optimize postsurgical outcomes.
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Affiliation(s)
- Sharmi Bascarane
- Department of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Pooja P. Kuppili
- Senior Clinical Fellow, Penn Hospital Black Country Healthcare NHS Foundation Trust United Kingdom
| | - Vikas Menon
- Department of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
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Sandman L, Hansson E. An ethics analysis of the rationale for publicly funded plastic surgery. BMC Med Ethics 2020; 21:94. [PMID: 33008385 PMCID: PMC7531084 DOI: 10.1186/s12910-020-00539-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 09/23/2020] [Indexed: 11/23/2022] Open
Abstract
Background Healthcare systems are increasingly struggling with resource constraints, given demographic changes, technological development, and citizen expectations. The aim of this article is to normatively analyze different suggestions regarding how publicly financed plastic surgery should be delineated in order to identify a well-considered, normative rationale. The scope of the article is to discuss general principles and not define specific conditions or domains of plastic surgery that should be treated within the publicly financed system. Methods This analysis uses a reflective equilibrium approach, according to which considered normative judgements in one area should be logically and argumentatively coherent with considered normative judgements and background theories at large within a system. Results and conclusions In exploring functional versus non-function conditions, we argue that it is difficult to find a principled reason for an absolute priority of functional conditions over non-functional conditions. Nevertheless, functional conditions are relatively easier to establish objectively, and surgical intervention has a clear causal effect on treating a functional condition. Considering non-functional conditions that require plastic surgery [i.e., those related to appearance or symptomatic conditions (not affecting function)], we argue that the patient needs to experience some degree of suffering (and not only a preference for plastic surgery), which must be ‘validated’ in some form by the healthcare system. This validation is required for both functional and non-functional conditions. Functional conditions are validated by distinguishing between statistically normal and abnormal functioning. Similarly, for non-functional conditions, statistical normality represents a potential method for distinguishing between what should and should not be publicly funded. However, we acknowledge that such a concept requires further development.
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Affiliation(s)
- Lars Sandman
- National Centre for Priorities in Health, Department of Health, Medicine and Caring Sciences, Linköping University, S-581 83, Linköping, Sweden. .,, Västra Götaland Region, Sweden. .,Borås University, Borås, Sweden.
| | - Emma Hansson
- Department of Plastic and Reconstructive Surgery, Sahlgrenska University Hospital, Gröna Stråket 8, SE-413 45 Gothenburg, Gröna Stråket 8, SE-413 45, Gothenburg, Sweden.,The Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
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Abstract
Background and Objectives:
Body Dysmorphic Disorder (BDD) is characterized
by an abnormal preoccupation with alleged misshapen body parts. There is often poor insight
and effort is made to hide the imagined defects, and consultation may be sought seeking
unnecessary cosmetic surgery or procedures. It is underdiagnosed and established treatment
protocols are lacking. The disease has a chronic and undulating course and is seriously
compromises quality of life. Despite the fact that the prime age of onset of BDD is during
adolescence relatively little has been written about it during this phase of life. This review
aims to comprehensively cover the present understanding of BDD, including clinical
features, epidemiology, psychopathology, nomenclature, comorbidity and management.
Methods:
A literature search was undertaken using suitable key words on Google Scholar,
MEDLINE & PsychoINFO up to June 2018 limited to articles in English.
Results:
he prevalence of BDD is variable in the general and psychiatric population with
equal gender distribution. Both sexes are equally affected. It is associated with poor
functioning and a chronic course. There is considerable comorbidity and diagnostic overlap
between BDD and obsessive-compulsive disorder, major depressive disorder, social anxiety
disorder, anorexia nervosa, schizophrenia spectrum disorders and personality disorders.
Psychiatric consultation is often late. Selective Serotonin Reuptake Inhibitors (SSRIs) and
Cognitive Behavior Therapy (CBT) are currently the first line modalities for treatment.
Internet based CBT, Acceptance and commitment therapy, and repetitive Transcranial
Magnetic Stimulation (rTMS) are emerging treatment options.
Conclusions:
BDD is a complex disorder with still lot of uncertainty about its diagnostic
placement, treatment approaches, especially for refractory patients, and prognosis. Further
study is needed to clarify its prevalence, especially in adolescents; to fully understand its
neurobiological aspects, to determine its exact relation to obsessive compulsive related
disorders, and to develop better treatment approaches.
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Affiliation(s)
- Himanshu Sharma
- Pramukh Swami Medical College & Shree Krishna Hospital, Karamsad, India
| | - Bharti Sharma
- Government Arts College, Garbada, Dahod, Gujarat, India
| | - Nisheet Patel
- Pramukh Swami Medical College & Shree Krishna Hospital, Karamsad, India
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Lee MT, Mpavaenda DN, Fineberg NA. Habit Reversal Therapy in Obsessive Compulsive Related Disorders: A Systematic Review of the Evidence and CONSORT Evaluation of Randomized Controlled Trials. Front Behav Neurosci 2019; 13:79. [PMID: 31105537 PMCID: PMC6491945 DOI: 10.3389/fnbeh.2019.00079] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 04/01/2019] [Indexed: 12/17/2022] Open
Abstract
Background: Habit Reversal Therapy (HRT) has long been used in the treatment of Tourette Syndrome and Tic Disorders. It has more recently been used to treat Trichotillomania and skin picking behaviors, both considered as Obsessive Compulsive Related Disorders (OCRD). Objectives: This literature review sought to establish and quality assess the existing randomized controlled trial evidence supporting the use of HRT in the DSM-5 family of OCRDs. Search Methods: EMBASE, PsycINFO, PubMed, and Cochrane databases were searched for key terms relating to each OCRD (as classified in the DSM-5), and HRT. Selection Criteria: Titles and abstracts were screened, and any literature matching pre-specified criteria were then selected to be reviewed further. Of these, 8 Randomized Controlled Trials (RCT) relating to Trichotillomania, and 2 RCTs relating to Excoriation Disorder, were extracted and reviewed against the 2010 Consolidating Standards of Reporting Trials (CONSORT) statement. Results: The review identified 10 RCTs of HRT, but these were limited to patients with a primary diagnosis of Trichotillomania or "excoriation behavior," only. There were some reports of the use of HRT in Tourette Syndrome or Tic Disorder with secondary OCD, but the OCD symptoms were not reliably reported on. Conclusion: There is a gap in the current literature regarding the use of HRT in the DSM-5 OCRDs. In those RCTs that have been reported, the quality of study methodology was questionable as evaluated by CONSORT criteria. The implications of these findings are discussed, and suggestions are made for future research.
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Affiliation(s)
- Melissa T. Lee
- Hertfordshire Partnership University NHS Foundation Trust, Welwyn Garden City, United Kingdom
| | - Davis N. Mpavaenda
- Hertfordshire Partnership University NHS Foundation Trust, Welwyn Garden City, United Kingdom
- University of Hertfordshire, Hatfield, United Kingdom
| | - Naomi A. Fineberg
- Hertfordshire Partnership University NHS Foundation Trust, Welwyn Garden City, United Kingdom
- University of Hertfordshire, Hatfield, United Kingdom
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