Body Dysmorphic Disorder Symptomatology Research Articles

When body dysmorphia symptomatology meets disordered eating: The role of shame and self-criticism

Body Dysmorphic Disorder (BDD) is a serious psychiatric condition that has long been identified as an important risk factor for the development of eating-related difficulties. However, little is known about the mechanisms that might explain this association. Therefore, the current study aimed to explore the link between body dysmorphic symptomatology and disordered eating, and test whether this relationship is mediated by higher levels of shame and self-criticism. This cross-sectional study included 291 women from the community, aged between 18 and 62 years old, who completed self-report measures. Path analysis revealed that BDD symptomatology has not only a direct effect on disordered eating, but also an indirect effect, mediated by shame and self-criticism. The path model revealed a very good fit, accounting for 38% and 31% of internal and external shames’ variances, respectively, for 69% of self-criticism variance, and 58% of the variance of disordered eating. These findings seem to suggest that in women with BDD symptomatology, disordered eating may emerge as a compensatory strategy to cope with general feelings of inferiority/defectiveness, particularly in the presence of shame experiences and self-critical attitudes/behaviours. Moreover, this study emphasizes the importance to invest in innovative treatment and prevention approaches for BDD that specifically target shame and self-criticism, such as compassion-based therapies. Level of evidenceIV, cross-sectional study.

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.

Needing to be “perfect” to be loved: the intersection of body dysmorphic disorder, sexual identity, and gay culture in gay men. A qualitative study

Body Dysmorphic Disorder (BDD) is distressing mental health disorder whose clinical features have been given little investigation among sexual minority gay men. While age and gender differences have been investigated, past quantitative studies have neglected to compare between-group differences in BDD symptomatology between heterosexual and sexual minority samples. This creates a lack of understanding for the lived experiences of BDD in the LGBTQ community, which can be remedied through qualitative research. Before exploring between group differences, this study sought to explore the lived experiences of gay men diagnosed with BDD. Ten self-identified gay men who struggle with BDD were interviewed. A phenomenological approach was used to capture the experiences of participants. As a result, four essential themes emerged from the data: Degrading and Abject Influence of BDD, Culpability of Gay Culture, Intersection of BDD and Gay Culture as a Barrier to Intimacy, and Toxic Masculinity’s Impact on Gay Men with BDD. Suggestions for clinical implications and future research implications are also provided.

The critical role of body dysmorphic disorder in dermatological patients’ body image: patients’ desire to seek even more medical treatments increases after dermatological treatment

Objective: To investigate whether patients with a visible skin disorder (acne) and non-visible disorder (psoriasis/eczema) present body image changes after dermatological treatment. Secondly, to examine whether the existence of body dysmorphic disorder (BDD) influences patients’ desire to receive more medical treatments after initial treatment.Materials and methods: A battery of questionnaires assessing body image, BDD and satisfaction with the medical outcome was shared with patients before treatment and with a six-month follow-up (after each patient completed their treatment). The sample included 54 patients with visible facial acne, 54 patients with non-visible psoriasis/eczema, and 54 participants without a dermatological disorder (control group). All patients were treated by dermatologists and were 18-35 years old. We examined body image and demographic characteristics using Multivariate analysis of covariance (MANCOVA) between all the study groups. Performing MANCOVA analysis we investigated patients’ body image and appearance satisfaction, before and after treatment, compared to the control group. Finally, to examine the role of BDD on patients’ desire to receive more treatments, MANCOVA analysis was performed, with BDD diagnosis as a covariate variable.Results: At both research phases, both groups of dermatological patients exhibited lower levels of appearance satisfaction, compared to the control group. MANCOVA analysis revealed that after treatment, acne patients diagnosed with BDD presented even lower levels of facial and overall satisfaction. Moreover, acne patients showed a higher desire for more treatments that improve the skin’s appearance, compared to psoriasis/eczema patients. Conclusion: Dermatological disorders negatively affect patients’ body image, which does not improve even after dermatological treatment completion. Patients with acne seem to be more dissatisfied with their facial and overall appearance, while their dissatisfaction is projected on other body parts. Lastly, the coexistence of BDD symptomatology increases patients’ desire to seek further aesthetic and cosmetic treatments, to further improve the skin’s appearance after treatment.

An update on gender differences in major symptom phenomenology among adults with body dysmorphic disorder

There has not been a comprehensive comparison of differences between men and women with body dysmorphic disorder (BDD) for approximately two decades. Major social and technological changes over this time may have changed patterns of bodily concerns and symptom profile among men and women with BDD, thus warranting an updated assessment of gender differences. BDD symptomatology, insight, and associated clinical and sociodemographic characteristics were compared between 49 women and 27 men with BDD.Skin was the most common concern for both men and women. Women showed more concerns than men about the appearance of their legs. Men were more concerned about muscularity/body build. Women demonstrated significantly more severe distress associated with BDD behaviours, and poorer illness insight than men. Age at BDD onset, illness duration, as well as mean severity of depression, anxiety, stress, and social anxiety were similar across the genders. These data suggest that the most common body areas of concern in people with BDD have not dramatically changed over the past two decades. However, the finding of worse insight among women is novel, and suggests a need for further investigation.

The use of social networking sites, body image dissatisfaction, and body dysmorphic disorder: A systematic review of psychological research.

The escalation of social networking site (SNS) usage has led to much research examining both the positive and negative implications SNS can have on well-being. However, whilst many studies have investigated the relationship between SNS usage and body image, there remains a paucity of research in regards to SNS usage and Body Dysmorphic Disorder (BDD). A systematic search was undertaken using Web of Science, PsychInfo and PubMed databases to identify SNS usage and patterns, SNS features and mediating factors contributing towards body image dissatisfaction, resulting in 40 studies meeting specific inclusion criteria. Findings identified passive SNS use and appearance-focused SNS use as particularly influential. Appearance-based comparisons were also found to be a strong mediator between SNS use and body image dissatisfaction. Using the current knowledge, parallels were highlighted in terms of body image dissatisfaction and BDD symptomatology, suggesting frequent SNS usage as a potential risk factor in the development of BDD symptoms.

Neural Correlates of Own- and Other-Face Perception in Body Dysmorphic Disorder.

BackgroundBody dysmorphic disorder (BDD) is characterized by an excessive preoccupation with one or more perceived flaws in one’s own appearance. Previous studies provided evidence for deficits in configural and holistic processing in BDD. Preliminary evidence suggests abnormalities at an early stage of visual processing. The present study is the first examining early neurocognitive perception of the own face in BDD by using electroencephalography (EEG). We investigated the face inversion effect, in which inverted (upside-down) faces are disproportionately poorly processed compared to upright faces. This effect reflects a disruption of configural and holistic processing, and in consequence a preponderance of featural face processing.MethodsWe recorded face-sensitive event-related potentials (ERPs) in 16 BDD patients and 16 healthy controls, all unmedicated. Participants viewed upright and inverted (upside-down) images of their own face and an unfamiliar other face, each in two facial emotional expressions (neutral vs. smiling). We calculated the early ERP components P100, N170, P200, N250, and the late positive component (LPC), and compared amplitudes among both groups.ResultsIn the early P100, no face inversion effects were found in both groups. In the N170, both groups exhibited the common face inversion effects, with significantly larger N170 amplitudes for inverted than upright faces. In the P200, both groups exhibited larger inversion effects to other (relative to own) faces, with larger P200 amplitudes for other upright than inverted faces. In the N250, no significant group differences were found in face processing. In the LPC, both groups exhibited larger inversion effects to other (relative to own) faces, with larger LPC amplitudes for other inverted than upright faces. These overall patterns appeared to be comparable for both groups. Smaller inversion effects to own (relative to other) faces were observed in none of these components in BDD, relative to controls.ConclusionsThe findings suggest no evidence for abnormalities at all levels of early face processing in our observed sample of BDD patients. Further research should investigate the neural substrates underlying BDD symptomatology.

Serum oxytocin levels are elevated in body dysmorphic disorder and related to severity of psychopathology

The neurobiological mechanisms underlying the pathophysiology of body dysmorphic disorder (BDD) are not well-understood. Oxytocin is a central nervous system peptide which regulates socioemotional functioning and may mediate physiologic processes in a range of psychiatric disorders, particularly those characterized by interpersonal dysfunction. Examining the role of oxytocin in the development and maintenance of BDD may elucidate new targets for intervention. The present study examined endogenous serum oxytocin levels in BDD. Given the prominent deficits in social functioning in BDD, we expected that BDD would be characterized by low basal serum oxytocin concentrations, relative to healthy controls, and that low oxytocin levels would be associated with BDD symptom severity as well as poor performance on measures of social cognition. Twenty individuals with BDD and 28 healthy controls completed a fasting blood draw consisting of frequent sampling every five minutes for one hour to measure pooled levels of oxytocin. Contrary to our hypotheses, people with BDD displayed higher concentrations of oxytocin, compared to their healthy control counterparts, and their oxytocin levels were positively correlated with BDD symptom severity. There were no associations between oxytocin levels and measures of social cognition. These findings suggest increased production of endogenous oxytocin in BDD. Prospective research is needed to determine whether this contributes to or is a consequence of BDD symptomatology.

Prevalence of Body Dysmorphic Disorder and its Association With Body Features in Female Medical Students.

BackgroundBody dysmorphic disorder (BDD) is a distressing psychiatric disorder. So far there have not been any studies on BDD in Saudi Arabia.ObjectivesThe aim of this study was to determine the prevalence of body dysmorphic disorder in female medical students and to investigate whether there is an association between BDD and body features of concern, social anxiety and symptoms of BDD.Materials and MethodsA cross sectional study was carried out on female medical students of the college of medicine, King Saud University, Riyadh, Saudi Arabia during January to April, 2015. Data were collected using the body image disturbance questionnaire, Body dysmorphic disorder symptomatology and social interaction anxiety scale. Descriptive statistics, bivariate and multivariate analysis were used to analyze the results.ResultsOut of 365 students who filled out the questionnaire, 4.4% (95% confidence intervals (CI): 2.54% to 7.04%) were positive for BDD with skin (75%) and fat (68.8%) as the most frequent body features of concern. Ten features (skin, fat, chest, hips, buttocks, arms, legs, lips, fingers, and shoulders) out of twenty-six were significantly associated with BDD. Arms and chest were independently associated with BDD. The odds of presence of body concern related to “arms” was 4.3 (95% C.I: 1.5, 12.1) times more in BDD subjects than non-BDD subjects, while concern about “chest” was 3.8 (1.3, 10.9) times more when compared to non-BDD subjects. No statistically significant association was observed between BDD and social anxiety (P = 0.13).ConclusionsThis was the first study conducted in Kingdom of Saudi Arabia (KSA) on female medical students, which quantified the prevalence of BDD and identified the body features associated with it. Body dysmorphic disorder is prevalent in female medical students but it is relatively rare and an unnoticed disorder.

Acceptance-Based Exposure Therapy for Body Dysmorphic Disorder: A Pilot Study

Body dysmorphic disorder (BDD) is an often severe, chronic, and disabling disorder, and although some controlled trials of cognitive behavior therapy (CBT) have shown efficacy, the body of evidence is still limited. The condition is generally considered difficult to treat, and further research to determine the effectiveness of psychological treatments for BDD is needed. The present study is the first to evaluate an acceptance-based therapy for BDD. In total, 21 patients received a 12-week group treatment consisting of weekly sessions of psychoeducation, acceptance and defusion practice, and exposure exercises to foster acceptance of internal discomfort and to strengthen the patients’ committed purposeful actions. The primary outcome was BDD symptomatology (measured on the BDD-YBOCS) assessed by a psychiatrist before and after treatment and at 6months follow-up. The secondary outcomes were self-rated BDD symptoms, psychological flexibility, depressive symptoms, quality of life, and disability. Reductions in BDD symptomatology from pre- to posttreatment were significant and showed a large effect size, d=1.93 (95% CI 0.82–3.04). At posttreatment, 68% of the participants showed clinically significant improvement in the primary outcome variable. Treatment gains were maintained at 6months follow-up. The treatment also resulted in significant improvements in all secondary outcomes. The dropout rate was low; 90.5% of the participants completed treatment. This study suggests that acceptance-based exposure therapy may be an efficacious and acceptable treatment for BDD that warrants further investigation in larger controlled trials.

Psychopathology symptoms in a sample of female cosmetic surgery patients

During the past decades, cosmetic surgery has become increasingly popular. People with certain psychopathology disorders, for example, body dysmorphic disorder (BDD), are dissatisfied with their physical appearance, and a significant number try to receive cosmetic medical treatment for their complaints. It seems relatively easy for them to receive this type of surgery, despite the fact that it has no or even adverse effects on the symptoms. The present study aimed to investigate the psychological condition and especially the presence of psychopathological symptoms such as BDD in cosmetic surgery patients. Questionnaires about body image dissatisfaction, symptoms of BDD and psychopathology in general and satisfaction about surgery were sent to patients who had been treated in a large cosmetic surgery clinic. Of the patients who replied, 86% were pleased with the outcome of the cosmetic procedure. Further, 21-59% of these former patients scored higher on questionnaires of body image dissatisfaction and psychopathological symptoms than a norm group from the general population. When differentiating the group on the basis of BDD symptomatology, it appeared that the high BDD symptomatic group displayed significantly worse outcome on all measurements. That is, high BDD symptomatic patients were more dissatisfied about the result of surgery, exhibited higher levels of psychopathology, and had lower self-esteem than the low symptomatic BDD patients. These findings clearly suggest that the evaluation of the psychological condition and motivation of the candidate patient might be a valuable addition to the standard procedure in cosmetic medical treatment settings.

Appearance concerns comparisons among persons with body dysmorphic disorder and nonclinical controls with and without aesthetic training

Body dysmorphic disorder (BDD) concerns may be on a continuum with normal appearance concerns, differing only quantitatively. As emerging evidence suggests that an increased aesthetic sensitivity plays a role in BDD, individuals with BDD ( n = 50) were compared with a control group of individuals with an education or employment in art and design related fields ( n = 50) and a control group of individuals without aesthetic training ( n = 50). Participants completed a demographic questionnaire and a series of measures for depression, BDD symptomatology, and body image. Most controls (with and without aesthetic training) reported appearance concerns and expressed comparable ideals to those with BDD. However, BDD participants differed by using negative, emotive, and morally based descriptions for their defect(s), spending a greater time preoccupied with their defect(s) causing increased interference with functioning, performing appearance-related behaviors more frequently, and experiencing greater distress when performing those behaviors.

Predicting consideration of cosmetic surgery in a college population: A continuum of body image disturbance and the importance of coping strategies

Elective cosmetic surgeries are increasing in the American population with reasons linked to body image disturbance and body dysmorphic disorder (BDD). Little research exists documenting the continuum of body image disturbance and its relationship to seeking surgery. The present research examined data from 544 participants, 55 of whom were diagnosable with BDD. Using assessments for body image disturbance, problematic coping strategies, and BDD symptomatology, results provided evidence for a continuum of body image distress. Logistic regression analysis supported the hypothesis that increased levels of body image disturbance and one type of problematic coping strategy (Appearance Fixing) predicted consideration of cosmetic surgery. Of participants diagnosable with BDD, those who considered cosmetic surgery showed more severe body image disturbance and problematic coping than those who did not consider surgery. These results have implications for pre-surgical assessment as well as psychological interventions rather than invasive medical interventions.

Body Dysmorphic Disorder among Diverse Racial/Ethnic and Sexual Orientation Groups: Prevalence Estimates and Associated Factors

Body Dysmorphic Disorder (BDD) is a psychological disorder characterized by excessive appearance concerns. This cross-sectional study assessed an undergraduate sample of 1,041 participants from a southeastern American university to estimate an overall prevalence of BDD; investigate differences by gender, race/ethnicity, and sexual orientation; and also examine the contributions of other related constructs including appearance comparison, obligatory exercise, body image disturbance, and self-esteem. Results indicated an overall prevalence of 4.9%. Women endorsed more symptoms of BDD than men, among women Caucasians and Latinas endorsed more symptoms than African Americans, and sexual minorities endorsed more symptoms than heterosexuals. Overall, BDD symptomatology was negatively correlated with body satisfaction and self-esteem and positively correlated with appearance comparison and obligatory exercise.

Body Dysmorphic Disorder: Gender differences and prevalence in a Pakistani medical student population

BackgroundBody dysmorphic disorder (BDD) is a psychiatric disorder characterized by a preoccupation with an imagined or slight defect which causes significant distress or impairment in functioning. Few studies have assessed gender differences in BDD in a non clinical population. Also no study assessed BDD in medical students. This study was designed to determine the point prevalence of BDD in Pakistani medical students and the gender differences in prevalence of BDD, body foci of concern and symptoms of BDD.MethodsThe medical students enrolled in a medical university in Karachi, Pakistan filled out a self-report questionnaire which assessed clinical features of BDD. BDD was diagnosed according to the DSM-IV criteria.ResultsOut of the 156 students, 57.1% were female. A total of 78.8% of the students reported dissatisfaction with some aspect of their appearance and 5.8% met the DSM-IV criteria for BDD. The male to female ratio for BDD was 1.7. Regarding gender differences in body foci of concern, the top three reported foci of concern in male students were head hair (34.3%), being fat (32.8%), skin (14.9%) and nose(14.9%), whereas in females they were being fat (40.4%), skin (24.7%) and teeth (18%). Females were significantly more concerned about being fat (p = 0.005). Male students were significantly more concerned about being thin (p = 0.01) and about head hair (p = 0.012).ConclusionBDD is fairly common in our medical student population, with a higher prevalence in males. Important gender differences in BDD symptomatology and reported body foci of concern were identified which reflected the influence of media on body image perception. The impact of cultural factors on the prevalence as well as gender differences in BDD symptomatology was also established.

Social anxiety in body dysmorphic disorder

Although clinical impressions suggest that patients with body dysmorphic disorder (BDD) experience distress in social situations, social anxiety in BDD has received little investigation. This study examined social anxiety in 81 patients with BDD and change in social anxiety with pharmacotherapy. Subjects completed the Social Avoidance and Distress Scale (SADS) and were assessed with measures of BDD symptomatology. Participants in a placebo-controlled fluoxetine trial completed measures at baseline and endpoint. The mean SADS score was 1.3 SD units higher than nonclinical sample means but consistent with other clinical sample means. Social anxiety was significantly correlated with BDD severity. Greater depressive symptoms as well as comorbid avoidant personality disorder, but not comorbid social phobia, were also associated with higher SADS scores. Social anxiety did not improve more with fluoxetine than placebo, yet it improved significantly more in fluoxetine responders than in nonresponders. Understanding social anxiety in BDD has implications for reducing rates of misdiagnosis and treatment dropout.