Abstract
Body dysmorphic disorder (BDD), together with its subtype muscle dysmorphia (MD), has been relocated from the Somatoform Disorders category in the DSM-IV to the newly created Obsessive-Compulsive and Related Disorders category in the DSM-5. Both categorizations have been criticized, and an empirically derived classification of BDD is lacking. A community sample of N = 736 participants completed an online survey assessing different psychopathologies. Using a structural equation modeling approach, six theoretically derived models, which differed in their allocation of BDD symptoms to various factors (i.e. general psychopathology, somatoform, obsessive-compulsive and related disorders, affective, body image, and BDD model) were tested in the full sample and in a restricted sample (n = 465) which indicated primary concerns other than shape and weight. Furthermore, measurement invariance across gender was examined. Of the six models, only the body image model showed a good fit (CFI = 0.972, RMSEA = 0.049, SRMR = 0.027, TLI = 0.959), and yielded better AIC and BIC indices than the competing models. Analyses in the restricted sample replicated these findings. Analyses of measurement invariance of the body image model showed partial metric invariance across gender. The findings suggest that a body image model provides the best fit for the classification of BDD and MD. This is in line with previous studies showing strong similarities between eating disorders and BDD, including MD. Measurement invariance across gender indicates a comparable presentation and comorbid structure of BDD in males and females, which also corresponds to the equal prevalence rates of BDD across gender.
Highlights
Body dysmorphic disorder (BDD) is characterized by excessive concerns about perceived flaws in one’s appearance and associated behavioral or mental rituals to hide, improve, or control these flaws [1]
The findings suggest that a body image model provides the best fit for the classification of BDD and muscle dysmorphia (MD)
The diagnostic entity of BDD has been reassigned: While it was classified as a subtype of hypochondriasis in the Somatoform Disorders category in the fourth version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), it represents a stand-alone diagnosis within the Obsessive-Compulsive and Related Disorders (OCRD) category in the DSM-5 [5, 6]
Summary
Body dysmorphic disorder (BDD) is characterized by excessive concerns about perceived flaws in one’s appearance (e.g. a crooked nose, skin blemishes, or not being sufficiently muscular in the case of the muscle dysmorphia [MD] subtype) and associated behavioral or mental rituals to hide, improve, or control these flaws [1]. While there is a broad agreement on the similarities between BDD and obsessive-compulsive disorder (OCD) [8,9,10,11,12,13], the empirical fit of the BDD diagnosis within this category has not yet been tested. Such confirmation might have important implications for both research and practice, for instance with regard to comorbidity screenings, improved clinical decision making, and information for the (further) development both of interventions and of etiological models
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