Severe Body Dysmorphic Disorder Research Articles

Surgical Rhinoplasty in Mild Forms of Body Dysmorphic Disorder: Safety, Protocols, and Long-Term Outcomes.

Body dysmorphic disorder (BDD) is an obsessive-compulsive disorder concerning body image which negatively distorts the patient's perception of their appearance. In rhinoplasty, surgery on patients with severe BDD is considered contraindicated as patients are often dissatisfied and their BDD symptoms rarely improve. For patients with borderline to mild BDD, however, there has been some preliminary evidence to show that they can benefit from surgical rhinoplasty. In our first article on this series of BDD in rhinoplasty, we presented our two-specialist protocol using mandatory psychiatric evaluation (MPE) to assess patient's suitability. In this present article, we used this protocol to identify a group of borderline to mild BDD patients, performed surgical rhinoplasty on this group, and evaluated the outcome using a visual analog scale (VAS) and a five-point Likert scale. From 2010 to 2023, 1,602 patients attended our practice seeking cosmetic rhinoplasty, out of which, 892 were sent for MPE to the same psychiatrist. The MPE identified 2.5% (22/892) patients as having mild BDD, out of which, 15 were considered suitable for surgical intervention and underwent successful rhinoplasty (follow-up 6-95 months, M = 54.13 months). Five of 15 patients scored 10/10 on the VAS and were very happy, 8 of 15 patients scored 7 to 9/10 on the VAS and were happy, and 2 of 15 patients scored 6/10 on the VAS but were still happy. Although all patients were happier, 3 of 15 patients requested revision rhinoplasty which was not offered as was planned and discussed before the initial intervention. This study shows that in the presence of safe protocols, including a two-specialist model, safe outcomes can be expected even in the long term. Further, the request for revision surgery appears to be common in borderline to mild BDD cases, and we like to warn the patients against it before surgery.

Body Dysmorphic Disorder: A Decade of Mandatory Psychiatric Evaluation in Cosmetic Rhinoplasty Aspirants.

The aim of rhinoplasty is to make the patient happier with their nose. The patient's perception plays a substantial role in their outcome satisfaction. Body dysmorphic disorder (BDD) is an obsessive-compulsive disorder concerning body image, which negatively distorts the patient's perception, rendering them dissatisfied with the outcome even if the results are close to the defined objectives. In this paper, we present a protocol with a two-specialist approach (rhinoplasty surgeon and a psychiatrist) to standardize BDD diagnosis using the DSM-5 criteria. The patients deemed suitable for cosmetic rhinoplasty by the rhinoplasty surgeon's first consultation were sent for Mandatory Psychiatric Evaluation (MPE) for further consultation and second opinion. MPE was employed with a semi-structured clinical interview by a psychiatrist incorporating the Cosmetic Procedure Screening Questionnaire and Appearance Anxiety Inventory. From 2010 to 2023, 1,602 patients attended our practice seeking cosmetic rhinoplasty, out of which, 892 were sent for MPE to the same psychiatrist. The MPE identified 2.5% (22/892) patients as having mild BDD; out of which, 15 were considered suitable for surgical intervention and underwent successful rhinoplasty (follow up: 1-10 years, M = 4.33 years). Although BDD is considered a contraindication in rhinoplasty, our experience shows that borderline and mild BDD can be offered surgery with good insight and support system. Moderate to severe BDD in our practice was filtered out at the first stage and was not offered surgical intervention. BDD among rhinoplasty aspirants is not as prevalent as previously reported. Standardized diagnostic protocols and studying the severity of BDD when present has clarified management of BDD in rhinoplasty aspirants in our practice. MPE is not easy to incorporate in every rhinoplasty practice, but we aim to present guidelines arising from our ongoing experience to help management of BDD in rhinoplasty.

Body dysmorphic disorder in adult orthodontic treatment candidates according to the index of treatment need

Objectives: Body image perception plays an important role in seeking orthodontic treatment. Body dysmorphic disorder (BDD) is a psychological condition where an individual constantly focuses on flaws in their appearance. This study aimed to assess BDD in adult orthodontic treatment candidates according to the index of treatment need (IOTN) in Qazvin city in 2020. Material and Methods: This descriptive study was conducted on 404 eligible patients over 18 years of age presenting to dental clinics in Qazvin seeking orthodontic treatment. The patients were categorized according to their IOTN (grades 1–5) and filled out the Body Deformation Metacognition Questionnaire (BDMCQ). Data were analyzed by t-test and Analysis of Variance using the Statistical Package for the Social Sciences. Results: Of all the patients, 50.2% were grade 1 (no need for treatment),and 1.5% were grade 5 (very great need for treatment). Furthermore, 54.5% of patients had severe BDD. BDD had no significant correlation with gender or marital status (P > 0.05). BDD was significantly correlated with age, educational level, and IOTN grade (P < 0.05). Conclusion: The present results revealed that over 50% of patients seeking orthodontic treatment did not need treatment, according to the IOTN. Dental clinicians are advised to be more careful in accepting patients with a history of psychological problems and numerous surgical procedures who seek cosmetic treatments.

Extending the cognitive-behavioral model of Body Dysmorphic Disorder: The role of attachment anxiety and self-ambivalence

This study aimed to extend the cognitive-behavioral model of Body Dysmorphic Disorder (BDD) by exploring the role of insecure attachment and self-ambivalence on the relationship between two specific cognitive factors, namely appearance orientation (seeing the self as an aesthetic object) and appearance evaluation (negative appraisal of internal body image), on levels of BDD severity. A convenience sample of 304 Australian residents (72.4% females) completed online self-report measures; 53% reported clinical or subclinical levels of BDD. Attachment anxiety and self-ambivalence were both associated with BDD severity, as were both cognitive factors. The direct effect of attachment anxiety was no longer significant after controlling for self-ambivalence, appearance orientation and evaluation. However, significant specific indirect effects were found suggesting that individuals who report greater levels of insecure attachment and self-ambivalence exhibit greater appearance orientation and negative appearance evaluation which, in turn, results in higher levels of BDD. The indirect effect through self-ambivalence was strongest suggesting a central role of self in the relationship between attachment anxiety and BDD severity. The current research demonstrates the importance of attachment anxiety and self-ambivalence in the context of BDD and implicates their potential role in treatment; however, further clinical studies are needed.

Characterizing observed and effective behavioral engagement with smartphone cognitive behavioral therapy for body dysmorphic disorder: A methods roadmap and use case

Smartphone psychotherapies are growing in popularity, yet little is understood about (1) how people prefer to engage with psychotherapy apps, or (2) which engagement patterns constitute effective engagement. The present study uses secondary data from a 12-week randomized waitlist-controlled trial of smartphone-delivered cognitive behavioral therapy (CBT) for body dysmorphic disorder (BDD) (N = 77) to address these aims. Additionally, using the present study as a use-case, we seek to provide a roadmap for how researchers may improve upon methodological limitations of existing smartphone psychotherapy engagement research. We measured behavioral engagement via 19 objective variables derived from phone analytics data, which we reduced via factor analysis into two factors: 1) use volume and frequency, and 2) session duration. Cluster analysis based on engagement factors yielded three engager types, which mapped onto “deep” users, “samplers,” and “light” users. The clusters did not differ significantly in improvement in BDD severity across treatment, although deep users improved more than light users at a marginally significant level. Results suggest that varying patterns of preferred engagement may be efficacious. Moreover, the study's methods provide an example of how researchers can measure and study behavioral engagement comprehensively and objectively.Trial Registration: ClinicalTrials.gov Identifier: NCT04034693

Prevalence and awareness on body dysmorphic disorder among female seeking cosmetic procedures, Riyadh, Saudi Arabia, 2023

Background: Body dysmorphic disorder (BDD) is defined as a mental health disorder characterized by preoccupation or excessive concern about defects in physical appearance that are unremarkable or slightly appear to others. This disorder causes significant distress and may affect a person's lifestyle. We aimed to assess the prevalence and awareness of BDD among females seeking cosmetic procedures. Methods: This cross-sectional study, targeted females seeking cosmetic procedures in the central region of Riyadh city. The study included 350 female participants. Data were collected in June and July 2023, by a paper based questionnaire. Diagnosis is based on the score of a patient in the first three questions. The data cleared, coded, and entered data analyzed using Statistical Package for the Social Sciences, with a p-value of 0.05 or less deemed statistically significant. Result: Among all participants, only (54.4%) have undergone cosmetic procedures, (57.3%) planning to undergo cosmetic procedures in the future. Among all participants, only (90.3%) were not diagnosed with BDD. 349 participants had a prevalence of BDD. The majority (67.34%) were with no prevalence of BDD, while the minority (0.57%) had extremely severe BDD. 15.47% of those who attended had mild BDD. On the other hand, 12.61% of the participants had moderate BDD, and the participants who had severe BDD were 4.01%, which means, 32.66% of participants had mild to severe BDD. Conclusion: It was found that most female participants need more awareness and knowledge about BDD to preserve it to reduce the risk of BDD. One-third of all participants have a moderate to severe prevalence of BDD. The results of this study have shown. Through the study, it was found that many female participants need more knowledge regarding BDD.

BODY DYSMORPHIC DISORDER, SELF-OBJECTION AND COMPETITIVE ATTITUDE IN INDIVIDUALS APPLICATION TO DERMATOLOGY CLINIC

Abstract: Purpose: Body dysmorphic disorder is important because it is a frequently encountered disorder in the dermatological patient group. This research aims to understand the relationship between body dysmorphic disorder and selfobjectification and competitive attitude and related factors. Method: The study was interviewed with 43 people who applied to the dermatology outpatient clinic between July 2022 and September 2022. Body Dysmorphic Disorder Screening- Self-Assessment Form was used to evaluate body dysmorphic disorder symptoms, Objectified Body Consciousness Scale was used to evaluate self-objectification, Competitive Attitude Scale was used to measure understanding of competitiveness. Study data were evaluated with t-test in independent groups, one-way analysis of variance and correlation analysis. Results: In the study, it was determined that the average age of the individuals who applied to the dermatology outpatient clinic was 26.49 and 69.8% of them were women. There was a significant positive correlation between body dysmorphic disorder symptom severity and body monitoring (rp = 0.32, p<0.05) and comparison (rp = 0.43, p<0.005) sub-dimensions; significant and negative correlations were found between body dysmorphic disorder symptom severity and competitive pleasure (rp = -0.40, p<0.05) sub-dimension. Conclusion: It is seen that watching and comparing one’s own body has a negative effect on the severity of body dysmorphic disorder. Determining the factors that feed the body monitoring and comparison behaviors will increase the success in the treatment of the dermatological patient group.

Neural and behavioral effects of modification of visual attention in body dysmorphic disorder

In individuals with body dysmorphic disorder (BDD), perceptual appearance distortions may be related to selective attention biases and aberrant visual scanning, contributing to imbalances in global vs. detailed visual processing. Treatments for the core symptom of perceptual distortions are underexplored in BDD; yet understanding their mechanistic effects on brain function is critical for rational treatment development. This study tested a behavioral strategy of visual-attention modification on visual system brain connectivity and eye behaviors. We acquired fMRI data in 37 unmedicated adults with BDD and 30 healthy controls. Participants viewed their faces naturalistically (naturalistic viewing), and holding their gaze on the image center (modulated viewing), monitored with an eye-tracking camera. We analyzed dynamic effective connectivity and visual fixation duration. Modulated viewing resulted in longer mean visual fixation duration compared to during naturalistic viewing, across groups. Further, modulated viewing resulted in stronger connectivity from occipital to parietal dorsal visual stream regions, also evident during the subsequent naturalistic viewing, compared with the initial naturalistic viewing, in BDD. Longer fixation duration was associated with a trend for stronger connectivity during modulated viewing. Those with more severe BDD symptoms had weaker dorsal visual stream connectivity during naturalistic viewing, and those with more negative appearance evaluations had weaker connectivity during modulated viewing. In sum, holding a constant gaze on a non-concerning area of one’s face may confer increased communication in the occipital/parietal dorsal visual stream, facilitating global/holistic visual processing. This effect shows persistence during subsequent naturalistic viewing. Results have implications for perceptual retraining treatment designs.

A psychometric validation of the Dysmorphic Concerns Questionnaire (DCQ) in adolescents and young adults

ABSTRACT Objective Body dysmorphic disorder (BDD) is a chronic mental health condition with symptoms typically emerging in early adolescence. Despite the onset in adolescence, most self-report BDD severity measures have not been validated with adolescent and young adult samples. The Dysmorphic Concerns Questionnaire (DCQ) was developed to assess dysmorphic concern and to date has only been psychometrically validated in adult samples. The aim of the current study was to examine the psychometric properties of the DCQ to ensure it is suitable for clinical use with adolescent and young adult patients. Method One hundred and ninety-five individuals aged 12–21 years (M = 18.25, SD = 2.51; 59% female) participated in the study. Results The DCQ demonstrated a unidimensional construct [χ2 (14) = 24.59, p = .04; RMSEA =.06, SRMR =.02 and CFI =.99], with good internal consistency (α = .88). The DCQ also showed high convergent validity with measures of BDD symptomatology, however, divergent validity was not supported in this study. Known-groups validity of the DCQ was established, with a large effect size (d = 1.28). Conclusions These findings indicate that the DCQ is a brief, reliable, and valid measure that is appropriate to screen for symptoms of BDD in adolescent and young adults and to monitor symptom change during treatment. KEY POINTS What is already known about this topic: Body dysmorphic disorder is a mental healthcondition which results in significant functional impairment. The Dysmorphic Concerns Questionnaire (DCQ) is a psychometrically sound measure of dysmorphic concern. Body dysmorphic disorder commonly occurs in adolescence. What this topic adds: (1) This is the first study to evaluate the psychometric properties of the DCQ in a sample of adolescents and young adults. (2) The psychometric properties of the DCQ are similar in adult and adolescent/young adult samples. (3) The DCQ is appropriate to use with adolescent and young adult patients.

Body dysmorphic disorder (BDD) symptomatology among undergraduate university students of Bangladesh

BackgroundBody Dysmorphic Disorder (BDD) is an obsessive-compulsive-related disorder causing clinically significant distress or impairment in functioning. The objective of this study was to assess the BDD symptoms and factors associated with BDD symptomatology among undergraduate students. MethodologyA cross-sectional study was conducted from November 2019 to March 2020 in six different universities (3 private and 3 public) across Bangladesh. A total of 1204 undergraduate students were selected through the multistage sampling technique. The BDD-YBOCS tool was used to assess the BDD symptomatology. ResultsMild to moderate BDD symptoms was observed among 11.0 % participants, and 1.5 % had severe BDD symptoms. Around 58 % of participants had at least one body defect. Most embarrassments occurred due to acne (12.5 %), followed by thin hair (9.5 %) and scar marks (6.4 %). Males had significantly lower odds of having BDD symptomatology (OR = 0.394; 95%CI = 0.254–0.614) and Participants aged between 20 and 24 years had higher odds (OR = 4.639; 95%CI = 1.024–21.107). Studying in private universities had 1.7 times higher odds in comparison to the public universities (OR = 1.671, 95%CI = 1.052–2.656). Smokers were more prone to have BDD symptomatology than non-smokers (OR = 2.72; 95%CI = 1.571–4.709) and students who had body defects had higher odds (OR = 2.647; CI = 1.723–4.066) of BDD symptomatology. ConclusionThe study has successfully revealed status and predictors of BDD symptomatology among university students. Further nationwide studies would be conducted to know the overall situation of Bangladesh.

Efficacy of App-Based Cognitive Behavioral Therapy for Body Dysmorphic Disorder with Coach Support: Initial Randomized Controlled Clinical Trial

Introduction: Body dysmorphic disorder (BDD) is severe, chronic, and undertreated. Apps could substantially improve treatment access. Objective: We provide an initial test of the usability and efficacy of coach-supported app-based cognitive behavioral therapy (CBT) for BDD. The Perspectives app covers core treatment components: psychoeducation, cognitive restructuring, exposure with response prevention, mindfulness, attention retraining, and relapse prevention. Methods: A randomized waitlist-controlled trial was conducted. Adults (N = 80) with primary BDD were assigned to 12 weeks of Perspectives or waitlist. Coaches promoted engagement and answered questions via in-app messaging and phone calls. BDD severity was measured at baseline, mid-treatment, and end of treatment by blinded independent evaluators (Yale-Brown Obsessive Compulsive Scale Modified for BDD; BDD-YBOCS). Secondary outcomes included BDD-related insight, depression, quality of life, and functioning. Results: App uptake and satisfaction were high. In intent-to-treat analyses, Perspectives app-based CBT was associated with significantly lower BDD-YBOCS severity at end of treatment (M [SD]: 16.8 [7.5]) compared to the waitlist (26.7 [6.2]; p < 0.001, d = 1.44). App-based CBT was associated with greater improvements across all secondary measures, with medium to large effects. Conclusions: Perspectives, supported by a bachelor’s-level coach, is an efficacious, scalable treatment for adults with BDD.

The Evaluation of body dysmorphic disorder in adult orthodontic patients

Introduction: The present study aimed to evaluate body dysmorphic disorder (BDD) in orthodontic patients. Also, the relation between demographic factors and BDD was investigated. Materials and Methods: This descriptive-analytical cross-sectional study was performed on 320 patients referred to the dental clinic. Participants were excluded if they had craniofacial syndromes, visible physical inabilities, mental diseases such as depression and OCD, and required orthognathic surgery. The YBOCS-BDD was used to assess BDD. Fisher’s exact test was performed using SPSS Version 24 at the significance level of P=0.05. Results: 47.5% of patients were normal and 34.4% had mild BDD and 17.2% had moderate BDD, and only 0.9% of the patients had severe BDD. A significant relation was found between gender and BDD, and between marital status and BDD. (P=0.004 and P&amp;lt;0.001, respectively). The relation of age and severity of BDD was not statistically significant. Conclusion: BDD disorder in orthodontic patients is more common in women and single people. In this regard, it is recommended that cosmetic clinicians be careful in accepting patients with a history of mental and personality problems, multiple and frequent esthetic surgeries, and if necessary, persuade and refer the patient to a psychiatrist and counselor to prevent the consequences.

Deciding on Optical Illusions: Reduced Alpha Power in Body Dysmorphic Disorder.

Background: Body dysmorphic disorder (BDD) is a psychiatric disorder characterized by excessive preoccupation with imagined defects in appearance. Optical illusions induce illusory effects that distort the presented stimulus, thus leading to ambiguous percepts. Using electroencephalography (EEG), we investigated whether BDD is related to differentiated perception during illusory percepts. Methods: A total of 18 BDD patients and 18 controls were presented with 39 optical illusions together with a statement testing whether or not they perceived the illusion. After a delay period, they were prompted to answer whether the statement was right/wrong and their degree of confidence in their answer. We investigated differences of BDD patients on task performance and self-reported confidence and analyzed the brain oscillations during decision-making using nonparametric cluster statistics. Results: Behaviorally, the BDD group exhibited reduced confidence when responding incorrectly, potentially attributed to higher levels of doubt. Electrophysiologically, the BDD group showed significantly reduced alpha power at the fronto-central and parietal scalp areas, suggesting impaired allocation of attention. Interestingly, the lower the alpha power of the identified cluster, the higher the BDD severity, as assessed by BDD psychometrics. Conclusions: Results evidenced that alpha power during illusory processing might serve as a quantitative EEG biomarker of BDD, potentially associated with reduced inhibition of task-irrelevant areas.

CYBERBULLYING AND VIDEOCONFERENCE EFFECTS ON BODY IMAGE DISTURBANCE IN MEDICAL STUDENTS OF YOGYAKARTA

Medical students are often expected to have ideal appearance and thus, may be susceptible to body dysmorphic disorder (BDD). Limited data exist about the influence of demographic factors on the severity of BDD in this population, especially during the COVID-19 pandemic. We aimed to understand the association between demographic variables and severity of body image disturbance in Indonesian medical students. Second-year medical students of Islamic University of Indonesia participated in the study (n=116). Participants completed the informed consent form, self-reported demographic questionnaire, Body Image Disturbance Questionnaire (BIDQ), and additional questions about bullying, cyberbullying, videoconference, and COVID-19. Data were analyzed using Pearson’s correlation and linear regression. We found significant correlations between height, female gender, history of being bullied, history of being cyberbullied, history of being body-shamed, history of being sexually-harassed, lack of confidence about appearance during videoconference, and the behavior of comparing appearance during videoconference with total BIDQ score (|r|=0.304-0.433, p=0.000-0.002). Regression analysis showed that only history of being cyberbullied, lack of confidence about appearance during videoconference, and the behavior of comparing appearance during videoconference (p=0.009 – 0.037) significantly predicted BIDQ score. Internet-related factors such as cyberbullying and worrying or comparing appearance during teleconference could significantly affect body image of medical students.

Body Dysmorphic and Narcissistic Personality Disorder in Cosmetic Rhinoplasty Candidates.

Body dysmorphic disorder (BDD) and other psychological problems are more common in cosmetic surgery applicants. The aim of this study was to investigate the frequency of the symptoms of BDD and narcissistic personality disorder in rhinoplasty candidates. This descriptive cross-sectional study was performed on rhinoplasty applicants. All subjects were evaluated by BDD and narcissistic personality questionnaires (NPI-16). A total of 380 patients were studied. Our findings showed that the prevalence of mild, moderate, and severe BDD symptoms was 31.6%, 43.4% and 25%, respectively. The mean BDD scores were not significantly different in variables such as gender, age, marital status, history of cosmetic surgery, education, place of residence, and income. 29.5% of the subjects had symptoms of narcissism. There was no significant relationship between the symptoms of narcissism and variables such as gender, age, marital status, history of cosmetic surgery, place of residence, and income. Higher education was associated with higher rates of narcissistic personality disorder (p-value = 0.021). According to the results of the study, there was no statistically significant relationship between BDD score and demographic parameters. Also, association between narcissistic personality disorder and demographic characteristics was not significant except for education. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Identity and shame in body dysmorphic disorder as compared to obsessive-compulsive disorder

BackgroundIdentity disruption and internalised shame may be important factors in explaining possible psychological mechanisms that underlie body dysmorphic disorder (BDD). These factors have also been linked to obsessive-compulsive disorder (OCD), a condition closely related to BDD. However, these factors have not been specifically examined in BDD, nor contrasted between BDD and OCD. MethodsWe compared identity functioning and internalised shame among 26 BDD, 22 OCD and 26 healthy control participants, and examined clinical correlates in both disorders. ResultsFindings demonstrated increased identity disruption and internalised shame in BDD and OCD relative to controls, and increased internalised shame in BDD relative to OCD. In both disorders, shame and identity disruption was correlated with suicidal ideation, depression, stress, and anxiety. In BDD only, increased identity disruption correlated with poorer insight, and increased internalised shame correlated with more severe BDD symptoms and poorer illness insight. ConclusionsThese data suggest that internalised shame may have important and specific relevance to BDD, and more general relevance to OCD. Moreover, identity disruption may represent an area meriting further research attention in both BDD and OCD. Clinical implications include the potential benefits of addressing internalised shame and identity problems in the treatment of both disorders.

Executive functioning in body dysmorphic disorder and obsessive-compulsive disorder.

To assess executive functions (EFs) in patients with body dysmorphic disorder (BDD) and obsessive-compulsive disorder (OCD) compared with healthy controls. Adults diagnosed with BDD (n=26) or OCD (n=29) according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, and healthy controls (n=28) underwent validated and computerized neuropsychological tests, spatial working memory (SWM), intra-extra-dimensional set shifting (IED), and stop signal task (SST), from the Cambridge Neuropsychological Test Automated Battery (CANTAB). Test performance was compared between groups, and correlated with standardized symptom severity of BDD and OCD. Significance level was set to P<.05. There were no statistically significant between-group differences on key outcome measures in SWM, IED, or SST. There was a weak positive correlation between symptom severity and test errors on SWM and IED in both OCD and BDD groups; increased clinical severity was associated with more errors in these tests. Furthermore, there was a negative correlation between symptom severity and SST in the BDD group. Patients with BDD or OCD did not differ from healthy control subjects in terms of test performance; however, there were several statistically significant correlations between symptom severity and performance in those with BDD or OCD. More studies on EFs in BDD and OCD are required to elucidate if there are differences in EFs between these two disorders.

Predictors and moderators of symptom change during cognitive-behavioral therapy or supportive psychotherapy for body dysmorphic disorder

BackgroundResearch on predictors of treatment outcome in body dysmorphic disorder, a common and severe disorder, is very limited, and no prior studies have examined moderators of outcome. Because treatment is often but not always efficacious, it is important to identify who is more likely to benefit. We examined predictors and moderators of improvement with therapist-delivered cognitive-behavioral therapy versus supportive psychotherapy in the only study of these treatments for body dysmorphic disorder. This report presents secondary analyses from a study whose primary findings have previously been published (Wilhelm et al., 2019). MethodsParticipants (N=120) with DSM-IV body dysmorphic disorder were randomized to therapist-delivered weekly cognitive-behavioral therapy or supportive therapy for 24 weeks. Using reliable and valid measures, we tested baseline body dysmorphic disorder severity, insight/delusionality, and depression severity as predictors and moderators of overall and treatment modality-specific symptom change. We explored additional variables as predictors and moderators of outcome. ResultsGreater treatment credibility (p=0.02) and presence of obsessive-compulsive personality disorder (p=0.03) predicted greater improvement. Serotonin-reuptake inhibitor treatment at baseline (unchanged during the study) (p=0.01) predicted less improvement. No other variables predicted or moderated outcome (all p>0.05). LimitationsThe study was not powered a priori to detect predictor or moderation effects, which limited our ability to detect them unless they were strong. ConclusionsBecause greater treatment credibility predicted better outcomes, fostering credibility during therapy may maximize gains. Improvement was not impeded by more severe body dysmorphic disorder, depressive symptoms, or poorer insight. No variables moderated treatment-specific improvement.

Early auditory-evoked potentials in body dysmorphic disorder: An ERP/sLORETA study

Body dysmorphic disorder (BDD) is characterized by excessive preoccupation with imagined or slight physical defects in appearance. BDD is associated with cognitive impairments (attention, visual processing). Our study aims to evaluate the early neural responses (N100, P200) to prepulse inhibition (PPI) and prepulse facilitation (PPF), to investigate attentional processing of BDD in the auditory domain. Fifty-five adults took part: 30 BDD patients and 25 healthy controls. We compared their brain responses to PPI and PPF by analyzing global field power (GFP), event-related potentials (ERPs) and their respective sources. BDD exhibited reduced N100 amplitudes compared to healthy controls in response to the startle tone elicited by both PPI and PPF, potentially suggesting impaired allocation of attention. Interestingly, the lower the GFP at the N100, the higher the BDD severity. Source reconstruction analysis showed reduced activation for BDD during the N100 time window in PPI. Scalp responses and source activations in PPI were decreased overall compared to PPF, confirming the gating effect of PPI. We provided evidence that the N100 may serve as an electrophysiological marker of BDD, predicting its severity. Our study demonstrated the potential of using ERPs combined with behavioural PPI and PPF protocols to advance our understanding of BDD pathophysiology.

Perceived Impact of Covid-19 Across Different Mental Disorders: A Study on Disorder-Specific Symptoms, Psychosocial Stress and Behavior.

The recent outbreak of the coronavirus disease (Covid-19) has plunged countries across the world into crisis. Both in the general population and in specific subgroups such as infected people or health care workers, studies have reported increased symptoms of anxiety, depression and stress. However, the reactions of individuals with mental disorders to Covid-19 have largely been neglected. The present study therefore aimed to investigate the perceived impact of Covid-19 and its psychological consequences on people with mental disorders. In this online survey, participants were asked to evaluate their disorder-specific symptoms, perceived psychosocial stress and behaviors related to Covid-19 in the current situation and retrospectively before the spread of Covid-19. The study included participants with self-identified generalized anxiety disorder (GAD), panic disorder and agoraphobia (PA), illness anxiety disorder (IA), social anxiety disorder (SAD), depression (DP), obsessive–compulsive disorder (OCD), body dysmorphic disorder (BDD), eating disorders (ED), schizophrenia spectrum and other psychotic disorders (SP), other non-specified mental disorder (other) as well as mentally healthy controls (HC). The results of bayesian parameter estimation suggest that the symptom severity of DP, GAD, IA and BDD has deteriorated as a reaction to Covid-19. Across all mental disorders and HC, self-reported psychosocial stress levels were higher during the outbreak of Covid-19 compared to before. A reduced frequency of social contacts and grocery shopping was found for all participants. People with self-identified mental disorders showed higher personal worries about Covid-19 and a higher fear of contagion with Covid-19 than did HC. According to our findings, Covid-19 may reinforce symptom severity and psychosocial stress in individuals with mental disorders. In times of pandemics, special support is needed to assist people with mental disorders and to prevent symptom deterioration.