A Preliminary Examination of the Associations Between Sleep Quality and Body Dysmorphia Symptoms Among Two Separate Samples of Adolescents.

Body dysmorphic disorder (BDD) is not uncommon, frequently onsets in early to late adolescence (from age 12 to 16 years), and is associated with severe impairments. Despite its prevalence and impact, current evidence suggests that BDD frequently goes undiagnosed. Building upon the existing theory and research, and recent changes to the diagnostic description and classification of BDD, the primary purpose of the current studies was to develop a new measure to assess BDD symptoms in adolescents and to examine risk and protective factors associated with BDD symptoms. This thesis consists of a series of three empirical studies, which have been published (Studies 1 and 2) or prepared for submission (Study 3) for publication. The first two studies were designed to advance science and practice related to the assessment of adolescent BDD symptoms, while the third study focused on the identification of risk and protective factors for emerging BDD symptoms among adolescents. In Study 1, the factor structure and validity of a widely used measure of body dysmorphic symptoms, the Appearance Anxiety Inventory (AAI; Veale et al., 2013) was investigated. The participants were Australian university students (N = 730) and Australian adolescents (N = 862) who completed surveys. Findings from the exploratory analysis with 50% (n = 365) of the university students supported a 1-factor solution with nine items. Confirmatory factor analysis with the remaining university student (n = 365) and the adolescent samples demonstrated the proposed 1-factor model had an adequate fit to the data on most indicators. It was concluded that the AAI is best considered as a single factor scale with 9 of the original 10 items when used with general, community samples of young adults or adolescents. Based on a review of existing measures of BDD for adolescents and consideration of the DSM-5 criteria for BDD, Study 2 involved the development of a new self-report measure to assess BDD symptoms in adolescents. The new measure, the Multidimensional Youth Body Dysmorphic Inventory (MY BODI), was developed to assess BDD symptoms across all domains of DSM-5 diagnostic criteria and uses a unique response set with the aim of reducing socially desirable responding. Following expert review and piloting of items, results from an exploratory factor analysis with data collected from 582 Australian secondary school students (55% female; Mage = 13.62 years) supported a 3-factor, 21-item measure, with excellent validity. The three factors conformed to 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 subscale scores correlated with other measures of BDD symptoms, including the AAI and BDDQ. Finally, in Study 3, the aims were to test whether dispositional mindfulness and self-compassion protect against the negative impact of peer appearance teasing on BDD symptoms. Participants were 170 Australian high school students (59% female; Mage = 15.44 years) who completed the MY BODI, and measures assessing peer teasing about appearance, five facets of dispositional mindfulness, self-compassion, and self-judgment. In hierarchical regressions, peer teasing was associated with reporting more total BDD symptoms, and two components of mindfulness (describing and non-judgment) and self-compassion were uniquely associated with adolescents’ reports of fewer total BDD symptoms. One factor of mindfulness, observing, was associated with more reported BDD symptoms. In moderation analyses, the association between peer appearance teasing and BDD symptoms was stronger when mindful describing was high relative to low, and when self-judgment was low relative to high. Findings were similar across all subscales of MY BODI. These findings suggest that mindfulness and self-compassion are generally associated with fewer BDD symptoms (with the exception of mindful observing). However, in contrast with the hypothesised protective effects, adolescents who reported a greater ability to mindfully describe their experience and those who were less self-judging were more negatively affected by peer appearance teasing. In summary, the results of this thesis support using a 9-item AAI measure with adolescents, provide a new multidimensional measure of BDD that appears reliable and valid, and advance the study of how social and individual factors should be considered in combination in order to explain when adolescents are at more risk for elevated BDD symptoms. BDD is a complex and debilitating disorder that tends to onset in adolescence and runs a chronic course, thus making this an important problem to study in children and adolescents.

Body dysmorphic disorder symptoms and quality of life: The role of clinical and demographic variables

Cognitive-Behavioral Therapy for Adolescent Body Dysmorphic Disorder: A Pilot Study

Body dysmorphic disorder (BDD) is common in childhood abuse survivors. Nonetheless, the relation between symptoms of BDD, posttraumatic stress disorder (PTSD), and complex PTSD, as well as the effects of different forms of childhood abuse in explaining these symptoms, remains unclear. This study explored (a) BDD scores as a function of childhood abuse; (b) the relationship between symptoms of BDD, PTSD, and disturbances in self-organization (DSO) in childhood abuse survivors; and (c) the effect of levels of different forms of childhood abuse on BDD, PTSD, and DSO symptoms. An online survey was conducted among a convenience sample of 404 Israeli adult women, of whom 53.7% (n = 217) were classified as having a history of childhood abuse. Background variables, BDD symptoms, and the classification and symptoms of PTSD and complex PTSD were assessed online via self-report measures. Results indicated elevated BDD scores in childhood abuse survivors and relationships between symptoms of BDD, PTSD, and DSO in childhood abuse survivors. Levels of emotional abuse served as a trans-diagnostic risk factor for PTSD, DSO, and BDD symptoms, whereas sexual abuse was associated with PTSD symptoms, and physical abuse had no significant effect. The strongest noncausal effect was found for PTSD and DSO symptoms, followed by BDD and DSO symptoms and BDD and PTSD symptoms. The present findings suggest that childhood abuse may be a risk factor for BDD and that trauma-related disorders and BDD are strongly associated in childhood abuse survivors. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

Body dysmorphic disorder (BDD) is a common and often severe disorder. Clinical observations suggest that panic attacks triggered by BDD symptoms may be common. However, to our knowledge, no study has examined such panic attacks in BDD. We investigated the prevalence, clinical features, and correlates of BDD- triggered panic attacks in individuals with this disorder. Panic attacks and other variables were assessed using reliable and valid measures in 76 individuals with lifetime DSM-IV BDD. 28.9% (95% CI, 18.5%-39.4%) of participants reported lifetime panic attacks triggered by BDD symptoms. The most common triggers of such attacks were feeling that others were looking at or scrutinizing the perceived appearance defects (61.9%), looking in the mirror at perceived defects (38.1%), and being in bright light where perceived defects would be more visible (23.8%). The most common panic attack symptoms were palpitations (86.4%), sweating (66.7%), shortness of breath (63.6%), trembling or shaking (63.6%), and fear of losing control or going crazy (63.6%). Compared to participants without such panic attacks, those with BDD-triggered panic attacks had more severe lifetime BDD, social anxiety, and depressive symptoms, as well as poorer functioning and quality of life on a number of measures. They were also less likely to be employed and more likely to have been psychiatrically hospitalized and to have had suicidal ideation due to BDD. Panic attacks triggered by BDD-related situations appear com- mon in individuals with this disorder. BDD-triggered panic attacks were associated with greater symptom severity and morbidity.

Family accommodation (FA) is widely-recognised as an important clinical phenomenon in obsessive-compulsive disorder (OCD) and anxiety disorders, and is related to poorer treatment outcomes. However, FA has not been quantitatively explored in Body Dysmorphic Disorder (BDD). The aim of this study was to investigate the patterns and correlates of maternal accommodation in adolescent BDD, and its association with treatment outcomes. Participants were 131 adolescents with BDD and their mothers who completed the Family Accommodation Scale-Parent Report (FAS-PR) as part of routine clinical practice in a National and Specialist Service for Young People at the Maudsley Hospital, London. Seventy-six (58%) young people received specialist cognitive behavioural therapy for BDD and had post-treatment data available. All mothers engaged in at least one form of accommodation. Providing reassurance (98.5%) and assisting avoidance (88.5%) were the most commonly endorsed behaviours. Levels of accommodation were positively associated with clinician-rated BDD symptom severity (r = 0.18, p = 0.041) and maternal symptoms of anxiety, depression and stress (r = 0.41, p < 0.001), and negatively associated with child global functioning (r = -0.38, p < 0.001). Maternal accommodation did not predict treatment outcomes (β = 0.055, p > 0.05). The findings indicate that maternal accommodation is common and has important clinical correlates, but does not impact on treatment response. Consequently, the relationship between maternal accommodation and BDD symptoms may differ to that evidenced in paediatric OCD. Future longitudinal research exploring maternal and paternal accommodation, and assessing variables of interest at multiple time-points throughout treatment, is needed to advance understanding of the role of FA in adolescent BDD.

Adolescence is a critical period for the development of several emotional disorders, including body dysmorphic disorder (BDD), social anxiety disorder (SAD) and depression. It has been suggested that this may be partly due to developmental changes in self-referential processing, including self-focused attention (SFA). However, to date little is known about normative changes in self-focused attention across adolescence. This study investigated age-related effects on SFA during adolescence, and its relationship with symptoms of BDD, SAD and depression. A sample of 638 adolescents aged 11-18 years (53% male) were recruited through government-funded secondary school students in the United Kingdom and completed validated self-reported measures of SFA, BDD, SAD and depression. Age was positively associated with SFA, and with symptoms of BDD, SAD and depression. The associations of age with SFA, SAD and depression were, on average, greater in females, although this age by sex interaction effect only reached statistical significance for BDD symptoms. SFA fully mediated the effect of age on SAD symptoms, and partially mediated age effects on symptoms of BDD and depression. The current findings indicate that self-focused attention increases during adolescence. Moreover, findings provide support for the notion that increased self-focused attention may partly account for the rise in symptoms of BDD, SAD and depression during this developmental period. Future research should seek to establish the direction of effects between self-focused attention and symptoms using longitudinal designs.

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. 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. 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. 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.

A network perspective on body dysmorphic disorder and major depressive disorder

In this study of young adolescents' (N = 188, M age = 11.93, 54.8% females) body dysmorphic disorder (BDD) symptoms, we examined a theoretically-derived model to determine if symptoms could be explained by appearance-related teasing, general peer victimization, and social anxiety. BDD symptoms were assessed as distressing preoccupation with perceived appearance defects, social avoidance, and repeated grooming and appearance checking. Associations were expected to occur via the social-perceptual bias known as appearance-based rejection sensitivity (appearance-RS). The source of appearance teasing was also considered (same-sex vs. cross-sex peers), and age and gender moderation were assessed. As predicted, in a structural equation model, BDD symptoms were higher when adolescents self-reported more appearance teasing and higher social anxiety. Moreover, it was appearance teasing by cross-sex peers, rather than same-sex peers, that was uniquely associated with elevated BDD symptoms. These associations were partially mediated by appearance-RS. Notably, peer-reported general victimization was not associated with BDD symptoms. There was no evidence for gender moderation, but some age moderation was found, with stronger associations usually found among older compared to younger adolescents. The findings suggest that appearance-related social adversity, particularly cross-sex teasing, is linked with greater concerns about rejection due to appearance and, in turn, heightened BDD symptoms. This has important implications for understanding the development and treatment of BDD. Continued research to identify the social experiences and interpretative biases that contribute to BDD symptomology is needed.

IntroductionThe prevalence of body dysmorphic disorder among candidates for plastic surgery may vary from 6% to 54%. Some studies report discrete benefits with the surgical results, while others show symptomatic exacerbation. Some authors even affirm that body dysmorphic disorder would be a surgical contraindication, against others who suggest satisfactory results. ObjectiveTo describe the prevalence of body dysmorphic disorder in rhinoseptoplasty candidates and to compare outcomes among patients with and without body dysmorphic disorder symptoms. MethodsCohort study. Individuals ≥ 16 years, candidates for aesthetic and/or functional rhinoseptoplasty were recruited at a university hospital in Brazil. The prevalence of body dysmorphic disorder was assessed through the Body Dysmorphic Disorder Examination (BDDE) and the patients divided into groups: no symptoms of body dysmorphic disorder, mild-moderate and severe symptoms. The specific quality of life outcomes, Nasal Obstruction Symptom Evaluation (NOSE) and Rhinoplasty Outcome Evaluation (ROE) were evaluated before and after 90 and 180 days of the procedure. Results131 individuals were included, 59.5% female. The prevalence of preoperative symptoms of body dysmorphic disorder was 38%. There was a reduction in the symptoms of body dysmorphic disorder in the preoperative body dysmorphic disorder examination versus 3 and 6 months in all groups (78.94 ± 2.46 vs. 33.63 ± 6.41 and 35.51 ± 5.92, respectively, p < 0.002). Among patients with severe body dysmorphic disorder symptoms, rhinoplasty outcome evaluation ranged from 21.24 ± 3.88 to 58.59 ± 5.83 at 3 months and 52.02 ± 5.41 at 6 months postoperatively (p < 0.001); while NOSE from 71 ± 8.47 to 36.11 ± 12.10 at 6 months postoperatively (p < 0.01). ConclusionThe prevalence of body dysmorphic disorder symptoms in our sample was high. Rhinoseptoplasty was associated with an improvement in quality of life outcomes related to nasal function and aesthetic outcome in all groups, irrespective of the presence and intensity of body dysmorphic disorder symptoms. Rhinoseptoplasty in body dysmorphic disorder symptomatic patients was also associated with a reduction in postoperative body dysmorphic disorder symptoms, even in severe cases.

The power within: The experimental manipulation of power interacts with trait BDD symptoms to predict interoceptive accuracy

Snapchat dysmorphia (SD) is an emerging phenomenon that characterizes individuals seeking aesthetic procedures to replicate the appearance of their digitally altered selfies. This phenomenon has been hypothesized to be linked to body dysmorphic disorder (BDD) symptoms. Additionally, body trust (ie, perceiving the body as safe and trustworthy, relying on its signals and sensations), which could contrast excessive focus on physical appearance, may moderate this relationship. Current literature on SD reveals a notable lack of comprehensive empirical investigations. In this study, the authors examine the factorial structure and internal consistency of a newly developed measure: the SD Questionnaire (SDQ). Additionally, it explored the relationship between SD and BDD symptoms, with a focus on the potential moderating role of body trust. Data were collected from a sample of 163 women seeking aesthetic medicine treatments. The factorial structure and internal consistency of the SDQ were examined. Its association with BDD symptoms was explored within a hierarchical regression model, after controlling for other variables (eg, motivations to pursue cosmetic procedures). Finally, the potential moderating role of body trust was tested. Findings supported a unidimensional factor structure for the SDQ, which also demonstrated a significant association with BDD symptoms. Body trust did not moderate this relationship. Findings provide preliminary support for the validity of the SDQ in women seeking aesthetic medicine procedures and lend empirical weight to anecdotal claims that SD is distinct yet related to BDD. Finally, although body trust was negatively associated with BDD symptoms, it did not show a moderation effect.

Body dysmorphic disorder (BDD) is relatively common in adolescents and can have serious negative consequences. However, the treatment of BDD in young people has received virtually no empirical attention to date, and the evidence-base for cognitive behaviour therapy (CBT) in this population is limited to a small number of single case reports. This study aimed to investigate treatment outcomes associated with CBT, primarily consisting of exposure and response prevention, in a group of young people with BDD. Six adolescents with a diagnosis of BDD received a course of developmentally appropriate CBT for BDD with parental involvement. BDD and depressive symptoms were evaluated at pre-treatment, post-treatment and at 3- or 6-month follow-up, using the Yale-Brown Obsessive Compulsive Scale for BDD (BDD-YBOCS) and the Beck Depression Inventory-Youth, respectively. Scores on the BDD-YBOCS indicated a 44% improvement in BDD symptoms at post-treatment and a 57% improvement at follow-up for the group. Considering response as a ≥ 30% reduction in BDD-YBOCS score, four of the six adolescents were classified as treatment responders. Improvements in depressive symptoms were observed among the treatment responders, but not the non-responders. These findings indicate the potential efficacy of CBT, including exposure and response prevention for adolescents with BDD, and highlight the need for further controlled trials.

Background. Cognitive-behavioral theories suggest that obsessions in obsessive-compulsive disorder (OCD) develop from maladaptive misinterpretations and coping strategies of unwanted intrusive thoughts (UITs). Models of Body Dysmorphic Disorder (BDD) and Illness Anxiety Disorder (IAD) propose that these symptoms stem from similar misinterpretations of common UITs relating to perceived defects in appearance and illness. This study examines whether maladaptive misinterpretations and control strategies leading to the escalation of obsessional UITs to OCD symptoms also have a similar effect on the development of BDD and IAD. More specifically, we examined whether misinterpretations and neutralizing responses mediate the associations between the frequency of disorder-specific UITs and symptoms of these disorders. Method. A total of 625 non-clinical participants from four countries completed the Questionnaire of Unpleasant Intrusive Thoughts (QUIT) that assesses OCD, BDD and IAD-related UITs and their associated misinterpretations and neutralizing strategies, as well as self-report measures of OCD, BDD, and IAD symptoms. Parallel multiple mediation models were conducted. Results. The frequency of OCD, BDD and IAD-related UITs predicted symptoms of each disorder. Dysfunctional appraisals and neutralizing behaviors mediated the associations between disorder-specific UITs and symptoms in OCD and IAD. The IAD model accounted for a smaller proportion of variance than the OCD model. No mediating effects were found for BDD symptoms. Conclusions. Experiencing disturbing UITs is a transdiagnostic risk factor of OCD, BDD and IAD, and is associated with symptoms of these disorders. Maladaptive interpretation of UITs and neutralizing strategies should be specific targets in the assessment and treatment of OCD and IAD. The absence of mediation effects for BDD could be due to the limitations observed on the self-report used to assess BDD symptoms and/or the low relevance of the misinterpretations and control strategies assessed by the QUIT, which are more typically endorsed by individuals with OCD.