The presence, predictive utility, and clinical significance of body dysmorphic symptoms in women with eating disorders.

Deborah Mitchison,Rocco Crino,Phillipa Hay

doi:10.1186/2050-2974-1-20

Abstract

BackgroundBoth eating disorders (EDs) and body dysmorphic disorder (BDD) are disorders of body image. This study aimed to assess the presence, predictive utility, and impact of clinical features commonly associated with BDD in women with EDs.MethodsParticipants recruited from two non-clinical cohorts of women, symptomatic and asymptomatic of EDs, completed a survey on ED (EDE-Q) and BDD (BDDE-SR) psychopathology, psychological distress (K-10), and quality of life (SF-12).ResultsA strong correlation was observed between the total BDDE-SR and the global EDE-Q scores (r = 0.79, p < 0.001). Multivariate analyses demonstrated that participants with probable EDs (n = 61) and BDD (n = 23) scored higher on 28 of the 30 BDDE-SR items compared to healthy controls (n = 173; all p < 0.05), indicating greater severity of BDD symptoms. BDD participants also scored higher than ED participants on 15 of the 30 BDDE-SR items (all p < 0.05). The remaining 15 items that ED and BDD participants scored similarly on (all p > 0.05) measured appearance checking, reassurance-seeking, camouflaging, comparison-making, and social avoidance. In addition to these behaviors, inspection of sensitivity (Se) and specificity (Sp) revealed that BDDE-SR items measuring preoccupation and dissatisfaction with appearance were most predictive of ED cases (Se and Sp > 0.60). Higher total BDDE-SR scores were associated with greater distress on the K-10 and poorer quality of life on the SF-12 (all p < 0.01).ConclusionsClinical features central to the model of BDD are common in, predictive of, and associated with impairment in women with EDs. Practice implications are that these features be included in the assessment and treatment of EDs.

Highlights

Both eating disorders (EDs) and body dysmorphic disorder (BDD) are disorders of body image
This study aimed to explore the applicability of symptoms associated with the model of BDD [17] to EDs in terms of presence, predictive utility, and association with distress and impairment
This study found that the vast majority of the Body Dysmorphic Disorder Examination Self Report (BDDE-SR) items had high specificity to ED cases, suggestive that BDD symptoms may not be commonly observed in people without an ED in the general community

Summary

Introduction

Both eating disorders (EDs) and body dysmorphic disorder (BDD) are disorders of body image. It has been found that 32.5% of a clinical BDD sample had a lifetime diagnosis of an ED [9]. The higher proportion of cases of BDD in ED than vice versa is expected due to the wider array of appearance concerns in BDD [4]. This high comorbidity would suggest that there may be underlying similarities in the predisposition to both EDs and BDD. The majority of people with EDs and BDD may not present for treatment of their body image problems [11,12,13], and because of this, research using non-clinical samples may provide a more representative account of comorbidity

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Results

Conclusion