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Krebs G, Rautio D, Fernández de la Cruz L, Hartmann AS, Jassi A, Martin A, Stringaris A, Mataix-Cols D. Practitioner Review: Assessment and treatment of body dysmorphic disorder in young people. J Child Psychol Psychiatry 2024; 65:1119-1131. [PMID: 38719455 DOI: 10.1111/jcpp.13984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/16/2024] [Indexed: 07/24/2024]
Abstract
Body dysmorphic disorder (BDD) is a relatively common and highly impairing mental disorder that is strikingly underdiagnosed and undertreated in Child and Adolescent Mental Health Services (CAMHS). The only clinical guidelines for the management of BDD in youth were published nearly 20 years ago, when empirical knowledge was sparse. Fortunately, there has been a surge in research into BDD over the last 10 years, shedding important insights into the phenomenology, epidemiology, assessment and treatment of the disorder in young people. This review aimed to provide an overview of recent research developments of relevance to clinicians and healthcare policymakers. We summarise key findings regarding the epidemiology of BDD in youth, which indicate that the disorder usually develops during teenage years and affects approximately 2% of adolescents at any one point in time. We provide an overview of aetiological research, highlighting that BDD arises from an interplay between genetic and environmental influences. We then focus on screening and assessment strategies, arguing that these are crucial to promote detection and diagnosis of this under-recognised condition. Additionally, we summarise the recommended treatment approaches for BDD in youth, namely cognitive behaviour therapy with or without selective serotonin reuptake inhibitors. The review concludes by highlighting key knowledge gaps and priorities for future research including, but not limited to, better understanding aetiological factors, long-term consequences and treatment.
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Affiliation(s)
- Georgina Krebs
- Anxiety, self-Image and Mood (AIM) Laboratory, Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
- National Specialist OCD, BDD and Related Disorders Clinic for Young People, Pears Maudsley Centre, South London and Maudsley NHS Foundation Trust, London, UK
| | - Daniel Rautio
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Healthcare Services, Region Stockholm, Stockholm, Sweden
| | - Lorena Fernández de la Cruz
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Healthcare Services, Region Stockholm, Stockholm, Sweden
| | - Andrea S Hartmann
- Division of Clinical Psychology and Psychotherapy of Childhood and Adolescence, Faculty of Psychology, University of Konstanz, Konstanz, Germany
| | - Amita Jassi
- National Specialist OCD, BDD and Related Disorders Clinic for Young People, Pears Maudsley Centre, South London and Maudsley NHS Foundation Trust, London, UK
| | - Alexandra Martin
- Department of Clinical Psychology and Psychotherapy, School of Human and Social Sciences, University of Wuppertal, Wuppertal, Germany
| | - Argyris Stringaris
- Anxiety, self-Image and Mood (AIM) Laboratory, Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
- Division of Psychiatry, University College London, London, UK
- First Department of Psychiatry, National and Kapodistrian University of Athens, Athens, Greece
| | - David Mataix-Cols
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Healthcare Services, Region Stockholm, Stockholm, Sweden
- Department of Clinical Sciences, Lund University, Lund, Sweden
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Turner MA, Veale D, Anson M. The nature and functions of appearance-related comparisons in body dysmorphic disorder. Scand J Psychol 2024. [PMID: 38982183 DOI: 10.1111/sjop.13043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 03/31/2024] [Accepted: 05/21/2024] [Indexed: 07/11/2024]
Abstract
Appearance-related comparisons (A-RCs) in body dysmorphic disorder (BDD) are under researched despite their probable role in disorder maintenance. The present study therefore aimed to explore the nature (frequency, direction and automaticity), and functions of A-RCs in BDD. N = 43 including people with BDD (n = 23) and controls (n = 20) matched approximately on age and sex were recruited. A mixture of standardized and devised questionnaires on body image and A-RCs were completed. A-RCs were significantly more frequent, generally more upward (to more attractive standards of comparison), and more automatic in people with BDD relative to the control group. People with BDD also held significantly stronger agreement with beliefs about A-RCs as serving functions of: self-evaluation, self-improvement, self-enhancement, and in particular, self-loathing (a way to confirm beliefs about physical unattractiveness) and social threat management. This research presents evidence that the nature and functions of A-RCs in BDD have a role in this disorder's maintenance. Clinical implications, limitations, and future directions for research are discussed.
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Affiliation(s)
- Mark A Turner
- The Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, Great Maze Pond, London, UK
| | - David Veale
- The Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Centre for Anxiety Disorders and Trauma, Maudsley Hospital, South London and Maudsley NHS Foundation Trust, London, UK
| | - Martin Anson
- The Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Centre for Anxiety Disorders and Trauma, Maudsley Hospital, South London and Maudsley NHS Foundation Trust, London, UK
- School of Psychology, Keynes College, University of Kent, Canterbury, Kent, UK
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Murshidi R, Hammouri M, Al-Ani A, Kitaneh R, Al-Soleiti M, Al Ta'ani Z, Sweis S, Halasa Z, Fashho E, Arafah M, Almaani N, Abdallat M, Al-Dar'awi F, Kittaneh E, Jaber B, Almudallal F, Smadi Z. Investigating the prevalence of body dysmorphic disorder among Jordanian adults with dermatologic and cosmetic concerns: a case-control study. Sci Rep 2024; 14:5993. [PMID: 38472284 PMCID: PMC10933333 DOI: 10.1038/s41598-024-56315-8] [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: 10/16/2023] [Accepted: 03/05/2024] [Indexed: 03/14/2024] Open
Abstract
Body Dysmorphic Disorder (BDD) is an underexplored psychiatric condition in Middle Eastern countries, particularly in patients with dermatologic concerns, where alterations in appearance may elevate the risk of BDD. We studied patients at Jordan University Hospital's general dermatology and cosmetic clinics from July to September 2022, comparing them to healthy controls. Patients with dermatologic conditions were evaluated per the International Classification of Diseases (ICD-10) criteria by trained dermatologists. All participants completed the Dysmorphic Concerns Questionnaire (DCQ), Perceived Stress Scale, Patient Health Questionnaire-2, General Anxiety Disorder Assessment tool-2. We assessed BDD prevalence using four DCQ cutoffs: 9, 11, 14, and 17, reporting effect sizes as odds ratios (OR). Our study involved 1500 participants, with an average age of 29.3 (± 14.8) years and a female-to-male ratio of 3.15-to-1. At the 9, 11, 14, and 17 DCQ cutoffs, BDD prevalence was 78.2%, 54.2%, 26.5%, and 11.7%, respectively. Patients with dermatologic concerns were more likely to exhibit clinical BDD symptoms than controls at the 11-cutoff (OR: 1.26; 95% CI 1.01-1.58; p < 0.05). Conversely, those with cosmetic concerns were more prone to clinical BDD than controls at cutoffs 9 (OR: 2.26; 95% CI 1.28-3.97; p < 0.05) and 11 (OR: 1.50; 95% CI 1.03-2.20; p < 0.05). Our logistic regression revealed consistent associations between higher DCQ scores and elevated anxiety, depression, perceived skin disease-related stigma, and reduced quality of life (p < 0.05). In conclusion, patients with dermatologic issues and those seeking cosmetic procedures are at significant risk of developing BDD, necessitating proactive screening and referrals for specialized care by dermatologists due to the associated psychological distress and unproductive consultations. Providing specialized training for healthcare professionals to establish an integrated care approach to address the needs of patients with BDD should be the focus of future research projects.
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Affiliation(s)
- Rand Murshidi
- Department of Dermatology, School of Medicine, The University of Jordan, Amman, Jordan
| | | | - Abdallah Al-Ani
- Office of Scientific Affairs and Research, King Hussein Cancer Center, Amman, Jordan
| | - Razi Kitaneh
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, 06519, USA
- Clinical Neuroscience Research Unit, Connecticut Mental Health Center, New Haven, CT, 06519, USA
| | | | - Zain Al Ta'ani
- Department of Dermatology, School of Medicine, The University of Jordan, Amman, Jordan
| | - Sami Sweis
- School of Medicine, The University of Jordan, Amman, Jordan
| | - Zeina Halasa
- School of Medicine, The University of Jordan, Amman, Jordan
| | - Eva Fashho
- School of Medicine, The University of Jordan, Amman, Jordan
| | - Malak Arafah
- School of Medicine, The University of Jordan, Amman, Jordan
| | - Noor Almaani
- Department of Dermatology, School of Medicine, The University of Jordan, Amman, Jordan
| | - Mahmoud Abdallat
- Department of Neurosurgery, School of Medicine, The University of Jordan, Amman, Jordan
| | | | - Eman Kittaneh
- School of Medicine, The University of Jordan, Amman, Jordan
| | - Besan Jaber
- School of Medicine, The University of Jordan, Amman, Jordan
| | | | - Zina Smadi
- School of Medicine, The University of Jordan, Amman, Jordan
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Loewen Á, Blasco-Fontecilla H, Li C, Bella-Fernández M, Ruiz-Antorán B. Prevalence of Body Dysmorphic Disorder in the Spanish Population: Cross-Sectional Web-Based Questionnaire Study. JMIR Form Res 2024; 8:e46515. [PMID: 38175692 PMCID: PMC10797500 DOI: 10.2196/46515] [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: 02/14/2023] [Revised: 10/30/2023] [Accepted: 11/20/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Body dysmorphic disorder (BDD) is defined as excessive concern with mild or nonexistent defects in personal physical appearance, which are not perceived by others. The worldwide prevalence of BDD ranges between 0.5% and 3.2%, with no differences across genders. The mean age of onset of BDD is 16.9 years. BDD is typically associated with young age, psychiatric disorders, and dermatological procedures. Patients with BDD typically display poorer mental health status than patients diagnosed with other mental disorders. OBJECTIVE The aim of this study was to estimate the prevalence of BDD in Spain and to identify the variables associated with BDD. METHODS We performed a cross-sectional descriptive study by collecting data through an anonymous web-based survey targeting the Spanish population aged 18 years or older. The measures in this study were (1) sociodemographic variables, (2) variables associated with dermatological and psychiatric disorders and cosmetic procedures, (3) scales measuring quality of life (12-item Short Form health survey, version 2) and (4) BDD (BDD Questionnaire). Statistical analysis was performed with SPSS software version 21. P values less than .05 were considered significant. RESULTS Of the 2091 participants who took the survey, 322 (15.2%) met the criteria of having BDD. The mean age of the participants with BDD was 23.5 (SD 9.6) years. In terms of BDD prevalence, women accounted for 19.9% (284/1421), men accounted for 5.2% (34/653), and students accounted for 25.2% (263/1043). Approximately 46.6% (150/322) of the participants with BDD reported a history of psychiatric comorbidities, including anxiety disorders, depressive disorders, and eating disorders. BDD was significantly associated with female gender, younger age (18-24 years), students, monthly income of less than €500 (€1=US $1.11), and the presence of dermatological and some psychiatric disorders such as depression, anxiety, and eating disorders (P<.05). The number of body parts of concern in participants with BDD was significantly higher than that in those without BDD (4.6 vs 2.2, respectively; P<.001). Regarding the body parts of concern, body fat was the most common concern for both groups with BDD and without BDD, followed by thighs, face, hips, and skin in the BDD group and thighs, teeth, and hair in the non-BDD group. Participants with BDD showed a significantly poorer self-perception of their mental health, irrespective of the presence of any mental disorder (P<.001). CONCLUSIONS Our findings showed that the prevalence of BDD in Spain was higher than expected. Further, BDD is frequently associated with other psychiatric disorders, particularly depressive disorder, anxiety disorder, and eating disorder. Participants with BDD had a poorer perception of quality of life associated with mental but not physical health problems. Finally, the perception of quality of mental health life in participants with BDD was independent of diagnosis of any mental disorder.
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Affiliation(s)
- Álvaro Loewen
- Facultad de Medicina, Universidad Autónoma de Madrid, Madrid, Spain
| | - Hilario Blasco-Fontecilla
- Facultad de Medicina, Universidad Autónoma de Madrid, Madrid, Spain
- Servicio de Psiquiatría Infanto-juvenil, Hospital Universitario Puerta de Hierro Majadahonda, Majadahonda, Spain
- Centro de Investigación Biomédica en Red - Salud Mental, Madrid, Spain
- Facultad de Ciencias de la Salud y Centro Médico, Universidad Internacional de La Rioja, Madrid, Spain
| | - Chao Li
- Facultad de Medicina, Universidad Autónoma de Madrid, Madrid, Spain
| | - Marcos Bella-Fernández
- Servicio de Psiquiatría Infanto-juvenil, Hospital Universitario Puerta de Hierro Majadahonda, Majadahonda, Spain
- Facultad de Psicología, Universidad Autónoma de Madrid, Madrid, Spain
- Departamento de Psicología, Universidad Pontificia de Comillas, Madrid, Spain
| | - Belén Ruiz-Antorán
- Servicio de Farmacología Clínica, Hospital Universitario Puerta de Hierro Majadahonda, Majadahonda, Spain
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Monzani B, Fallah D, Rautio D, Gumpert M, Jassi A, Fernández de la Cruz L, Mataix-Cols D, Krebs G. Psychometric Evaluation of the Yale-Brown Obsessive-Compulsive Scale Modified for Body Dysmorphic Disorder for Adolescents (BDD-YBOCS-A). Child Psychiatry Hum Dev 2023; 54:1799-1806. [PMID: 35678889 PMCID: PMC10582126 DOI: 10.1007/s10578-022-01376-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 05/09/2022] [Accepted: 05/12/2022] [Indexed: 11/03/2022]
Abstract
The Yale-Brown Obsessive-Compulsive Scale Modified for Body Dysmorphic Disorder for Adolescents (BDD-YBOCS-A) is a clinician-rated measure of BDD symptom severity in youth. Despite widespread use in both research and clinical practice, its psychometric properties have not been formally evaluated. The current study examined the factor structure, reliability, validity, and sensitivity to change of the BDD-YBOCS-A in 251 youths with BDD attending two specialist clinics. A principal component analysis identified two factors, explaining 56% of the variance. The scale showed good internal consistency (Cronbach's alpha = 0.87) and adequate convergent and divergent validity. In a subgroup of participants receiving BDD treatment (n = 175), BDD-YBOCS-A scores significantly decreased over time, demonstrating sensitivity to change. BDD-YBOCS-A change scores over treatment were highly correlated with severity changes measured by the Clinical Global Impression - Severity scale (r = .84). The study provides empirical support for the use of the BDD-YBOCS-A in children and adolescents with BDD.
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Affiliation(s)
- Benedetta Monzani
- National and Specialist OCD and Related Disorders Clinic for Young People, South London and Maudsley NHS Foundation Trust, London, UK.
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
| | - Deanna Fallah
- National and Specialist OCD and Related Disorders Clinic for Young People, South London and Maudsley NHS Foundation Trust, London, UK
| | - Daniel Rautio
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Martina Gumpert
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Amita Jassi
- National and Specialist OCD and Related Disorders Clinic for Young People, South London and Maudsley NHS Foundation Trust, London, UK
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Lorena Fernández de la Cruz
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - David Mataix-Cols
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Georgina Krebs
- National and Specialist OCD and Related Disorders Clinic for Young People, South London and Maudsley NHS Foundation Trust, London, UK
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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Van Rood YR, Wyk van N, Böhringer S, van der Wee NJA, Möllmann A, Dingemans AE. Development of a body dysmorphic disorder screener for DSM-5 (BDDS-5). Compr Psychiatry 2023; 127:152416. [PMID: 37688935 DOI: 10.1016/j.comppsych.2023.152416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 07/29/2023] [Accepted: 08/31/2023] [Indexed: 09/11/2023] Open
Abstract
Early identification of individuals with Body dysmorphic disorder (BDD) is essential to direct them to appropriate care and to reduce the chance of developing or maintaining comorbid psychiatric disorders (like an eating disorder (ED)). The present study aimed to develop a simple screener, the Body Dysmorphic Disorder Screener for DSM-5 (BDDS-5), to overcome existing screeners' limitations and test its psychometric properties. The BDDS-5 consists of 12 statements with dichotomous answer options. Specific attention is paid to the readability of the screener for those with lower reading skills. Additional eating disorder screening questions (S section) were added to investigate whether these questions are necessary for detecting potential BDD cases. Finally, the factor structure, internal consistency, and validity of the BDDS-5 were examined within populations with a high risk of screening positive for BDD or ED. Principal axis factor analysis showed that two factors accounted for 63.5% of the variance. The factor analysis was based on polychoric correlation. Based on the BDDS-5, 33 persons (14% of N = 235) were screened as likely BDD cases. Nineteen persons were excluded as potential BDD cases based on the eating disorder related question (question D). Based on the S-section, this turned out to be largely correct for the majority, however, in 8% (n = 4) of the cases BDD was probably missed. The convergent validity appeared to be high (r > 0.80) with three other BDD measures. The BDDS-5 is a valid and widely applicable screener for BDD that may help in the early detection of BDD. The BDDS-5 uses simple wording and is thus suitable for people 8 years and older.
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Affiliation(s)
- Y R Van Rood
- Department of Psychiatry, Leiden University Medical Centre, Albinusdreef 2, PO Box 6900, 2300 RC Leiden, the Netherlands.
| | - N Wyk van
- Bartiméus, Oude Arnhemse Bovenweg 3, 3941 XM Doorn, the Netherlands
| | - S Böhringer
- Biomedical Data Sciences, Leiden University Medical Center, Albinusdreef 2, PO Box 6900, 2300 RC Leiden, the Netherlands; Department of Clinical Pharmacology and Toxicology, Leiden University Medical Center, Albinusdreef 2, PO Box 6900, 2300 RC Leiden, the Netherlands
| | - N J A van der Wee
- Department of Psychiatry, Leiden University Medical Centre, Albinusdreef 2, PO Box 6900, 2300 RC Leiden, the Netherlands
| | - A Möllmann
- University of Bielefeld, Department of Psychology, Clinical Child and Adolescent Psychology and Psychotherapy, Universitätsstrasse 25, 33615 Bielefeld, Germany
| | - A E Dingemans
- Department of Psychiatry, Leiden University Medical Centre, Albinusdreef 2, PO Box 6900, 2300 RC Leiden, the Netherlands; Rivierduinen Eating Disorders Ursula, PO Box 405 2300, AK, Leiden, the Netherlands
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Phillips KA, Susser LC. Body Dysmorphic Disorder in Women. Psychiatr Clin North Am 2023; 46:505-525. [PMID: 37500247 DOI: 10.1016/j.psc.2023.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
Body dysmorphic disorder (BDD) consists of distressing or impairing preoccupation with perceived defects in physical appearance that are actually nonexistent or only slight. This common and often-severe disorder, which affects more women than men, frequently goes unrecognized. BDD is associated with marked impairment in functioning, poor quality of life, and high rates of suicidality. Most patients seek cosmetic treatment, which virtually never improves BDD symptoms. In contrast, serotonin-reuptake inhibitors, often at high doses, and cognitive behavioral therapy that is tailored to BDD's unique clinical features are often effective. This article provides a clinical overview of BDD, including BDD in women.
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Affiliation(s)
- Katharine A Phillips
- New York-Presbyterian/Weill Cornell Medical Center and Weill Cornell Medical College, Weill Cornell Psychiatry Specialty Center, 315 East 62nd Street, New York, NY 10065, USA.
| | - Leah C Susser
- New York-Presbyterian/Weill Cornell Medical Center and Weill Cornell Medical College, Outpatient Department, 21 Bloomingdale Road, White Plains, NY 10605, USA
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Nabavizadeh SS, Naseri R, Sadeghi E, Afshari A, Dehdari Ebrahimi N, Sadeghi A. Prevalence of body dysmorphic disorder in rhinoplasty candidates: A systematic review and meta-analysis. Health Sci Rep 2023; 6:e1495. [PMID: 37599660 PMCID: PMC10435832 DOI: 10.1002/hsr2.1495] [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: 05/18/2023] [Revised: 07/18/2023] [Accepted: 08/02/2023] [Indexed: 08/22/2023] Open
Abstract
Background Body dysmorphic disorder (BDD) is a prevalent mental disorder, particularly in those seeking plastic surgery, leading to unnecessary surgeries and postsurgical dissatisfaction. Among the plastic surgeries, rhinoplasty is the most commonly sought, yet the data on prevalence of BDD among the candidates of rhinoplasty is limited. Therefore, this systematic review and meta-analysis aimed to estimate the prevalence of BDD in rhinoplasty candidates. Methods The online libraries of Web of Science, PubMed, Cochrane Library, ProQuest, Research Square, Scopus, and Google Scholar were searched up to August 2022. Statistical analyses were performed using STATA software (v. 16). The heterogeneity was determined using the I 2 statistic, and an overall estimated analysis was conducted. Subgroup analyses were performed on study year, age, gender, World Health Organization regional classification, sociodemographic index, country, sample size, and employed diagnostic tool. A meta-regression analysis was performed to identify potential sources of heterogeneity. Results Out of 12,999 studies assessed, 18, with a combined sample size of 2132 individuals, met our criteria and were included in the study. The pooled prevalence of BDD was 32.7% (95% CI: 23.6-41.7; I 2 = 96.45%). Subgroup analyses revealed the studies that were conducted in the European region (42.8%), with a sample size of ≥100 (40.2%), utilized the BDD modification of the Y-BOCS (BDD-YBOCS) diagnostic method (47.3%), and with a quality score of ≥6 (34.2%) demonstrated higher prevalence of BDD. The meta-regression analysis identified a higher prevalence in the BDD-YBOCS diagnostic method than in the BDD questionnaire (β: 0.23; 95% CI: 0.04-0.43; p = 0.022). Conclusions The prevalence of BDD is high in those seeking rhinoplasty. Clinicians should be aware of BDD symptoms to prevent unnecessary surgery and dissatisfaction. Public awareness through the media and access to affordable medical services should also be provided.
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Affiliation(s)
- Sara S. Nabavizadeh
- Student Research Committee, School of MedicineShiraz University of Medical SciencesShirazIran
- Otolaryngology Research CenterShiraz University of Medical SciencesShirazIran
| | - Reyhaneh Naseri
- Thoracic and Vascular Surgery Research CenterShiraz University of Medical ScienceShirazIran
- School of MedicineShiraz University of Medical SciencesShirazIran
| | - Erfan Sadeghi
- Research Consultation Center (RCC)Shiraz University of Medical SciencesShirazIran
| | - Aylar Afshari
- Student Research Committee, School of MedicineShiraz University of Medical SciencesShirazIran
| | | | - Alireza Sadeghi
- Transplant Research CenterShiraz University of Medical SciencesShirazIran
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McGuire FH, Goldbach JT, Senese JG, Cabrera JR, Schrager SM, Duncan AE. Longitudinal association of homonegative school climate with body dysmorphic disorder among cisgender sexual minority adolescents: Testing mediation through proximal minority stressors. Body Image 2023; 45:86-93. [PMID: 36842424 PMCID: PMC10192080 DOI: 10.1016/j.bodyim.2023.02.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 02/19/2023] [Accepted: 02/19/2023] [Indexed: 02/27/2023]
Abstract
In a US national cohort study of cisgender sexual minority adolescents (SMAs), we prospectively (1) assessed whether within-person changes in homonegative school climate (i.e., school contextual factors that lead SMAs to feel unsafe or threatened) were associated with risk of probable body dysmorphic disorder (BDD) and (2) tested whether internalized homonegativity and negative expectancies mediated this association. Data came from consecutive time points (18-month, 24-month, 30-month) of the Adolescent Stress Experiences over Time Study (ASETS; N = 758). The Body Dysmorphic Disorder Questionnaire measured probable BDD. Sexual Minority Adolescent Stress Inventory subscales measured past 30-day minority stress experiences. Multilevel models were specified with person mean-centered predictor variables to capture within-person effects. Across one year of follow-up, 26.86% screened positive for probable BDD at least once. Model results indicated significant total (risk ratio [RR]=1.43, 95% credible interval [CI]=1.35-1.52) and direct effects (RR=1.18, 95% CI=1.05-1.34) of homonegative school climate. Internalized homonegativity was independently associated with probable BDD (RR=1.28, 95% CI=1.12-1.46) and mediated 49.7% (95% CI=12.4-82.0) of the total effect. There was limited evidence of mediation via negative expectancies. Implementing SMA-protective school policies and targeting internalized homonegativity in clinical practice may reduce the prevalence and incidence of probable BDD among cisgender SMAs.
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Affiliation(s)
- F Hunter McGuire
- The Brown School, Washington University in St. Louis, St. Louis, MO, USA.
| | - Jeremy T Goldbach
- The Brown School, Washington University in St. Louis, St. Louis, MO, USA.
| | - John G Senese
- Center for LGBTQ+ Health Equity, Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, USA.
| | - Juan R Cabrera
- The Brown School, Washington University in St. Louis, St. Louis, MO, USA.
| | | | - Alexis E Duncan
- The Brown School, Washington University in St. Louis, St. Louis, MO, USA.
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Body Dysmorphic Disorder. Psychiatr Clin North Am 2023; 46:197-209. [PMID: 36740353 DOI: 10.1016/j.psc.2022.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
This article summarizes current knowledge of body dysmorphic disorder across the life span. An overview of the epidemiology and phenomenology of this condition is provided, as well as clinical perspectives on assessment and treatment. Barriers to accessing treatment are considered, along with recent developments to improve access. Future directions in research and clinical care for this population are summarized.
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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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12
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Salari N, Kazeminia M, Heydari M, Darvishi N, Ghasemi H, Shohaimi S, Mohammadi M. Body dysmorphic disorder in individuals requesting cosmetic surgery: A systematic review and meta-analysis. J Plast Reconstr Aesthet Surg 2022; 75:2325-2336. [PMID: 35715310 DOI: 10.1016/j.bjps.2022.04.098] [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: 11/29/2021] [Revised: 04/14/2022] [Accepted: 04/26/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Body dysmorphic disorder (BDD) is known as a mental disorder in which a person suffers from concern and distress with the perceived defects in their appearance and subsequently can experience significant impairment in social, occupational, and interpersonal functioning. Various studies have reported different BDD prevalence rates in patients with cosmetic surgery. However, there has been no comprehensive study that has examined the results of these studies. Therefore, this study aims to determine BDD prevalence in individuals requesting cosmetic surgery in a systematic review and meta-analysis. METHODS In this review study, a search was conducted in national and international databases of Cochrane, Embase, ScienceDirect, Scopus, PubMed, and Web of Science (WoS) between 1878 and January 2020. A random-effects model was used to analyze the data, and heterogeneity of studies was examined with the I2 index. Data analysis was done using comprehensive meta-analysis (Version 2). RESULTS BDD prevalence in individuals requesting cosmetic surgery in 48 articles with a sample size of 14,913 was 19.2% (95% CI: 15.8-23%). Regarding heterogeneity based on meta-regression, a significant difference between the sample size (p<0.001) and BDD prevalence in patients with cosmetic surgery was observed. CONCLUSION The results of this study showed that BDD prevalence in individuals requesting cosmetic surgery is high. Therefore, with the provision of feedback at hospitals, appropriate interventions, such as pre-screening for body image disturbance, should be mandated.
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Affiliation(s)
- Nader Salari
- Department of Biostatistics, School of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mohsen Kazeminia
- Student Research Committee of Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mohammadbagher Heydari
- Department of General Surgery, Faculty of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Niloofar Darvishi
- Student Research Committee of Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Hooman Ghasemi
- Student Research Committee of Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Shamarina Shohaimi
- Department of Biology, Faculty of Science, University Putra Malaysia, Serdang, Selangor, Malaysia
| | - Masoud Mohammadi
- Cellular and Molecular Research Center, Gerash University of Medical Sciences, Gerash, Iran.
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13
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Rajabi S, Kamran L, Joukar KamalAbadi M. Epidemiology of body dysmorphic disorder among adolescents: A study of their cognitive functions. Brain Behav 2022; 12:e01710. [PMID: 35307985 PMCID: PMC9015000 DOI: 10.1002/brb3.1710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Revised: 05/02/2020] [Accepted: 05/16/2020] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Body dysmorphic disorder (BDD) is characterized by a preoccupation with an imagined defect in one's appearance. In case of a slight physical anomaly, the person would experience an excessive concern. This disorder causes cognitive dysfunction. PURPOSE The aim of this study was to examine epidemiology of body dysmorphic disorder among students at secondary schools of the first and second stage in Shiraz, Iran. It also compares executive functions in students with BDD to healthy students. METHODS The Body Dysmorphic Disorder Questionnaire (BDDQ), Stroop Color and Word Test (SCWT),Wisconsin Card Sorting Test (WCST), Tower of London test (ToL), and Trail Making Test (TMT) were measured in participants with BDD (N = 52; Mage = 16.20; SD = 1.03) and healthy control group (N = 52; Mage = 15.91; SD = 0.96). RESULTS The frequency of BDD was significantly higher in women than men (14.8% vs. 6.8%), and its prevalence was 10.4% in total. There was a significant difference between the two groups of students concerning attentional set-shifting, inhibition of cognitive interference, visual-spatial searching, and sequencing, but not problem-solving tasks. CONCLUSIONS Students with BDD have cognitive deficits, which need to be addressed in cognitive rehabilitation.
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Affiliation(s)
- Soran Rajabi
- General Psychology, Persian Gulf University, Bushehr, Iran
| | - Leila Kamran
- General Psychology, Persian Gulf University, Bushehr, Iran
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14
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Sarangi A, Yadav S, Gude J, Amor W. Video Conferencing Dysmorphia: Assessment of Pandemic-Related Body Dysmorphia and Implications for the Post-lockdown Era. Cureus 2022; 14:e22965. [PMID: 35411264 PMCID: PMC8989628 DOI: 10.7759/cureus.22965] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2022] [Indexed: 11/20/2022] Open
Abstract
Background: The coronavirus 2019 (COVID-19) pandemic has led to global effects on human interaction and mental health. The most drastic changes are seen in ways people continue to stay connected with each other. Video-conferencing applications like Zoom gained popularity and have become the primary means of communication for social or work events and meetings. These applications have also in many places replaced face-to-face healthcare visits and have penetrated school-based learning. The long-term implications of this digital technology on self-esteem and body image require further study. Main Body: Video-conferencing applications have led to people being more conscious of their appearance and this has resulted in increased cases of body dysmorphic disorder (BDD). There is increased focus on body appearance and cosmetic procedures to fix minor defects. Although the treatment for BDD is like depression, it requires the personalization of therapy specific to the needs of the patient. Conclusion: In this review, we aim to highlight the impact of the pandemic on body image and the long-term implications of virtual conferencing. The review also highlights available pharmacological and non-pharmacological treatment approaches in the management of body dysmorphic disorder related to virtual video conferencing.
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15
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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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16
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Phillips KA, Kelly MM. Body Dysmorphic Disorder: Clinical Overview and Relationship to Obsessive-Compulsive Disorder. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2021; 19:413-419. [PMID: 35747292 PMCID: PMC9063569 DOI: 10.1176/appi.focus.20210012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 07/07/2021] [Accepted: 08/20/2021] [Indexed: 06/15/2023]
Abstract
Body dysmorphic disorder (BDD), characterized by a distressing or impairing preoccupation with nonexistent or slight defects in appearance, is associated with markedly poor quality of life and high rates of suicidality. Onset of BDD is usually in childhood or adolescence and, unless appropriately treated, tends to be chronic. The first-line pharmacologic approach for both delusional and non-delusional BDD is serotonin reuptake inhibitors (SRIs), often at high doses. SRI augmentation and switching strategies can be effective. The first-line psychotherapy is cognitive-behavioral therapy (CBT) tailored to BDD's unique clinical features. Cosmetic treatment (such as surgery or dermatologic treatment), although received by a majority of patients with BDD, is not recommended. BDD has many similarities to obsessive-compulsive disorder (OCD) and appears closely related to OCD but also has some important differences. This article, which updates a 2015 article on BDD that we published in this journal, provides a clinically focused overview of BDD and its relationship to OCD.
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Affiliation(s)
- Katharine A Phillips
- New York-Presbyterian/Weill Cornell Medical Center, New York (Phillips); Department of Psychiatry, Weill Cornell Medical College, New York (Phillips); U.S. Department of Veterans Affairs VA Bedford Healthcare System, Bedford, Massachusetts (Kelly); Department of Psychiatry, University of Massachusetts Medical School, Worcester (Kelly)
| | - Megan M Kelly
- New York-Presbyterian/Weill Cornell Medical Center, New York (Phillips); Department of Psychiatry, Weill Cornell Medical College, New York (Phillips); U.S. Department of Veterans Affairs VA Bedford Healthcare System, Bedford, Massachusetts (Kelly); Department of Psychiatry, University of Massachusetts Medical School, Worcester (Kelly)
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17
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Morgan-Sowada H, Gamboni C. Needing to be “perfect” to be loved: the intersection of body dysmorphic disorder, sexual identity, and gay culture in gay men. A qualitative study. SEXUAL AND RELATIONSHIP THERAPY 2021. [DOI: 10.1080/14681994.2021.1975672] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
| | - Casey Gamboni
- The Family Institute at Northwestern University, Evanston, IL, USA
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18
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Validation of the body image dimensional assessment in adolescents from Spanish high school. Eat Weight Disord 2021; 26:1749-1756. [PMID: 32876933 DOI: 10.1007/s40519-020-00992-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 08/19/2020] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION There are not many valid instruments to quickly and easily identify body dissatisfaction in adolescents. Most studies have used the Stunkard Rating Scale to assess body image. Nevertheless, this scale has been described as too abrupt and crude for adolescents. AIM Was to validate the body image dimensional assessment (BIDA) questionnaire in a sample of adolescents from Secondary schools of Spain. METHOD The BIDA consists of four items to answer with reference to a series of four silhouettes using a numeric scale that allows the quantification of the degree of body dissatisfaction (BD), sexual body dissatisfaction (SxBD), comparative body dissatisfaction (CBD) and the calculation of the final body dissatisfaction index (BDIndex). The sample included 2059 adolescents, 1132 males and 929 females aged 13.10 ± 0.89. Participants answered the BIDA and then their anthropometrics measurements were taken. RESULTS Reliability test, a convergent test and confirmatory factorial analysis were conducted to validate BIDA instrument. A single factor structure emerged from confirmatory factorial analysis; the BIDA demonstrated adequate internal consistency in adolescents: (CFI > 0.90, TLI > 0.90, α > 0.80). Significant correlations (p < 0.001) emerged between the BIDA indices and all the anthropometric measures. CONCLUSIONS The BIDA questionnaire is a valid and reliable instrument to evaluate body dissatisfaction in Spanish adolescents. LEVEL OF EVIDENCE Level V, descriptive study.
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19
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Pellegrini L, Maietti E, Rucci P, Burato S, Menchetti M, Berardi D, Maina G, Fineberg NA, Albert U. Suicidality in patients with obsessive-compulsive and related disorders (OCRDs): A meta-analysis. Compr Psychiatry 2021; 108:152246. [PMID: 34062378 DOI: 10.1016/j.comppsych.2021.152246] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 05/03/2021] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Previous meta-analyses showed that OCD is associated with a substantial risk of suicidal behaviours. Conclusive rates of suicidal ideation (current and lifetime) and suicide attempts based on pooled prevalence rates have not so far been calculated using meta-analysis for the other DSM-5 Obsessive-Compulsive and Related Disorders (OCRDs). OBJECTIVES This meta-analysis aims to separately calculate the pooled prevalence rates of lifetime suicide attempts and current or lifetime suicidal ideation in BDD, Hoarding Disorder (HD), Skin Picking Disorder (SPD) and Trichotillomania (TTM) and to identify factors associated with increased suicide rates. METHODS Our protocol was pre-registered with PROSPERO (CRD42020164395). A systematic review and meta-analysis following PRISMA reporting guidelines was performed by searching in PubMed/Medline, PsycINFO, Web of Science and CINAHL databases from the date of the first available article to April 20th, 2020. Stata version 15 was used for the statistical analysis. Given the small number of studies in TTM and SPD, the two grooming disorders were grouped together. Meta-analyses of proportions based on random effects (Der-Simonian and Laird method) were used to derive the pooled estimates. RESULTS Thirty-eigth studies (N = 4559 participants) were included: 23 for BDD, 8 for HD, 7 for Grooming Disorders. For BDD, the pooled prevalence of lifetime suicide attempts, current and lifetime suicidal ideation was, respectively 35.2% (CI:23.4-47.8), 37.2% (CI:23.8-51.6) and 66.1% (CI:53.5-77.7). For HD, the pooled prevalence of lifetime suicide attempts, current and lifetime suicidal ideation was 24.1% (CI:12.8-37.6), 18.4% (CI:10.2-28.3) and 38.3% (CI:35.0-41.6), respectively. For Grooming Disorders, the pooled prevalence of lifetime suicide attempts and current suicidal ideation were 13.3% (CI:5.9-22.8) and 40.4% (CI:35.7-45.3), respectively (no data available for lifetime suicidal ideation). CONCLUSIONS The OCRDs as a group are associated with relatively high rates of suicidal behaviour. Through indirect comparisons, we infer that BDD has the greatest risk. Comorbid substance abuse, possibly reflecting poor underlying impulse control, is associated with higher rates of suicidal behaviour in BDD. Our data emphasize the need for clinicians to consider the risk of suicidal behaviour in the management of patients presenting with all forms of OCRDs.
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Affiliation(s)
- Luca Pellegrini
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK; Hertfordshire Partnership University NHS Foundation Trust, Welwyn Garden City, UK; Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy.
| | - Elisa Maietti
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy
| | - Paola Rucci
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy
| | - Sofia Burato
- Department of Medicine, Surgery and Health Sciences, UCO Clinica Psichiatrica, University of Trieste, Trieste, Italy
| | - Marco Menchetti
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy
| | - Domenico Berardi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy
| | - Giuseppe Maina
- Rita Levi Montalcini Department of Neuroscience, University of Torino, Italy
| | - Naomi A Fineberg
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK; Hertfordshire Partnership University NHS Foundation Trust, Welwyn Garden City, UK; University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Umberto Albert
- Department of Medicine, Surgery and Health Sciences, UCO Clinica Psichiatrica, University of Trieste, Trieste, Italy
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20
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Hanley SM, Bhullar N, Wootton BM. Development and initial validation of the Body Dysmorphic Disorder Scale for Youth. CLIN PSYCHOL-UK 2021. [DOI: 10.1111/cp.12225] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Sarah M. Hanley
- University of New England, Armidale, New South Wales, Australia,
| | - Navjot Bhullar
- University of New England, Armidale, New South Wales, Australia,
| | - Bethany M. Wootton
- University of New England, Armidale, New South Wales, Australia,
- University of Technology Sydney, Sydney, New South Wales, Australia,
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21
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Collison J, Harrison L. Prevalence of Body Dysmorphic Disorder and Predictors of Body Image Disturbance in Adolescence. ADOLESCENT PSYCHIATRY 2020. [DOI: 10.2174/2210676610999200420112129] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background:
Body dysmorphic disorder encompasses a range of cognitive and
behavioural states stemming from distressing, negative evaluations of one’s appearance. Despite
the seriousness of this condition, little is known about who is likely to receive a diagnosis
and more importantly what the putative risk factors are. This is particularly so among
adolescent samples, where the extant literature is considerably smaller.
Objective:
This study had two broad aims: to estimate the prevalence of body dysmorphic
disorder within a young-adult population, and to examine the predictors of body image disturbance.
Methods:
Three-hundred and four adolescents (242 females; Mage = 17.68) completed the
Body Image Disturbance Questionnaire and Body Dysmorphic Disorder Questionnaire,
along with measures of clinical psychopathology, self-esteem, experiences of parenting, and
bullying.
Results:
Body dysmorphic disorder was present in 3.9% of the sample, which is in line with
previous estimates among adolescents. More interestingly, results indicated that instances of
high stress, low self-esteem, and reported experiences of bullying were able to predict 48%
of body image dissatisfaction.
Conclusions:
Psychological interventions should be directed towards adolescents with body
image concerns, especially if they also report bullying, elevated stress, or diminished selfesteem.
However, additional research is still warranted to gain an increasingly accurate understanding
of the prevalence of body dysmorphic disorder and who is susceptible to developing
this disorder and how we can best serve these individuals in the community.
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Affiliation(s)
- James Collison
- School of Psychology, Western Sydney University, Sydney, New South Wales, Australia
| | - Lisa Harrison
- School of Psychology, Western Sydney University, Sydney, New South Wales, Australia
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22
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Oakes A, Collison J, Milne‐home J. Repetitive, Safe, and Automatic: The Experience of Appearance‐Related Behaviours in Body Dysmorphic Disorder. AUSTRALIAN PSYCHOLOGIST 2020. [DOI: 10.1111/ap.12247] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Alissa Oakes
- School of Social Sciences and Psychology, Western Sydney University,
| | - James Collison
- School of Social Sciences and Psychology, Western Sydney University,
| | - Jo Milne‐home
- School of Social Sciences and Psychology, Western Sydney University,
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Aouizerate B, Pujol H, Grabot D, Faytout M, Suire K, Braud C, Auriacombe M, Martin D, Baudet J, Tignol J. Body dysmorphic disorder in a sample of cosmetic surgery applicants. Eur Psychiatry 2020; 18:365-8. [PMID: 14643566 DOI: 10.1016/j.eurpsy.2003.02.001] [Citation(s) in RCA: 76] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
AbstractBody dysmorphic disorder (B.D.D.) consists of a preoccupation with an imagined or slight physical defect. This study is the first European report on prevalence and several clinical and functional characteristics of patients with B.D.D. in a cosmetic surgery setting. Comparisons with defect- and severity-matched subjects without B.D.D. were also performed.
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Affiliation(s)
- B Aouizerate
- Service Universitaire de Psychiatrie d'Adultes, Centre Hospitalier Charles Perrens, Université Victor Segalen (Bordeaux 2), Centre Carreire, 121, rue de la Béchade, 33076 cedex, Bordeaux, France
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24
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Schulte J, Schulz C, Wilhelm S, Buhlmann U. Treatment utilization and treatment barriers in individuals with body dysmorphic disorder. BMC Psychiatry 2020; 20:69. [PMID: 32070300 PMCID: PMC7027080 DOI: 10.1186/s12888-020-02489-0] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Accepted: 02/10/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although effective treatments are available, most individuals with body dysmorphic disorder (BDD) do not receive an appropriate diagnosis or treatment. We aimed to examine treatment utilization and barriers to treatment, and to identify associated socio-demographic and clinical characteristics. METHODS German individuals completed an online self-report survey of appearance concerns. A sample of N = 429 individuals met criteria for BDD. We examined the frequency of treatment utilization and barriers, analyzed comparisons between treated and untreated individuals and assessed the relationships of socio-demographic and clinical features with mental health treatment utilization and treatment barriers, respectively. RESULTS Only 15.2% of the individuals with BDD had been diagnosed with BDD, and lifetime rates of mental health treatment were low (39.9%). Individuals endorsed multiple barriers to mental health treatment, especially shame, low perceived need and a preference for cosmetic and medical treatments. Associated features were identified, including age, a BDD diagnosis, body dysmorphic symptom severity, a likely major depressive disorder, prior cosmetic surgery, and insight. CONCLUSIONS The results of this largest study to date highlight that BDD is still underrecognized and undertreated even in a country with extensive mental health care and few financial barriers. We discuss modifiable factors and strategies to foster awareness of BDD in sufferers and professionals to improve treatment dissemination and to reduce treatment barriers.
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Affiliation(s)
- Johanna Schulte
- grid.5949.10000 0001 2172 9288Institute of Psychology, University of Münster, Fliednerstraße 21, 48149 Münster, Germany
| | - Claudia Schulz
- grid.5949.10000 0001 2172 9288Institute of Psychology, University of Münster, Fliednerstraße 21, 48149 Münster, Germany ,Present address: AMEOS Hospital Osnabrück, Knollstraße 31, Osnabrück, Germany
| | - Sabine Wilhelm
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Simches Research Building, 185 Cambridge Street, Boston, MA 02114 USA
| | - Ulrike Buhlmann
- Institute of Psychology, University of Münster, Fliednerstraße 21, 48149, Münster, Germany.
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Pillai VT, Sündermann O. Racial teasing and body dysmorphic disorder symptoms – A cross-sectional study of Asian ethnic groups in Singapore. ASIA PACIFIC JOURNAL OF COUNSELLING AND PSYCHOTHERAPY 2019. [DOI: 10.1080/21507686.2019.1708425] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- V Thivya Pillai
- Department of Psychology, National University of Singapore, 20 Lower Kent Ridge, 119080, Singapore
| | - Oliver Sündermann
- Department of Psychology, National University of Singapore, 20 Lower Kent Ridge, 119080, Singapore
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Abstract
A new measure specifically designed for adolescents to assess body dysmorphic disorder (BDD) symptoms is needed to identify youth who could benefit from intervention to reduce their BDD-related symptomology. To address this gap, the Multidimensional Youth Body Dysmorphic Inventory (MY BODI) was developed and the psychometric properties were evaluated. Following development and expert assessment, Australian secondary school students (N = 582; 55% female; Mage = 13.62, SD = 1.59, aged 11 to 18 years, grades 7 to 12) completed a survey with the new items and validation measures. Results from the factor analysis supported a 3-factor, 21-items measure, which aligned with the DSM-5 diagnostic criteria of Impairment/avoidance, Preoccupation/repetitive behaviours, and Insight/distress. Supporting the convergent validity of the measure, the MY BODI total score and sub-scale scores correlated with measures of BDD symptoms, including the Appearance Anxiety Inventory (AAI) and Body Dysmorphic Disorder Questionnaire-Adolescent Version (BDDQ-A). This study provides preliminary validation of the MY BODI, a self-report measure of BDD symptoms and symptom severity, using a response set aimed to facilitate more reliable reporting, which may identify risk for BDD, and symptoms of BDD.
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27
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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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28
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Body dysmorphic disorder and its relationship to sexuality, impulsivity, and addiction. Psychiatry Res 2019; 273:260-265. [PMID: 30658211 PMCID: PMC6420059 DOI: 10.1016/j.psychres.2019.01.036] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 12/13/2018] [Accepted: 01/10/2019] [Indexed: 01/22/2023]
Abstract
This study sought to examine the prevalence of probable body dysmorphic disorder (BDD) in a university sample and its associated physical and mental health correlates. A 156-item anonymous online survey was distributed via email to a randomly chosen subset of 10,000 university students, at a large public university. The survey queried current use of alcohol and drugs, psychological and physical status, academic performance, sexual behaviors, and questionnaire-based measures of impulsivity and compulsivity. A total of 3,459 participants (59.1% female) completed the survey and were included in the analysis. The overall prevalence of BDD was 1.7% (n = 59). Compared to students without BDD, those with BDD were significantly more likely to endorse symptoms of compulsive sexual behavior, depression, PTSD, and anxiety. Questionnaire-based measures revealed higher levels of both compulsivity and impulsivity associated with BDD. BDD appears to be common in young adults, and is associated with specific mental health comorbidities, as well as both impulsive and compulsive traits. Clinicians should be aware of the presentation of BDD and screen for it in primary care and mental health settings.
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29
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Mohajerin B, Bakhtiyar M, Olesnycky OS, Dolatshahi B, Motabi F. Application of a transdiagnostic treatment for emotional disorders to body dysmorphic disorder: A randomized controlled trial. J Affect Disord 2019; 245:637-644. [PMID: 30445389 DOI: 10.1016/j.jad.2018.11.058] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 09/14/2018] [Accepted: 11/03/2018] [Indexed: 11/20/2022]
Abstract
BACKGROUND Body dysmorphic disorder (BDD) is a common disorder which is associated with a high rate of comorbidity and functional impairment. Although research shows that cognitive-behavioral therapy can be an efficacious treatment for BDD, there is growing evidence that dysregulated emotion is a core deficit. The Unified Protocol for the Transdiagnostic Treatment of Emotional Disorders (UP) is a transdiagnostic, emotion focused cognitive-behavioral therapy protocol that has been developed to target emotion regulation processes that play an important role in the development and maintenance of many emotional disorders METHODS: : In the present study, 128 patients meeting criteria for BDD were randomized to either the UP (n = 64) or waitlist/treatment-as-usual (WL/TAU) condition. Diagnoses were determined using semi-structural interviews and patients also completed the Brown Assessment of Beliefs Scale (BABS), the Appearance Anxiety Inventory (AAI), the Difficulties in Emotion Regulation Scale (DERS), the Beck Depression Inventory (BDI) and the Clinical Global Impression (CGI). RESULTS Repeated measure ANOVA indicated that the UP significantly decreased depression, BDD symptoms and body-related anxiety, as well as significantly improving emotional regulation all with large effect sizes compared to the TAU/WL condition. Treatment gains as well as remission of comorbid conditions were maintained at the three-month follow-up. LIMITATIONS Our study limitations include restricted follow-up periods and excluding participants who were actively suicidal. CONCLUSIONS To our knowledge, this is the first examination of the UP for BDD, and results suggest that this disorder shares common mechanisms with other disorders of emotion, and that the UP may be an additional efficacious treatment for this condition.
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Affiliation(s)
- Banafsheh Mohajerin
- Department of Clinical Psychology, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Maryam Bakhtiyar
- Department of Clinical Psychology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Olenka S Olesnycky
- Center for Anxiety and Related Disorders, Boston University, Massachusetts, USA
| | - Behrouz Dolatshahi
- Department of Psychology, Iranian Research Center for Substance Abuse and Dependence, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Fereshteh Motabi
- Family Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Enander J, Ljótsson B, Anderhell L, Runeborg M, Flygare O, Cottman O, Andersson E, Dahlén S, Lichtenstein L, Ivanov VZ, Mataix-Cols D, Rück C. Long-term outcome of therapist-guided internet-based cognitive behavioural therapy for body dysmorphic disorder (BDD-NET): a naturalistic 2-year follow-up after a randomised controlled trial. BMJ Open 2019; 9:e024307. [PMID: 30647044 PMCID: PMC6340432 DOI: 10.1136/bmjopen-2018-024307] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES Most patients with body dysmorphic disorder (BDD) do not receive evidence-based treatment. A randomised controlled trial (RCT) has found that a therapist-guided internet-based cognitive-behavioural therapy (CBT) programme for BDD (BDD-NET) can be delivered safely via the internet with significant improvements in BDD symptom severity in the short term. The purpose of this study was to evaluate if the therapeutic gains of BDD-NET are maintained 2 years after treatment. SETTING Academic medical centre. PARTICIPANTS A naturalistic 2-year follow-up study of the 88 self-referred adult outpatients with a diagnosis of BDD that had received BDD-NET within the context of the RCT. PRIMARY AND SECONDARY OUTCOMES The primary outcome was the BDD-Yale-Brown Obsessive-Compulsive Scale (YBOCS). Responder status was defined as a ≥30% reduction in symptoms. Remission was defined as no longer meeting Diagnostic and Statistical Manual of Mental Disorders 5th edition criteria for BDD. Secondary outcomes included measures of depression, global functioning and quality of life. RESULTS The efficacy of BDD-NET was sustained long- term, with further improvements observed on the BDD-YBOCS during the follow-up period. At follow-up, 69% (95% CI 57% to 80%) were classified as responders and 56% (95% CI 43% to 69%) were in remission. Gains on depressive symptoms and global functioning were also sustained but not quality of life. A majority of participants reported that the main reason for seeking help for their BDD was the possibility to access the treatment from home. CONCLUSION BDD-NET is an effective treatment for BDD, and the patients' gains are maintained in the long term. BDD-NET has the potential to increase access to CBT and may lower the threshold for BDD sufferers to seek help in the first place. TRIAL REGISTRATION NUMBER NCT02010619.
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Affiliation(s)
- Jesper Enander
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Brjánn Ljótsson
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Lina Anderhell
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Martin Runeborg
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Oskar Flygare
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Oskar Cottman
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Erik Andersson
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Sofia Dahlén
- Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - Linn Lichtenstein
- Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - Volen Z Ivanov
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - David Mataix-Cols
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - Christian Rück
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
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31
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Abstract
Body dysmorphic disorder (BDD), also known as dysmorphophobia, is a condition that consists of a distressing or impairing preoccupation with imagined or slight defects in appearance, associated repetitive behaviors and where insight regarding the appearance beliefs is often poor. Despite the fact it is relatively common, occurs around the world and can have a significant impact on a sufferer's functioning, levels of distress, and risk of suicide, the diagnosis is often missed. In this review, we outline the clinical features of BDD including as characterized in the newly published World Health Organization's International Classification of Diseases 11, review the prevalence of BDD within different settings, and highlight the reasons why BDD may be underdiagnosed even within psychiatric settings. We additionally review the cultural considerations for BDD and finally discuss the evidence-based treatment approaches for BDD, particularly the use of serotonin reuptake inhibitor medication and cognitive behavioral therapy.
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Affiliation(s)
| | - David Veale
- South London and Maudsley NHS Foundation Trust, London, UK.,Institute of Psychiatry, Psychology and Neurosciences, King's College, London, UK
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32
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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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33
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Abstract
Body dysmorphic disorder is an obsessive-compulsive spectrum disorder involving a perceived defect in physical appearance that most commonly develops in early adolescence and causes significant functional impairment and suicidality at much higher rates than in affected adults. Patients may also present with subthreshold body dysmorphic disorder or obsessive concerns over a diagnosable dermatologic condition, both of which can present similarly to body dysmorphic disorder. Pediatric dermatologists can play an important role in detecting body dysmorphic disorder and body dysmorphic disorder-like symptoms, which may occur in as many as 20% of dermatology patients. Greater awareness of the prevalence, clinical presentation, and effect of these symptoms, as well as better screening tools and greater collaboration with our mental health colleagues, may lead to earlier, more effective intervention.
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Affiliation(s)
- Margaret H Dennin
- Pritzker School of Medicine, University of Chicago, Chicago, IL, USA
| | - Margaret S Lee
- Department of Dermatology, School of Medicine, Boston University, Boston, MA, USA.,Department of Pediatrics, School of Medicine, Boston University, Boston, MA, USA
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Buckley V, Krebs G, Bowyer L, Jassi A, Goodman R, Clark B, Stringaris A. Innovations in Practice: Body dysmorphic disorder in youth - using the Development and Well-Being Assessment as a tool to improve detection in routine clinical practice. Child Adolesc Ment Health 2018; 23:291-294. [PMID: 32677303 DOI: 10.1111/camh.12268] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/25/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND Body Dysmorphic Disorder (BDD) is a distressing disorder that is widely underdetected in youth. This study aimed to examine the potential utility of the Development and Well-Being Assessment (DAWBA) as a tool to improve recognition of BDD in routine clinical practice. METHODS One hundred and sixty-one patients assessed across two national and specialist child and adolescent mental health services, one specialising in mood disorders and one specialising in obsessive compulsive disorder and BDD, were included in this study. Results from the DAWBA were compared with clinical diagnosis to examine the utility of the DAWBA in detecting BDD. RESULTS Only 27% of participants who received a diagnosis of BDD at assessment had been referred with concerns about appearance anxiety suggesting significant under detection in youth mental health services. Using the single-screener question on the DAWBA, it was possible to correctly identify 97% of cases with BDD. CONCLUSIONS Body dysmorphic disorder often goes undetected in routine clinical practice. The DAWBA shows promise as a tool for helping clinicians to accurately detect BDD in routine clinical practice.
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Affiliation(s)
- Vanessa Buckley
- National & Specialist CAMHS Mood Disorders Clinic, South London and Maudsley NHS Foundation Trust, London, UK
| | - Georgina Krebs
- National & Specialist OCD, BDD and Related Disorders Clinic for Young People, South London & Maudsley NHS Foundation Trust, London, UK.,Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Laura Bowyer
- National & Specialist OCD, BDD and Related Disorders Clinic for Young People, South London & Maudsley NHS Foundation Trust, London, UK
| | - Amita Jassi
- National & Specialist OCD, BDD and Related Disorders Clinic for Young People, South London & Maudsley NHS Foundation Trust, London, UK
| | - Robert Goodman
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Bruce Clark
- National & Specialist OCD, BDD and Related Disorders Clinic for Young People, South London & Maudsley NHS Foundation Trust, London, UK
| | - Argyris Stringaris
- Mood Brain and Development Unit, Emotion & Development Branch, National Institute of Mental Health, Bethesda, MD, USA
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35
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Neziroglu F, Bonasera B, Curcio D. An Intensive Cognitive Behavioral Treatment for Body Dysmorphic Disorder. Clin Case Stud 2018. [DOI: 10.1177/1534650118782439] [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: 11/16/2022]
Abstract
Body dysmorphic disorder affects 2.4% of the U.S. adult population, with the most common age of onset between 12 and 13 years. However, research in the area of adolescent BDD is minimal. This case study describes the intensive approach of treatment used for a 14-year-old female diagnosed with BDD. Treatment included an individualized course of cognitive behavioral therapy and exposure and response prevention. BDD symptoms decreased after 27 full-day sessions in an outpatient clinic. In addition, general levels of anxiety decreased and level of functioning increased. Tailoring standard treatments and utilizing developmentally appropriate techniques were significant factors for the adolescent’s success. Implications for future research and treatment are discussed.
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Abstract
Body dysmorphic disorder (BDD) is a disabling illness with a high worldwide prevalence. Patients demonstrate a debilitating preoccupation with one or more perceived defects, often marked by poor insight or delusional convictions. Multiple studies have suggested that selective serotonin reuptake inhibitors and various cognitive behavioral therapy modalities are effective first-line treatments in decreasing BDD severity, relieving depressive symptoms, restoring insight, and increasing quality of life. Selective serotonin reuptake inhibitors have also recently been shown to be effective for relapse prevention. This review provides a comprehensive summary of the current understanding of BDD, including its clinical features, epidemiology, genetics, and current treatment modalities. Additional research is needed to fully elucidate the relationship between BDD and comorbid illnesses such as obsessive–compulsive-related disorders and depression and to develop therapies for refractory patients and those who have contraindications for pharmacological intervention.
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Affiliation(s)
- Kevin Hong
- Department of Psychiatry and Behavioral Sciences, Autism and Obsessive-Compulsive Spectrum Program, Anxiety and Depression Program, Albert Einstein College of Medicine, Montiefiore Medical Center, The Bronx, New York, USA
| | - Vera Nezgovorova
- Department of Psychiatry and Behavioral Sciences, Autism and Obsessive-Compulsive Spectrum Program, Anxiety and Depression Program, Albert Einstein College of Medicine, Montiefiore Medical Center, The Bronx, New York, USA
| | - Eric Hollander
- Department of Psychiatry and Behavioral Sciences, Autism and Obsessive-Compulsive Spectrum Program, Anxiety and Depression Program, Albert Einstein College of Medicine, Montiefiore Medical Center, The Bronx, New York, USA
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37
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Blum AW, Redden SA, Grant JE. Neurocognitive Functioning in Young Adults with Subclinical Body Dysmorphic Disorder. Psychiatr Q 2018; 89:45-52. [PMID: 28367586 DOI: 10.1007/s11126-017-9510-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Despite reasonable knowledge of body dysmorphic disorder (BDD), little is known of its cognitive antecedents. In this study, we evaluated executive functioning and decision-making in people at risk of developing BDD using neuropsychological tests. Participants were non-treatment seeking volunteers (18-29 years) recruited from the general community, and split into two groups: those "at risk" of developing BDD (N = 5) and controls (N = 82). Participants undertook the One-Touch Stockings of Cambridge, Cambridge Gamble and Spatial Working Memory tasks and were assessed with the Body Dysmorphic Disorder Questionnaire. Results showed that the at-risk subjects performed significantly worse on a measure of executive function, whereas measures of risk-seeking behavior, quality of decision-making, and spatial working memory were largely intact. The findings suggest that selective cognitive dysfunction may already be present in terms of executive functioning in those at risk of developing BDD, even before psychopathology arises.
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Affiliation(s)
- Austin W Blum
- Department of Psychiatry & Behavioral Neuroscience, Pritzker School of Medicine, University of Chicago, 5841 S. Maryland Avenue, MC-3077, Chicago, IL, 60637, USA.
| | - Sarah A Redden
- Department of Psychiatry & Behavioral Neuroscience, Pritzker School of Medicine, University of Chicago, 5841 S. Maryland Avenue, MC-3077, Chicago, IL, 60637, USA
| | - Jon E Grant
- Department of Psychiatry & Behavioral Neuroscience, Pritzker School of Medicine, University of Chicago, 5841 S. Maryland Avenue, MC-3077, Chicago, IL, 60637, USA
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38
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Schneider SC, Baillie AJ, Mond J, Turner CM, Hudson JL. The classification of body dysmorphic disorder symptoms in male and female adolescents. J Affect Disord 2018; 225:429-437. [PMID: 28858657 DOI: 10.1016/j.jad.2017.08.062] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Revised: 08/10/2017] [Accepted: 08/20/2017] [Indexed: 12/19/2022]
Abstract
BACKGROUND Body dysmorphic disorder (BDD) was categorised in DSM-5 within the newly created 'obsessive-compulsive and related disorders' chapter, however this classification remains subject to debate. Confirmatory factor analysis was used to test competing models of the co-occurrence of symptoms of BDD, obsessive-compulsive disorder, unipolar depression, anxiety, and eating disorders in a community sample of adolescents, and to explore potential sex differences in these models. METHODS Self-report questionnaires assessing disorder symptoms were completed by 3149 Australian adolescents. The fit of correlated factor models was calculated separately in males and females, and measurement invariance testing compared parameters of the best-fitting model between males and females. RESULTS All theoretical models of the classification of BDD had poor fit to the data. Good fit was found for a novel model where BDD symptoms formed a distinct latent factor, correlated with affective disorder and eating disorder latent factors. Metric non-invariance was found between males and females, and the majority of factor loadings differed between males and females. Correlations between some latent factors also differed by sex. LIMITATIONS Only cross-sectional data were collected, and the study did not assess a broad range of DSM-5 defined eating disorder symptoms or other disorders in the DSM-5 obsessive-compulsive and related disorders chapter. CONCLUSIONS This study is the first to statistically evaluate competing models of BDD classification. The findings highlight the unique features of BDD and its associations with affective and eating disorders. Future studies examining the classification of BDD should consider developmental and sex differences in their models.
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Affiliation(s)
- Sophie C Schneider
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia
| | - Andrew J Baillie
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia; NHMRC Centre of Research Excellence in Mental Health and Substance Use, Australia
| | - Jonathan Mond
- Centre for Rural Health, School of Health Sciences, University of Tasmania, Launceston, Australia; Centre for Health Research, School of Medicine, Western Sydney University, Sydney, Australia
| | - Cynthia M Turner
- School of Psychology, Australian Catholic University, Brisbane, Australia
| | - Jennifer L Hudson
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia.
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39
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Brohede S, Wyon Y, Wingren G, Wijma B, Wijma K. Body dysmorphic disorder in female Swedish dermatology patients. Int J Dermatol 2017; 56:1387-1394. [PMID: 28960272 DOI: 10.1111/ijd.13739] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 06/13/2017] [Accepted: 07/22/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Individuals with body dysmorphic disorder (BDD) are highly distressed and impaired owing to perceived defects in their physical appearance that are not noticeable to others. They are frequently concerned about their skin and often present to dermatologists rather than psychiatrists. However, BDD patients attending dermatology clinics may be at risk of not receiving an appropriate assessment and beneficial treatment. The aims of this study were to estimate the BDD prevalence rate among Swedish female dermatology patients and to assess the psychological condition of BDD patients compared to that of other dermatology patients. METHODS The occurrence of BDD was estimated using the Body Dysmorphic Disorder Questionnaire (BDDQ), a validated self-report measure for BDD. Symptoms of depression and anxiety were measured by the Hospital Anxiety and Depression Scale (HADS), and quality of life was assessed using the Dermatology Life Quality Index (DLQI). RESULTS The prevalence rate of BDD among female Swedish dermatology patients was 4.9% (95% CI 3.2-7.4). Anxiety (HADS A ≥ 11) was 4-fold more commonly reported by patients with positive BDD screening (48% vs. 11%), and depression (HADS D ≥ 11) was over 10-fold more common in patients with positive BDD screening (19% vs. 1.8%) (P < 0.001). The median DLQI score was 18 in the BDD group, compared to a score of 4 in the non-BDD group (P < 0.001). CONCLUSIONS Our results indicate that BDD is fairly common among female Swedish dermatology patients (4.9%) and that BDD patients have high levels of depression and anxiety and severely impaired quality of life.
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Affiliation(s)
- Sabina Brohede
- Unit of Medical Psychology, Department of Clinical and Experimental Medicine, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden.,Department of Paediatrics and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Yvonne Wyon
- Department of Dermatology and Venereology and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Gun Wingren
- Occupational and Environmental Medicine, Department of Clinical and Experimental Medicine, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden
| | - Barbro Wijma
- Gender and Medicine, Department of Clinical and Experimental Medicine, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden
| | - Klaas Wijma
- Unit of Medical Psychology, Department of Clinical and Experimental Medicine, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden
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Schneider SC, Turner CM, Mond J, Hudson JL. Prevalence and correlates of body dysmorphic disorder in a community sample of adolescents. Aust N Z J Psychiatry 2017; 51:595-603. [PMID: 27585880 DOI: 10.1177/0004867416665483] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Body dysmorphic disorder typically begins in adolescence, yet little is known about the prevalence and correlates of the disorder in this age group. The current study aimed to explore the presenting features of adolescents meeting probable criteria for body dysmorphic disorder in a large community sample, and compare levels of comorbid psychopathology, quality of life and mental health service use between adolescents with probable body dysmorphic disorder and those without. METHOD Questionnaires were completed at school by 3149 adolescents: 63% male, aged 12-18 years ( M = 14.58). These assessed Diagnostic and Statistical Manual of Mental Disorders (4th ed.) body dysmorphic disorder criteria, past mental health service use and symptoms of body dysmorphic disorder, anxiety, depression, obsessive-compulsive disorder and eating disorders. In male participants, additional measures assessed quality of life, muscularity concerns, emotional symptoms, peer problems, conduct problems and hyperactivity. RESULTS The prevalence of probable body dysmorphic disorder was 1.7%; there was no sex difference in prevalence, but older adolescents reported higher prevalence than younger adolescents. Probable body dysmorphic disorder participants reported substantially elevated levels of psychopathology, quality of life impairment and mental health service use compared to non-body dysmorphic disorder participants. CONCLUSIONS The prevalence of body dysmorphic disorder in adolescents is similar to adult samples, and probable body dysmorphic disorder is associated with comorbidity, distress and functional impairment in a community sample. Further research is required to better understand the presentation of body dysmorphic disorder in adolescents, and to improve diagnosis and treatment.
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Affiliation(s)
- Sophie C Schneider
- 1 Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, NSW, Australia
| | - Cynthia M Turner
- 2 School of Psychology, The University of Queensland, Brisbane, QLD, Australia
| | - Jonathan Mond
- 1 Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, NSW, Australia
| | - Jennifer L Hudson
- 1 Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, NSW, Australia
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Schneider SC, Mond J, Turner CM, Hudson JL. Sex Differences in the Presentation of Body Dysmorphic Disorder in a Community Sample of Adolescents. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2017; 48:516-528. [PMID: 28541768 DOI: 10.1080/15374416.2017.1321001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The current study sought to explore sex differences in the presentation of probable full-syndrome and subthreshold body dysmorphic disorder (BDD) in adolescents from an Australian community sample. Specifically, it examined sex differences in the types of BDD symptoms endorsed, body areas of concern, and the association with elevated symptoms of comorbid disorders. In male participants, it also compared the presenting features of those with and without muscle dysmorphia. Of 3,149 adolescents assessed using self-report questionnaires, 162 (5.1%) reported probable BDD (57.4% male, Mage = 14.89 years, SD = 1.33, primarily from Oceanian or European cultural backgrounds). All participants completed measures of BDD symptoms; past mental health service use; and symptoms of anxiety, depression, obsessive-compulsive disorder, and eating disorders. Male participants completed additional measures of quality of life, drive for muscularity, hyperactivity, conduct disorder, peer problems, and emotional symptoms. Controlling for demographic variables that varied by sex, male and female participants reported similar BDD symptom severity, rates of most elevated comorbid symptoms, and mental health service use. Concerns regarding muscularity, breasts/nipples, and thighs differed by sex. Female participants were more likely than male participants to report elevated generalized anxiety symptoms. In male participants, muscle dysmorphia was not associated with greater severity across most measures. The presenting features of BDD were broadly similar in male and female participants, and in male participants with and without muscle dysmorphia. Future research should seek to increase mental health service use in adolescents with BDD and to improve rates of disorder detection in clinical settings.
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Affiliation(s)
| | - Jonathan Mond
- b School of Medicine , Western Sydney University.,c School of Health Sciences , University of Tasmania
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Schneider SC, Mond J, Turner CM, Hudson JL. Subthreshold body dysmorphic disorder in adolescents: Prevalence and impact. Psychiatry Res 2017; 251:125-130. [PMID: 28199910 DOI: 10.1016/j.psychres.2017.01.085] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Revised: 11/09/2016] [Accepted: 01/29/2017] [Indexed: 11/24/2022]
Abstract
The aim of the current study was to establish the prevalence of subthreshold body dysmorphic disorder (subthreshold-BDD) in a community sample of adolescents, and to compare disorder correlates in individuals with subthreshold-BDD to those with probable full-syndrome BDD (probable-BDD) and those without BDD (non-BDD). Self-report questionnaires assessing DSM-IV BDD criteria, past mental health service use, and symptoms of body dysmorphic disorder, anxiety, depression, obsessive-compulsive disorder and eating disorders, were completed by 3149 Australian high school students (mean age =14.6 years, 63.5% male). Male participants also completed measures assessing quality of life, muscularity concerns, emotional symptoms, conduct problems, hyperactivity, and peer problems. The prevalence of subthreshold-BDD was 3.4%, and probable-BDD was 1.7%. Compared to the non-BDD group, subthreshold-BDD was associated with elevated symptoms of comorbid psychopathology and greater past mental health service use, and in male-only measures, with poorer quality of life and elevated muscularity concerns. Subthreshold-BDD participants reported significantly lower mental health service use, and fewer symptoms of depression, eating disorders, and hyperactivity than probable-BDD participants, however, other comorbid symptoms did not differ significantly between these groups. These findings indicate that subthreshold-BDD is associated with substantial difficulties for adolescents in the general community. BDD screening should include subthreshold presentations, as these may be an important target for early intervention programs.
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Affiliation(s)
- Sophie C Schneider
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia
| | - Jonathan Mond
- Centre for Health Research, School of Medicine, Western Sydney University, Sydney, Australia; Centre for Rural Health, School of Health Sciences, University of Tasmania, Launceston, Australia
| | - Cynthia M Turner
- School of Psychology, Australian Catholic University, Brisbane, Australia
| | - Jennifer L Hudson
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia.
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Body dysmorphic disorder: history and curiosities. Wien Med Wochenschr 2017; 167:5-7. [DOI: 10.1007/s10354-017-0544-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 01/18/2017] [Indexed: 11/26/2022]
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Schneider SC, Storch EA. Improving the Detection of Body Dysmorphic Disorder in Clinical Practice. J Cogn Psychother 2017; 31:230-241. [PMID: 32755898 DOI: 10.1891/0889-8391.31.4.230] [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: 11/25/2022]
Abstract
The aim of this article is to raise awareness of the underdiagnosis of body dysmorphic disorder (BDD) in clinical practice and provide suggestions to overcome key barriers to BDD detection. Disclosure of BDD symptoms is uncommon during routine assessments but can be increased by asking specifically about such symptoms. When BDD symptoms are present, it is important to differentiate them from anxiety, depression, obsessive-compulsive disorder, and eating disorders, which may present with some similarities and are commonly comorbid with BDD. Assessment of BDD should be sensitive to issues of poor insight, elevated suicide risk, subthreshold BDD presentations, and the possibility of BDD by proxy. Furthermore, assessment should consider the potential impact of age, gender, ethnicity, and minor physical defects on the presentation of BDD. Improving the assessment of BDD in routine clinical practice will enhance disclosure, improve case conceptualization, and provide the opportunity to deliver appropriate treatment for this underdiagnosed and often serious disorder.
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Affiliation(s)
- Sophie C Schneider
- Department of Pediatrics, University of South Florida, St. Petersburg, Florida
| | - Eric A Storch
- University of South Florida, St. Petersburg, Florida.,Rogers Behavioral Health, Tampa, Florida.,Johns Hopkins All Children's Hospital, St. Petersburg, Florida
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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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Prevalence and Characteristics of Body Dysmorphic Disorder Among Patients in a Partial Hospital Program. J Nerv Ment Dis 2016; 204:554-7. [PMID: 27362701 DOI: 10.1097/nmd.0000000000000543] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Body dysmorphic disorder (BDD) is a common disorder that is usually associated with impaired functioning and high levels of suicidality. The current study is the first to assess prevalence of BDD among patients in a partial hospital program and compare patients with and without BDD on demographic and clinical variables. Participants were 207 patients with a variety of Axis I diagnoses. Prevalence of current BDD was 7.2%, and a diagnosis of BDD did not predict worse treatment outcome in the program. Patients with current BDD were more likely to be female and younger and have more comorbid diagnoses than patients without current BDD. No other significant differences were found at baseline between patients with and without current BDD. Results indicate that BDD is relatively common among patients in partial hospital programs and that such programs may be as beneficial to patients with BDD as to other patients.
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Enander J, Andersson E, Mataix-Cols D, Lichtenstein L, Alström K, Andersson G, Ljótsson B, Rück C. Therapist guided internet based cognitive behavioural therapy for body dysmorphic disorder: single blind randomised controlled trial. BMJ 2016; 352:i241. [PMID: 26837684 PMCID: PMC4737850 DOI: 10.1136/bmj.i241] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES To evaluate the efficacy of therapist guided internet based cognitive behavioural therapy (CBT) programme for body dysmorphic disorder (BDD-NET) compared with online supportive therapy. DESIGN A 12 week single blind parallel group randomised controlled trial. SETTING Academic medical centre. PARTICIPANTS 94 self referred adult outpatients with a diagnosis of body dysmorphic disorder and a modified Yale-Brown obsessive compulsive scale (BDD-YBOCS) score of ≥ 20. Concurrent psychotropic drug treatment was permitted if the dose had been stable for at least two months before enrolment and remained unchanged during the trial. INTERVENTIONS Participants received either BDD-NET (n=47) or supportive therapy (n=47) delivered via the internet for 12 weeks. MAIN OUTCOME MEASURES The primary outcome was the BDD-YBOCS score after treatment and follow-up (three and six months from baseline) as evaluated by a masked assessor. Responder status was defined as a ≥ 30% reduction in symptoms on the scale. Secondary outcomes were measures of depression (MADRS-S), global functioning (GAF), clinical global improvement (CGI-I), and quality of life (EQ5D). The six month follow-up time and all outcomes other than BDD-YBOCS and MADRS-S at 3 months were not pre-specified in the registration at clinicaltrials.gov because of an administrative error but were included in the original trial protocol approved by the regional ethics committee before the start of the trial. RESULTS BDD-NET was superior to supportive therapy and was associated with significant improvements in severity of symptoms of body dysmorphic disorder (BDD-YBOCS group difference -7.1 points, 95% confidence interval -9.8 to -4.4), depression (MADRS-S group difference -4.5 points, -7.5 to -1.4), and other secondary measures. At follow-up, 56% of those receiving BDD-NET were classed as responders, compared with 13% receiving supportive therapy. The number needed to treat was 2.34 (1.71 to 4.35). Self reported satisfaction was high. CONCLUSIONS CBT can be delivered safely via the internet to patients with body dysmorphic disorder. BDD-NET has the potential to increase access to evidence based psychiatric care for this mental disorder, in line with NICE priority recommendations. It could be particularly useful in a stepped care approach, in which general practitioner or other mental health professionals can offer treatment to people with mild to moderate symptoms at low risk of suicide.Trial registration ClinicalTrials.gov ID: NCT02010619.
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Affiliation(s)
- Jesper Enander
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden
| | - Erik Andersson
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden
| | - David Mataix-Cols
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Linn Lichtenstein
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
| | - Katarina Alström
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
| | - Gerhard Andersson
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
| | - Brjánn Ljótsson
- Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden
| | - Christian Rück
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden
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Veale D, Akyüz EU, Hodsoll J. Prevalence of body dysmorphic disorder on a psychiatric inpatient ward and the value of a screening question. Psychiatry Res 2015; 230:383-6. [PMID: 26404769 DOI: 10.1016/j.psychres.2015.09.023] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2015] [Revised: 06/13/2015] [Accepted: 09/13/2015] [Indexed: 10/23/2022]
Abstract
The aim of this study was to estimate the prevalence of body dysmorphic disorder (BDD) on an inpatient ward in the UK with a larger sample than previously studied and to investigate the value of a simple screening question during an assessment interview. Four hundred and thirty two consecutive admissions were screened for BDD on an adult psychiatric ward over a period of 13 months. Those who screened positive had a structured diagnostic interview for BDD. The prevalence of BDD was estimated to be 5.8% (C.I. 3.6-8.1%). Our screening question had a slightly low specificity (76.6%) for detecting BDD. The strength of this study was a larger sample size and narrower confidence interval than previous studies. The study adds to previous observations that BDD is poorly identified in psychiatric inpatients. BDD was identified predominantly in those presenting with depression, substance misuse or an anxiety disorder. The screening question could be improved by excluding those with weight or shape concerns. Missing the diagnosis is likely to lead to inappropriate treatment.
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Affiliation(s)
- David Veale
- The Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; The Priory Hospital North London, UK.
| | | | - John Hodsoll
- The Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
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Kelly MM, Zhang J, Phillips KA. The prevalence of body dysmorphic disorder and its clinical correlates in a VA primary care behavioral health clinic. Psychiatry Res 2015; 228:162-5. [PMID: 25935375 DOI: 10.1016/j.psychres.2015.04.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Revised: 02/08/2015] [Accepted: 04/05/2015] [Indexed: 11/28/2022]
Abstract
We examined the prevalence of body dysmorphic disorder (BDD) in a Veterans Affairs (VA) primary care behavioral health clinic. Of 100 Veterans, 11% (95% CI = 6.3-18.6%) had current BDD and 12% (95% CI = 7.0-19.8%) had lifetime BDD. However, only 8.3% of these Veterans had been diagnosed with BDD. BDD was significantly associated with a substantially elevated rate of suicide attempts, major depression, and obsessive-compulsive disorder. This severe disorder appears to be underdiagnosed in VA settings.
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Affiliation(s)
- Megan M Kelly
- Psychology Service, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, USA; Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA; Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA, USA.
| | - Jinxin Zhang
- Psychology Service, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, USA; Center for Psychological Studies, Nova Southeastern University, Fort Lauderdale, FL, USA
| | - Katharine A Phillips
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA; Rhode Island Hospital, Providence, RI, USA
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Rashid H, Khan AA, Fineberg NA. Adjunctive antipsychotic in the treatment of body dysmorphic disorder - A retrospective naturalistic case note study. Int J Psychiatry Clin Pract 2015; 19:84-9. [PMID: 25363200 DOI: 10.3109/13651501.2014.981546] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES A retrospective naturalistic case note study to determine the frequency, co-morbidity and treatment-response of body dysmorphic disorder (BDD). METHODS Records from 280 patients attending a highly specialised obsessive-compulsive disorder (OCD)/BDD service were analysed. The clinical outcome was measured either through scoring of the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) for OCD/BDD, or textual analysis of case notes for evidence of symptomatic improvement, treatment tolerability, and premature disengagement. RESULTS A total of 32 patients (11.43%) were diagnosed with BDD. Of these, 28 (87.5%) had at least one co-morbidity. All patients were offered cognitive behavioural therapy (CBT) and selective serotonin reuptake inhibitor (SSRI). Adjunctive low-dose antipsychotic was prescribed for 21 (66%) patients. Overall, 18/32 (56%) responded, and 7/32 (22%) disengaged prematurely. Patients offered antipsychotic, SSRI and CBT (n = 21) were compared with those offered SSRI and CBT only (n = 11). The treatment was well-tolerated. Whereas there was no significant inter-group difference in the clinical response rate, premature disengagement occurred less frequently in the antipsychotic-treated patients (9.5% versus 45%; Fisher's Exact Test P = 0.0318). CONCLUSIONS BDD frequently presents with co-morbidity, treatment-resistance and premature disengagement. Adjunctive antipsychotic was associated with significantly better treatment adherence, but responder rates did not differ significantly, possibly related to the small sample-size. A well-powered randomised controlled study is warranted, to determine clinical outcomes with adjunctive antipsychotic in BDD.
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Affiliation(s)
- Haroon Rashid
- Highly Specialised OCD/BDD Service, Hertfordshire Partnership University NHS Foundation Trust, Mental Health Unit, Queen Elizabeth II Hospital , Howlands, Welwyn Garden City, Hertfordshire , UK
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