Abstract

Previous research indicates that body dysmorphic disorder (BDD) is associated with risk of suicidality. However, studies have relied on small and/or specialist samples and largely focussed on adults, despite these difficulties commonly emerging in youth. Furthermore, the aetiology of the relationship remains unknown. Two independent twin samples were identified through the Child and Adolescent Twin Study in Sweden, at ages 18 (N = 6027) and 24 (N = 3454). Participants completed a self-report measure of BDD symptom severity. Young people and parents completed items assessing suicidal ideation/behaviours. Logistic regression models tested the association of suicidality outcomes with: (a) probable BDD, classified using an empirically derived cut-off; and (b) continuous scores of BDD symptoms. Bivariate genetic models examined the aetiology of the association between BDD symptoms and suicidality at both ages. Suicidal ideation and behaviours were common among those with probable BDD at both ages. BDD symptoms, measured continuously, were linked with all aspects of suicidality, and associations generally remained significant after adjusting for depressive and anxiety symptoms. Genetic factors accounted for most of the covariance between BDD symptoms and suicidality (72.9 and 77.7% at ages 18 and 24, respectively), but with significant non-shared environmental influences (27.1 and 22.3% at ages 18 and 24, respectively). BDD symptoms are associated with a substantial risk of suicidal ideation and behaviours in late adolescence and early adulthood. This relationship is largely explained by common genetic liability, but non-shared environmental effects are also significant and could provide opportunities for prevention among those at high-risk.

Highlights

  • Body dysmorphic disorder (BDD) is characterised by a distressing and impairing preoccupation with perceived or slight defects in physical appearance, typically accompanied by timeconsuming, repetitive behaviours (American Psychiatric Association, 2013; World Health Organization, 2018)

  • The current study represents the largest investigation of body dysmorphic disorder (BDD) symptoms and suicidality to date and is the first to explore the contribution of genetic and environmental influences to this association

  • With respect to our first aim, we found that self-reported suicidal ideation and behaviours were significantly elevated among young people with probable BDD, relative to those without

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Summary

Introduction

Body dysmorphic disorder (BDD) is characterised by a distressing and impairing preoccupation with perceived or slight defects in physical appearance, typically accompanied by timeconsuming, repetitive behaviours (American Psychiatric Association, 2013; World Health Organization, 2018). Bivariate genetic models examined the aetiology of the association between BDD symptoms and suicidality at both ages. Suicidal ideation and behaviours were common among those with probable BDD at both ages. Genetic factors accounted for most of the covariance between BDD symptoms and suicidality (72.9 and 77.7% at ages 18 and 24, respectively), but with significant non-shared environmental influences (27.1 and 22.3% at ages 18 and 24, respectively). BDD symptoms are associated with a substantial risk of suicidal ideation and behaviours in late adolescence and early adulthood. This relationship is largely explained by common genetic liability, but non-shared environmental effects are significant and could provide opportunities for prevention among those at high-risk

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