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PubMed2002

Computerized perceptual analysis of patients with body dysmorphic disorder: a pilot study.

Many factors influence the development of body image, one of which is the perception we have of our body. Perception can refer to actual visual input or the interpretation of vision; in other words, cognitive appraisal. The goal of this preliminary study is to determine if three groups (body dysmorphic disorder, obsessive-compulsive disorder, and a non-psychiatric control group) differed in the perception of their faces. Thirty individuals, 10 in each group, were asked to make changes to a computerized image of their face. In addition, affective and perceptual tests were administered. The groups did not differ on affective and perceptual organizational measures, although the obsessive-compulsive disorder group reported a higher level of anxiety than the body dysmorphic disorder group. Imaging software showed that facial features were modified by patients with body dysmorphic disorder and obsessive-compulsive disorder in about 50% of cases. No modifications were made in the control group. Future studies need to investigate the possible causes of these differences.

Journal Article↗
PubMed1998

Body dysmorphic disorder: clinical aspects and treatment strategies.

Body dysmorphic disorder (BDD), a distressing and impairing preoccupation with an imagined or slight defect in appearance, is an "OCD-spectrum disorder" that appears to be relatively common. BDD often goes unrecognized and undiagnosed, however, due to patients' reluctance to divulge their symptoms because of secrecy and shame. Any body part can be the focus of concern (most often, the skin, hair, and nose), and most patients engage in compulsive behaviors, such as mirror checking, camouflaging, excessive grooming, and skin picking. Approximately half are delusional, and a majority experience ideas or delusions of reference. Nearly all patients suffer some impairment in functioning as a result of their symptoms, some to a debilitating degree. Psychiatric hospitalization, suicidal ideation, and suicide attempts are relatively common. While treatment data are preliminary at this time, selective serotonin reuptake inhibitors (SSRIs) appear to often be effective for BDD, even if symptoms are delusional. Cognitive-behavioral therapy is another promising approach. While much remains to be learned about BDD, it is important that clinicians screen patients for this disorder and accurately diagnose it, as available treatments are very promising for those who suffer from this distressing and sometimes disabling disorder.

Adult↗
PubMedDate not supplied

Prevalence of symptoms of body dysmorphic disorder and its correlates: a cross-cultural comparison.

The authors investigated the prevalence of body image concerns, body dysmorphic disorder, and related psychiatric symptoms in a group of 101 American students. Results were compared with data from a group of 133 German students. Survey data were collected on body image concerns, self-esteem, depression, anxiety, obsessive-compulsive symptoms, and skin picking. A total of 74.3% of the American students endorsed body image concerns, and 28.7% were preoccupied by them; 4.0% appeared to meet DSM-IV criteria for body dysmorphic disorder. Body esteem was significantly correlated with self-esteem and depressive, anxiety, and obsessive-compulsive symptoms. Body image concerns and preoccupation were significantly greater in American than in German students, although the prevalence of probable body dysmorphic disorder was not.

Adolescent↗
PubMed2001

Body dysmorphic disorder: a review of conceptualizations, assessment, and treatment strategies.

Increased interest in body dysmorphic disorder (BDD) has generated a wealth of recent research. This paper reviews the current literature regarding conceptualizations of the disorder, the development of assessment tools, and treatment outcome. Although BDD has been viewed as a variant of an eating disorder, obsessive compulsive disorder, or a somatoform disorder, it appears best conceptualized as a body image disorder with social, psychological, and possibly biological influences. Assessment instruments with acceptable psychometric properies have been developed to specifically assess BDD (e.g., the Body Dysmorphic Disorder Examination and the Yale-Brown Obsessive Compulsive Scale modified for Body Dysmorphic Disorder). Examination and the initial results from uncontrolled and controlled treatment research suggest that cognitive behavioral treatments for BDD may be as effective as those for possibly related disorders such as obsessive compulsive disorder and bulimia nervosa.

Body Image↗
PubMed2002

Possible association of body dysmorphic disorder with an occupation or education in art and design.

OBJECTIVE: The authors hypothesized that because patients with body dysmorphic disorder are preoccupied with their appearance and aesthetics, they are more likely to have an occupation or education in art and design than patients with other psychiatric disorders. METHOD: Information on occupation and higher education or training was extracted from the case notes of 100 consecutive patients with body dysmorphic disorder and compared with the same information for 100 patients with a major depressive episode, 100 with obsessive-compulsive disorder (OCD), and 100 with posttraumatic stress disorder (PTSD). RESULTS: Twenty percent of the patients with body dysmorphic disorder had an occupation or education in art or design, compared with 4% of the patients with major depressive episode, 3% of those with OCD, and 0% of those with PTSD. CONCLUSIONS: Onset of body dysmorphic disorder is usually gradual during adolescence, and an education in art and design may be a contributory factor to its development in some patients. An equally plausible explanation is that patients with body dysmorphic disorder tend to have an interest in aesthetics.

Adult↗
PubMed2005

Associations in the longitudinal course of body dysmorphic disorder with major depression, obsessive-compulsive disorder, and social phobia.

Body dysmorphic disorder (BDD) is an impairing and relatively common disorder that has high comorbidity with certain Axis I disorders. However, the longitudinal associations between BDD and comorbid disorders have not previously been examined. Such information may shed light on the nature of BDD's relationship to putative "near-neighbor" disorders, such as major depression, obsessive-compulsive disorder (OCD), and social phobia. This study examined time-varying associations between BDD and these comorbid disorders in 161 participants over 1-3 years of follow-up in the first prospective longitudinal study of the course of BDD. We found that BDD had significant longitudinal associations with major depression--that is, change in the status of BDD and major depression was closely linked in time, with improvement in major depression predicting BDD remission, and, conversely, improvement in BDD predicting depression remission. We also found that improvement in OCD predicted BDD remission, but that BDD improvement did not predict OCD remission. No significant longitudinal associations were found for BDD and social phobia (although the results for analyses of OCD and social phobia were less numerically stable). These findings suggest (but do not prove) that BDD may be etiologically linked to major depression and OCD, i.e., that BDD may be a member of both the putative OCD spectrum and the affective spectrum. However, BDD does not appear to simply be a symptom of these comorbid disorders, as BDD symptoms persisted in a sizable proportion of subjects who remitted from these comorbid disorders. Additional studies are needed to elucidate the nature of BDD's relationship to commonly co-occurring disorders, as this issue has important theoretical and clinical implications.

Adult↗
PubMed2001

Prevalence of body dysmorphic disorder in a community sample of women.

OBJECTIVE: In a large population-based study, the authors examined the prevalence and correlates of body dysmorphic disorder, a debilitating and chronic condition characterized by an imagined defect in appearance. METHOD: Rates and diagnostic correlates of body dysmorphic disorder were examined by using data from the Harvard Study of Moods and Cycles. This study used in-person structured clinical interviews to characterize the diagnostic status of a population-based, cross-sectional sample of 318 depressed and 658 nondepressed women between the ages of 36 and 44 who were selected from seven Boston metropolitan area communities. RESULTS: The presence of body dysmorphic disorder was significantly associated with the presence of major depression and anxiety disorders. The authors estimated the overall point prevalence of body dysmorphic disorder as 0.7% in women in this age range in the community. CONCLUSIONS: The authors found that the presence of body dysmorphic disorder was linked to the presence of major depression and anxiety disorders, which is similar to findings in clinical studies. Their estimate of the point prevalence of body dysmorphic disorder is consistent with data from a community-based sample of Italian women and suggests a prevalence similar to that of other serious psychiatric disorders in women (e.g., schizophrenia and drug abuse and dependence). These prevalence data encourage the further development of treatment options for this debilitating condition.

Adult↗
PubMed2005

Body dysmorphic disorder and the liposuction patient.

BACKGROUND: Body dysmorphic disorder (BDD) is an under-recognized disorder that affects a sizeable number of patients who seek cosmetic enhancement, in particular liposuction. Understanding and recognizing BDD can positively impact the care delivered to patients. OBJECTIVE: To familiarize physicians with the presenting signs of BDD and present strategies for caring for BDD patients in a liposuction and/or cosmetic surgery practice. METHODS: Review of currently available literature and diagnostic criteria. RESULTS: BDD affects approximately 1% of patients in the United States, but as many as 7 to 15% of patients seeking cosmetic surgery. Patients with BDD will usually demonstrate an obsession with the area they seek treatment of. In addition, patients with BDD present a unique challenge to the liposuction surgeon. CONCLUSIONS: Physicians who care for patients seeking liposuction or other cosmetic procedures should learn to recognize those who have BDD. Proper recognition and counseling of BDD patients can have a significant positive impact on not only their care but also on the patient-physician relationship. Failure to recognize BDD can, and often does, lead to patient dissatisfaction, as well as difficult future interactions with the BDD patient.

Body Image↗
PubMed2006

Comorbidity of body dysmorphic disorder and eating disorders: severity of psychopathology and body image disturbance.

OBJECTIVE: The current study examined comorbidity and clinical correlates of eating disorders in a large sample of individuals with body dysmorphic disorder (BDD). METHOD: Two hundred individuals with DSM-IV (4th ed. of the Diagnostic and Statistical Manual of Mental Disorders. Washington, DC: American Psychiatric Association; 1994) BDD completed reliable interviewer-administered and self-report measures, including diagnostic assessments and measures of body image, symptom severity, delusionality, psychosocial functioning, quality of life (QOL), and history of psychiatric treatment. RESULTS: A total of 32.5% of BDD subjects had a comorbid lifetime eating disorder: 9.0% had anorexia nervosa, 6.5% had bulimia nervosa, and 17.5% had an eating disorder not otherwise specified. Comparisons of subjects with a comorbid lifetime eating disorder (n = 65) and subjects without an eating disorder (n = 135) indicated that the comorbid group was more likely to be female, less likely to be African American, had more comorbidity, and had significantly greater body image disturbance and dissatisfaction. There were no significant group differences in BDD symptom severity, degree of delusionality, or suicidal ideation or attempts. Functioning and QOL were notably poor in both groups, with no significant between-group differences. However, a higher proportion of the comorbid eating disorder group had been hospitalized for psychiatric problems. This group had also received a greater number of psychotherapy sessions and psychotropic medications. CONCLUSION: Eating disorders appear relatively common in individuals with BDD. BDD subjects with a comorbid eating disorder differed on several demographic variables, had greater comorbidity and body image disturbance, and had received more mental health treatment than subjects without a comorbid eating disorder. These findings have important implications for the assessment and treatment of these comorbid body image disorders.

Adolescent↗
PubMed1999

Thirty-three cases of body dysmorphic disorder in children and adolescents.

OBJECTIVE: Body dysmorphic disorder (BDD), a preoccupation with a nonexistent or slight defect in appearance, usually begins during adolescence. Because there have been no studies of the clinical features of BDD in children and adolescents, the authors assessed these features in the largest series to date. METHOD: Thirty-three children and adolescents with DSM-IV BDD were assessed for demographic characteristics, phenomenology, associated psychopathology, and treatment history and response. RESULTS: Bodily preoccupations most often focused on the skin (61%) and hair (55%). All subjects had associated compulsive behaviors, most often camouflaging (e.g., with clothing) in 94%, comparing with others (87%), and mirror checking (85%). Ninety-four percent reported impairment in social functioning and 85% in academic or job functioning due to BDD. Thirty-nine percent had had psychiatric hospitalizations, and 21% had made a suicide attempt. Ten (53%) of 19 subjects treated with a serotonin reuptake inhibitor had much or very much improvement in BDD symptoms; in contrast, 0 of 8 trials with other psychotropic medications, 0 of 1 trial of cognitive-behavioral therapy, and 1 of 20 psychotherapy trials resulted in improvement. Twelve (36%) subjects received surgical, dermatological, or dental treatment, with a poor outcome in all cases. CONCLUSIONS: BDD can cause significant morbidity in children and adolescents. These preliminary data suggest that serotonin reuptake inhibitors may be an effective treatment in this age group.

Adolescent↗
PubMed1999

Two-year follow-up of behavioral treatment and maintenance for body dysmorphic disorder.

Recent research has suggested that body dysmorphic disorder (BDD) is part of the obsessive-compulsive compulsive spectrum of disorders. As such, it has been hypothesized that these disorders respond in a similar manner to obsessive-compulsive disorder when behavioral interventions are used. A continuation of follow-up was conducted with a group of patients with BDD following treatment. Ten patients completed an intensive behavioral therapy program and either participated in a 6-month maintenance program or served as controls. At 12-, 18-, and 24-month follow-up assessments, patients participating in the maintenance program were more effective at managing limited symptom return and had significantly lower anxiety and depression. Both groups remained improved for acute symptomatology and behavioral avoidance. The results suggest that maintenance programs following behavioral treatment are effective in preventing symptom relapse and assist in patient self-management of lapses typically associated with BDD.

Adult↗
PubMed2000

Body dysmorphic disorder: diagnostic controversies and treatment challenges.

Body dysmorphic disorder (BDD) is a distressing, impairing, and relatively common yet underrecognized disorder. This clinically focused article discusses the following diagnostic controversies and challenges associated with BDD: the underdiagnosis and misdiagnosis of BDD, the relationship between BDD and obsessive-compulsive disorder, the relationship between BDD and depression, the delusionality controversy, and whether BDD can be diagnosed in children and adolescents. This article also discusses treatment controversies and challenges associated with serotonin reuptake inhibitors, antipsychotics, cognitive-behavioral therapy, approaches to treatment-resistant BDD, and getting reluctant patients to accept psychiatric treatment.

Adult↗
PubMed2004

Body dysmorphic disorder: recognizing and treating imagined ugliness.

Body dysmorphic disorder (BDD), also known as dysmorphophobia, is a severe psychiatric disorder that occurs around the world. However, the diagnosis is usually missed in clinical settings. It is important to recognize and diagnose BDD, because this disorder is relatively common and causes significant distress and impairment in functioning. It is also associated with markedly poor quality of life. Although research on effective treatment is still limited, serotonin reuptake inhibitors (SRIs) are currently considered the medication treatment of choice. For symptoms to improve, a relatively high SRI dose and at least 12 weeks of treatment is often needed. The psychosocial treatment of choice is cognitive behavioral therapy, consisting of elements such as exposure, response prevention, behavioral experiments, and cognitive restructuring. Although knowledge of BDD is rapidly increasing, further research is needed on all aspects of this disorder, including treatment studies, epidemiology studies, and investigation of its cross-cultural features and pathogenesis.

Journal Article↗
PubMed1998

Body image dissatisfaction and body dysmorphic disorder in 100 cosmetic surgery patients.

This study was the first empirical investigation of body image dissatisfaction and body dysmorphic disorder in cosmetic surgery patients. Of 132 women, 100 women (response rate, 76 percent) completed two body image measures prior to surgery, the Multidimensional Body-Self Relations Questionnaire and the Body Dysmorphic Disorder Examination Self-Report. Cosmetic surgery patients did not demonstrate greater dissatisfaction with their overall appearance compared with the reported normal values of the measures. However, when asked about the specific bodily feature they were considering for cosmetic surgery, they reported significantly greater dissatisfaction than a normative sample. In addition, 7 percent of the sample met diagnostic criteria for body dysmorphic disorder, a potential psychiatric contraindication to cosmetic surgery. Implications of these findings are discussed with respect to the nature of body image dissatisfaction and the prevalence of body dysmorphic disorder in cosmetic surgery populations.

Adult↗
PubMed1998

The relationship between body dysmorphic disorder and depression, self-esteem, somatization, and obsessive-compulsive disorder.

The present study investigated the relationship of depression, self-esteem, somatization, and obsessive-compulsive disorder to the incidence of body dysmorphic disorder (BDD). Female (n=83) and male (n=25) undergraduates completed measures of body esteem, self-esteem, obsessive-compulsive behavior, and somatization. Subjects were also screened for eating disorders utilizing the DSM-IV criteria for such in an effort to control for anorexia and bulimia. Upon excluding those subjects who met the criteria for eating disorders, the final sample included 78 females and 24 males. The results indicated that lower body esteem scores were linked with lower levels of self-esteem but with higher levels of obsessive-compulsive tendencies, depressive tendencies, and somatization tendencies. The findings are discussed with regard to the need for more accurate measures of body dysmorphic disorder, as well as etiology and future treatment implications.

Adolescent↗
PubMed1993

Body dysmorphic disorder: does it have a psychotic subtype?

BACKGROUND: Although body dysmorphic disorder (BDD) is classified in DSM-III-R as a nonpsychotic somatoform disorder, controversy exists as to whether BDD can present with psychotic features. If it can, this raises the possibility that its DSM-III-R psychotic counterpart-delusional disorder, somatic type--may not be a separate disorder. The purpose of this study was to determine whether patients with nonpsychotic BDD (defined according to DSM-III-R criteria, i.e., with maintenance of some insight) were different from patients with psychotic BDD (those whose preoccupation was without insight and of delusional intensity). METHOD: Fifty consecutive patients meeting DSM-III-R criteria A and C for BDD were assessed with a semistructured interview and the Structured Clinical Interview for DSM-III-R (SCID). Family histories of psychiatric disorders were blindly assessed. The 24 patients with nonpsychotic BDD were compared with the 26 patients with psychotic BDD with respect to demographics, phenomenology, course of illness, associated features, comorbid psychiatric disorders, family history, and treatment response. RESULTS: Patients with psychotic BDD displayed a significantly higher rate of lifetime DSM-III-R psychotic disorder diagnoses than patients with nonpsychotic BDD. However, the two groups did not differ significantly on most other variables examined. For instance, both psychotic and nonpsychotic patients displayed significant morbidity; high comorbidity with mood, anxiety, and psychoactive substance use disorders; and apparent preferential response to serotonin reuptake inhibitors rather than to non-serotonin reuptake blocking antidepressants or antipsychotics. CONCLUSION: Body dysmorphic disorder may have a closely related psychotic subtype that significantly overlaps with, or may even be the same disorder as, the BDD variant of delusional disorder, somatic type. Inclusion of a psychotic subtype for BDD should be considered for future editions of DSM.

Adult↗
PubMed2001

A screening questionnaire for body dysmorphic disorder in a cosmetic dermatologic surgery practice.

BACKGROUND: Dermatologic surgeons frequently see patients with body dysmorphic disorder, a distressing or impairing preoccupation with a nonexistent or slight defect in appearance. Recognition of this disorder is essential to avoid unnecessary and generally unsatisfying surgical outcomes, but no screening tools are available for use in a dermatology setting. OBJECTIVE: To develop and validate a brief self-report questionnaire to screen for body dysmorphic disorder in dermatology settings. METHODS: A questionnaire was developed and its sensitivity and specificity determined in 46 subjects, using a reliable clinician-administered diagnostic interview for body dysmorphic disorder. The interrater reliability of a defect severity scale was also determined (n = 50). RESULTS: The self-report questionnaire had a sensitivity of 100% and a specificity of 93%. The interrater reliability (ICC) of the defect rating scale was.88. CONCLUSIONS: This brief questionnaire was a highly effective screening tool for body dysmorphic disorder in a cosmetic dermatology setting. Use of this questionnaire may help identify patients with this syndrome.

Adolescent↗