Imagined Defect In Appearance Research Articles

Body dysmorphic disorder and addiction to medical aesthetic procedures

According to the Diagnostic and Statistical Manual of Mental Disorders, body dysmorphic disorder (BDD), or dysmorphophobia, is the preoccupation with an imagined defect in appearance that leads to significant distress and impairments to daily functioning. Due to their lack of insight, individuals with BDD believe that cosmetic procedures will be the solution to their insecurities, even though they rarely get satisfaction from them. Cosmetic procedures can then become an addiction, as patients never reach full satisfaction. In response to this issue, aesthetic practitioners need to identify those presenting with BDD by administering a questionnaire that asks how many cosmetic surgeries the individual has had previously, before continuing with any aesthetic procedure. Those who show signs of BDD can then be referred to mental health professionals for specialised treatments, such as medications, cognitive behavioural therapy, exposure and response prevention, and family support.

Examining neurocognition in body dysmorphic disorder using the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS): A comparison with obsessive-compulsive disorder

Body dysmorphic disorder (BDD) is characterised by (i) an excessive preoccupation with an imagined defect in appearance, as well as (ii) repetitive behaviours and/or mental acts that occur in response to the preoccupation. To date, neuropsychological investigations have been limited. This study examined performance on the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), tapping into five indices of neurocognition: (i) Immediate Memory, (ii) Visuospatial Construction, (iii) Language, (iv) Attention, and (iv) Delayed Memory. Twenty-one BDD participants were compared with 19 obsessive-compulsive disorder (OCD) participants and 21 healthy controls (HC), who were age-, sex-, and IQ-matched. Results indicated the BDD and OCD groups demonstrated poor overall neuropsychological performance (i.e. total RBANS) as well as deficits on the indices of Immediate Memory and Attention. Further group differences involving the subtests of Story Memory, Digit Span, and Story Recall were detected. Neuropsychological impairment in BDD with indicated similarities in OCD were corroborated. Future research should extend investigations focusing on gist and delayed memory, and aspects of attentional processing.

Body Dysmorphic Disorder, Self-esteem and Depression in Cosmetic Rhinoplasty

Introduction Body dysmorphic disorder is characterized by a preoccupation with an imagined defect in appearance that causes clinically significant distress or impairment in important areas of functioning. Aims This study aimed to evaluate body dysmorphic disorder, self-esteem, and depression in cosmetic rhinoplasty patients Methods 250 cosmetic rhinoplasty patients completed a demographic questionnaire, dysmorphic concern questionnaire (DCQ), Rosenberg self-esteem scale, and Beck depression index-II (BDI-II). Data were analyzed by appropriate tests. Results Of 250 patients, 30 (12.0%) were male and 220 (88.0%) were female. Mean ± SD was 24.0 ± 4.7 for age. Frequency of body dysmorphic disorder (BDD) was 18.0% (45). BDD showed a significant correlation with lower self-esteem and higher depression (both P Lower self-esteem showed in the patients with age The prevalence of depression (BDI score >13) was 107 (42.2%). Severity of depression was significantly higher in married patients (P=0.003), lower education (P=0.001), lower income (P=0.04), cigarette smoking (P=0.008), having more children (P Conclusions There should be special concerns about psychiatric aspects of people who seek cosmetic surgeries.

The frequency of body dysmorphic disorder in dermatology and cosmetic dermatology clinics: a study from Turkey.

Body dysmorphic disorder (BDD) is a distressing and impairing preoccupation with a slight or imagined defect in appearance. There are few reports on the prevalence of BDD in the Turkish population. To investigate the frequency of BDD in dermatology settings, and to compare the results from cosmetic dermatology with those from general dermatology settings. This cross-sectional study recruited 400 patients from cosmetic dermatology (CD) (n=200) and general dermatology (GD) clinics (n=200). A mini-survey was used to collect demographic and clinical characteristics, and the dermatology version of a brief self-report BDD screening questionnaire was administered. A five-point Likert scale was used for objective scoring of the stated concern, which was performed by dermatologists, and patients who scored ≥3 were excluded from the study. In total, 318 patients (151 in the CD group and 167 in the GD group) completed the study, and of these, 20 were diagnosed with BDD. The CD group had a higher rate of BDD (8.6%) than the GD group (4.2%) but this was not significant (P=0.082). The major concern focused on body and weight (40.0%), followed by acne (25.0%). The number of cosmetic procedures in dermatology practices is increasing Therefore, it is becoming more important to recognize patients with BDD. Although the rates of BDD found in the present study are in agreement with the literature data, population-based differences still exist between this study and previous studies.

A Case of Body Dysmorphic Disorder by Proxy

To the Editor: Body dysmorphic disorder (BDD) is characterized by preoccupation with an imagined defect in appearance of self. We present and discuss the case of a 28-year-old woman with a preoccupation regarding perceived deformities of appearance for her daughter as well as for herself. A PubMed search of BDD and dysmorphophobia by proxy yielded only 5 such reports1–4; the current report extends the boundaries of “self” in the psychopathology of BDD. Case report. Ms A, a 28-year-old woman, presented 6 months before the time of this report with an illness of 10 years’ duration with repetitive thoughts and preoccupation related to short stature and facial deformity. She was repeatedly checking the mirror and seeking assurance about her presumed facial deformity and height. Her appetite and sleep were reduced, and she had preferred staying at home because of doubts that people were looking at her and mocking her ugliness. After she was married, she was critical of the attributes of her husband and felt that his face was disproportionately big. With the fear that her baby would also share her physical ugliness, she even attempted an abortion, though unsuccessful. Since the birth of her daughter, she indulged in frequent checking and assurance seeking for her daughter’s assumed deformity of face. She used to feel guilty for passing along ugliness to her daughter, and thoughts of strangling her own child troubled her repeatedly, which led her to avoid the child while alone. There was no family history of any significant psychiatric or medical illness, and her general physical examinations revealed no abnormalities. Her score on the Yale-Brown Obsessive Compulsive Scale modified for BDD (BDD-YBOCS)5 was 32 for self and 30 for her daughter; the overall Clinical Global Impressions-Severity of Illness scale6 score was 5, indicating severe symptoms and functioning mainly with assistance. On the 17-item Hamilton Depression Rating Scale (HDRS17),7 her score was 38. She received tablet venlafaxine 150 mg/d and trifluoperazine 10 mg/d as well as cognitive-behavioral therapy. After 12 weeks, her BDD-YBOCS scores were 12 for self and 6 for her daughter. Her overall Clinical Global Impressions Improvement scale6 score was 2 (much improved), and her HDRS17 score was 12; her distress had improved, but mild dysmorphic ideas for self persisted. The patient had characteristic preoccupation and distress with an imagined defect in appearance of self. She had apprehensions of passing along ugliness to her baby, and the attempted abortion indicates the extent and intensity of her dysmorphic symptoms, which continued for herself and her daughter. The possible psychopathological explanation of proxy manifestation may be due to (1) a variant of BDD, (2) severity of BDD, and (3) association of depression. Josephson and Hollander2 reported 2 cases of proxy BDD and suggested that BDD criteria should be expanded as “appearance obsessions” in others. In this and previous cases,1,2 the proxy component appeared later in the course of illness of established BDD and also improved earlier with treatment, suggesting proxy manifestation may be due to extension of the BDD itself, in terms of severity, and not a variant of BDD. Associated depression may also be confounding to psychopathology. This case illustrates that the idea of self-ugliness in BDD may extend beyond self as proxy manifestation.

Body dysmorphic disorder and aesthetic dentistry

This paper outlines the features and presentation of body dysmorphic disorder (BDD), a psychological syndrome which results in patients seeking treatment for an imagined defect in appearance. The assessment of patients with suspected body dysmorphic disorder is outlined, as well as management strategies. Clinicians working in the field of aesthetic dentistry should be aware that some patients presenting for treatment may have body dysmorphic disorder. Aesthetic dental treatment for such patients is not beneficial and carries some risks. Advice for clinicians on assessment and management is outlined.

Botulinophilia: contraindication for therapy with botulinum toxin

Botulinum toxin inhibits neuromuscular transmission and is one of the most potent toxins. It has proven to be effective in the treatment of hyperhidrosis and is being more frequently demanded for therapy. Patients with body dysmorphic disorder also seek costly treatment with botulinum toxin. This botulinophilia is a new venenophilia. Body dysmorphic disorder is defined as a preoccupation with an imagined defect in appearance. If a slight physical anomaly is present, the person's concern is markedly exessive. The patient's preoccupation causes clinically significant distress or impairment in socially, occupational, or other important areas of functioning. The sweat test according to Minor is negative. Patients with botulinophilia are among the most difficult patients managed by the dermatologist. They are demanding and time-consuming. In our clinic, 23.1% of a series of patients seeking treatment with botulinum toxin screened positive for body dysmorphic disorder. Botulinophilia is a contraindication for therapy with botulinum toxin but is an indication for psychotherapy.

Pharmacotherapy and psychotherapy for body dysmorphic disorder

Body dysmorphic disorder (BDD) is a prevalent and disabling preoccupation with a slight or imagined defect in appearance. Trials have investigated the use of serotonin reuptake inhibitors (SRIs) and cognitive behaviour therapy (CBT) for BDD. To assess the efficacy of pharmacotherapy, psychotherapy or a combination of both treatment modalities for body dysmorphic disorder. We searched the Cochrane Depression, Anxiety and Neurosis Trial Register (December 2007), the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 4, 2007), MEDLINE (January 1966 to December 2007), and PsycINFO (1967 to December 2007). Ongoing and unpublished trials were located through searching the metaRegister of Controlled Trials, the CRISP and WHO ICTRP search portals (databases searched in December 2007), and through contacting key researchers and pharmaceutical companies. Additional studies were located through study reference lists. Randomised controlled trials (RCTs) of patients meeting DSM or ICD diagnostic criteria for BDD, in which the trials compare pharmacotherapy, psychotherapy or multi-modal treatment groups with active or non-active control groups. Short or long-term trials were eligible. Two review authors independently assessed RCTs for inclusion in the review, collated trial data, and assessed trial quality. Investigators were contacted to obtain missing data. Summary effect sizes for dichotomous and continuous outcomes were calculated using a random effects model and heterogeneity was assessed. Two pharmacotherapy and three psychotherapy trials were eligible for inclusion in the review, with data from four short-term RCTs (169 participants) available for analysis. Response data from a single placebo-controlled trial of fluoxetine suggested overall superiority of medication relative to placebo (relative risk (RR) 3.07, 95% CI 1.4 to 6.72, n = 67). Symptom severity was also significantly reduced in the RCTs of fluoxetine and clomipramine (relative to desipramine), as well as in the two CBT trials (WMD -44.96, 95% CI -54.43 to -35.49, n = 73). A low relapse rate (4/22) was demonstrated in one trial of CBT. Results from the small number of available RCTs suggest that SRIs and CBT may be useful in treating patients with BDD. The findings of these studies need to be replicated. In addition, future controlled studies in other samples, such as adolescents, and using other selective SRIs, as well as a range of psychological therapy approaches and modalities (alone and in combination), are essential in supplementing the sparse data currently available.

Mirror gazing increases attractiveness in satisfied, but not in dissatisfied women: A model for body dysmorphic disorder?

Body dysmorphic disorder is a severe disturbance in which the person is preoccupied with an imagined defect in appearance. It is unclear what causes and what maintains BDD, although it is assumed that patients are characterized by an increased self-focused attention. Since patients spend a lot of time examining their ‘defect’ in reflecting surfaces, it might well be that mirror gazing itself is an important maintaining factor for BDD, as it may lead to a loss of sense of proportions. If so, normal individuals' body evaluations are expected to decrease likewise after mirror exposure. In the present study, 50 female students watched both their own face in the mirror and a photograph of a neutral female face for 3.5 min. Before and after gazing, they rated the attractiveness of the faces. Results indicate that mirror exposure did not lead to decreased attractiveness in normal participants. However, when participants were divided into high and low satisfaction about appearance, highly satisfied individuals' evaluations of their own face improved, whereas low satisfied individuals' evaluations tended to decrease. For the other face, only the low satisfied individuals showed increased attractiveness scores at post-test. The results are explained by selective visual attention and are in line with recent findings in eating disordered women.

Examining the Prevelance of Body Dysmorphia within a Physically Active Female Population

Examining the Prevalence of Body Dysmorphia within a Physically Active Female Population Body image consists of perceptional and attitudinal dimensions, while body dysmorphia (as a psychological construct) is a disorder of perceiving that body size and appearance determines the worthiness of the individual (McArthur, Holbert, & Peña, 2005). This disorder has been recognized within the DSM-IV containing specific diagnostic criteria. The National Institute on Media and the Family [NIMF] estimated that at age 13, 53% of American girls are not happy with their bodies. This number grows to 78% by the time girls reach age 17 (NIMF, 2002). Therefore, the researchers have determined the need to assess the prevalence of body dysmorphia within a physically active female population. The complexity of body dysmorphia includes several risk factors according to the DSM-IV. These include preoccupation with an imagined defect in appearance, the preoccupation causes clinically significant distress or impairment in social, occupational, or other important areas of functioning, and the preoccupation is not better accounted for by another mental disorder (e.g., dissatisfaction with body shape and size in anorexia nervosa). Although there are many negative risk factors affecting body dysmorphia, the real dangers come in the form of health consequences including dieting practices, eating disorders, compulsive exercise, and cosmetic surgery. For the purposes of this study, the researchers examined prevalence rates of body dysmorphia within an active female population as described by the American College of Sports Medicine. The Sociocultural Attitudes Towards Appearance Questionnaire (SATAQ-3) was the instrument chosen to evaluate body dysmorphia prevalence among female populations. The SATAQ-3 is a 30 item questionnaire comprising of five subscales consisting of information, awareness, pressures, internalization-athlete, and internalization-general. Internal consistency for the SATAQ-3 has been tested and proven as a reliable instrument to assess body dysmorphia (Cronbach's alpha .96). Prevalence data collected in this study will assist health professionals identify predictive and intervention strategies to prevent possible behaviors of body dysmorphia within the physical active female population

Delusional disorders in dermatology: A brief review

There are several unique psychiatric disorders that are likely to present to a dermatologist because of their accompanying skin complaints. Delusions of parasitosis (DP) is a fixed, false belief of parasitic infestation that may lead patients to compulsively self-mutilate while attempting to remove the non-existent parasites. Morgellons disease is a controversial condition characterized by a fixed belief that fibers that are imbedded or extruding from the skin; this condition is likely in the spectrum of DP. Body dysmorphic disorder (BDD) is a preoccupation with an imagined defect in appearance that causes significant distress and is associated with time consuming rituals, isolation, depression, and increased risk of suicide. Olfactory reference syndrome (ORS) is a preoccupation with body odor leading to the stigmata of shame, embarrassment, and social isolation. This brief review examines each of these conditions and their management because any one of them may present to a dermatologist.

Body dysmorphic disorder symptoms among patients with acne vulgaris

Acne is one of the most common concerns of patients with body dysmorphic disorder (BDD), a psychiatric condition defined as a preoccupation with a slight or imagined defect in appearance that causes significant disruption in daily functioning. We sought to screen for BDD symptoms among patients with acne across a spectrum of acne severity. We used a validated self-report questionnaire and an objective assessment of acne severity by a single observer. Rates of BDD ranged from 14.1% using more stringent criteria to assess acne severity to 21.1% using less stringent criteria. Two-fold increased odds of having BDD was seen in patients requiring systemic isotretinoin therapy. Cross-sectional study design is a limitation. A significant proportion of patients, regardless of their acne severity at the time of examination, have substantial distress and preoccupation related to their facial appearance.

A Sociodemographic, Phenomenological, and Long-Term Follow-up Study of Patients with Body Dysmorphic Disorder in Brazil

The main characteristic of body dysmorphic disorder (BDD) is a preoccupation with an imagined defect in appearance in a normal-appearing person or an excessive preoccupation with appearance in a person with a small physical defect. In this non-controlled study, our objective was to describe the socio-demographic, phenomenological, and long-term outcome features of a Brazilian sample of patients with BDD. We performed a chart-review of the 166 patients who attended the Obsessions, Compulsions, and Impulsions Subprogram of the Institute of Psychiatry of the Federal University of Rio de Janeiro, Brazil, during the period between 1998 and 2005. Twenty patients (12%) had clinically significant BDD. This sample was characterized by a predominance of female (n = 11; 55%), single or divorced (n = 18; 90%), and economically unproductive patients (n = 17; 85%). We found an average of 2.5 current imagined defects per patient. The most frequently reported body parts of excessive concern were the overall appearance, size or shape of the face (n = 7; 35%), the skin (n = 6; 30%), the hair (n = 6; 30%), the nose (n = 5; 25%), and the body build and weight (n = 5; 25%). Most individuals exhibited a chronic condition (n = 13; 65%) and kept the same concerns during the course of the disorder (n = 12; 60%). All patients displayed compulsive behaviors, including recurrent mirror checking (n = 14; 70%), camouflaging (n = 13; 65%), reassurance seeking by means of repetitive questioning of others (n = 9; 45%), and excessive use of cosmetics (n = 7; 35%). Two patients reported "do-it-yourself" surgeries. Seven patients had current suicidal ideation (35%). Six patients (30%) showed no insight over their dysmorphic beliefs. Fifteen patients (95%) exhibited psychiatric comorbidities, mostly obsessive-compulsive disorder (OCD) (n = 14, 70%) and major depressive disorder (n = 11; 55%). The majority of patients were treated naturalistically with serotonin reuptake inhibitors (n = 15; 75%), either solo or in association with antipsychotics (n = 10; 50%). Nevertheless, only 5 (25%) responded favorably to treatment during the long-term follow-up (CGI < or = 2). BDD is a severe disorder that is frequently associated with other psychiatric conditions and responds poorly to treatment in the naturalistic setting. No significant trans-cultural variations were identified in the comparison between Brazilian, North American, and European samples.

Body dysmorphic disorder due to hirsutism in a patient treated with cyclosporin

Sir, Currently administered immunosuppression schemes usually include cyclosporin. Cyclosporin has brought about a revolution in patient prognosis and in renal graft survival, but, unfortunately, it has many side effects [1,2]. While physicians are attentive to the more serious and life threatening of these side effects, there are others which, although not life threatening, can compromise the patient’s quality of life. To the latter group belongs hirsutism. The incidence of cyclosporin-induced hirsutism in renal graft recipients is 5% [1,2]. We describe the case of a 20-year-old male patient with end-stage renal disease due to Alport’s syndrome. After 5 months on haemodialysis, the patient received a renal transplant from his father. On discharge from the hospital, the patient was taking Medrol 56mg/day, mycophenolate mofetil 1.5 g/day and cyclosporin A 400mg/day. Over a 3 month period, he developed heavy hirsutism of the face and body, which affected both his mood and his social behaviour. He withdrew from his daily activities, became socially isolated and declared that he would stay at home and stop his education. At that time, his serum creatinine was 1.1mg/dl. The patient was referred to a psychiatrist and the final diagnosis was body dysmorphic disorder [3]. It must be noted that in our department, a psychiatric examination is obligatory for any transplant candidate. In this case, the examination was done a few months before transplantation and showed no psychiatric disorder. Because of this, and despite the good graft function, cyclosporin was switched to tacrolimus (10mg/day), an efficient immunosupressive drug that dose not cause hirsutism [1,2,4]. The hirsutism disappeared gradually, and both the mood and behaviour of the patient were restored. One year later, the patient’s serum creatinine is 1.2mg/dl and the dose of tacrolimus is 5mg/day. Although hirsutism occasionally leads to patient noncompliance, our patient was compliant with medications, but he also fulfilled the criteria oulined in the Diagnostic and Statistical Manual of Mental Disorders (DSM IV) of the American Psychiatric Association for body dysmorphic disorder [3]. These criteria are: (i) preoccupation with an imagined defect in appearance; if a slight physical anomaly is present, the person’s concern is markedly excessive; (ii) the preoccupation causes clinically significant distress or impairment in social, occupational or other important areas of functioning; and (iii) the preoccupation is not better accounted for by another mental disorder. Body dysmorphic disorder is a serious situation that needs psychiatric evaluation as it is often accompanied by major depression; suicide attempts are rather common [5]. In conclusion, physicians should take care, not only of directly life-threatening side effects of an immunosuppressive regimen, but also of other side effects that can compromise the patient’s quality of life. In this case, the switch from cyclosporin to tacrolimus was enough to restore the patient’s physical and mental status.

Highlights of the 2003 Institute on Psychiatric Services

Numerous cross-sectional analyses have shown that individuals with mental illness are less likely to be employed, and many psychological studies have demonstrated that the loss of employment is a risk factor for developing depression. It remains less clear, however, whether depression affects job retention among the employed.

Body dysmorphic disorder: recognition and treatment.

Body dysmorphic disorder (BDD) is classified as a somatoform disorder in the Diagnostic and Statistical Manual of Mental Disorder-IV-TR (DSM-IV-TR) (American Psychiatric Association, 2000). According to the DSM-IV-R, BDD is characterized as a preoccupation with an imagined defect in appearance. If a slight physical anomaly exists, the person's concern is markedly excessive and this preoccupation causes clinically significant distress or impairment in social, occupational, or other important areas of functioning. This diagnosis is most appropriately used when symptoms associated with this dissatisfaction with the body shape and size are not better explained by an eating disorder (American Psychiatric Association, 2000).

Prevalence of body dysmorphic disorder in a community sample of women.

In a large population-based study, the authors examined the prevalence and correlates of body dysmorphic disorder, a debilitating and chronic condition characterized by an imagined defect in appearance. Rates and diagnostic correlates of body dysmorphic disorder were examined by using data from the Harvard Study of Moods and Cycles. This study used in-person structured clinical interviews to characterize the diagnostic status of a population-based, cross-sectional sample of 318 depressed and 658 nondepressed women between the ages of 36 and 44 who were selected from seven Boston metropolitan area communities. The presence of body dysmorphic disorder was significantly associated with the presence of major depression and anxiety disorders. The authors estimated the overall point prevalence of body dysmorphic disorder as 0.7% in women in this age range in the community. The authors found that the presence of body dysmorphic disorder was linked to the presence of major depression and anxiety disorders, which is similar to findings in clinical studies. Their estimate of the point prevalence of body dysmorphic disorder is consistent with data from a community-based sample of Italian women and suggests a prevalence similar to that of other serious psychiatric disorders in women (e.g., schizophrenia and drug abuse and dependence). These prevalence data encourage the further development of treatment options for this debilitating condition.

A review of cognitive behavioral and pharmacological treatment of body dysmorphic disorder.

Body dysmorphic disorder (BDD) first appeared in the diagnostic nomenclature in 1987 with the Diagnostic and Statistical Manual of Mental Disorders, 3rd Edition Revised (DSM-III-R) (APA, 1987). Currently in DSM-IV (APA, 1994), the criterion of impairment in functioning was added to the already existing criteria of preoccupation with an imagined defect in appearance not accounted for by another mental disorder. The body parts most often perceived as defective are the nose, hair, and complexion. Behavioral and pharmacological studies consist primarily of case reports. Systematic desensitization, exposure and response prevention, and cognitive therapy are promising approaches that need further investigation. Pharmacological agents noted to be beneficial are the selective serotonin reuptake inhibitors. Controlled studies in this area are also needed.

Body dysmorphic disorder: 30 cases of imagined ugliness

Body dysmorphic disorder, preoccupation with an imagined defect in appearance, is included in DSM-III-R but has received little empirical study. The authors investigated the demographics, phenomenology, course, associated psychopathology, family history, and response to treatment in a series of 30 patients with the disorder. The patients (including 12 whose preoccupation was of probable delusional intensity) were assessed with a semistructured interview and the Structural Clinical Interview for DSM-III-R, and their family histories were obtained. The 17 men and 13 women reported a lifetime average of four bodily preoccupations, most commonly "defects" of the hair, nose, and skin. The average age at onset of body dysmorphic disorder was 15 years, and the average duration was 18 years. Seventy-three percent of the patients reported associated ideas or delusions of reference; 73%, excessive mirror checking; and 63%, attempts to camouflage their "deformities." As a result of their symptoms, 97% avoided usual social and occupational activities, 30% had been housebound, and 17% had made suicide attempts. Ninety-three percent of the patients had an associated lifetime diagnosis of a major mood disorder; 33%, a psychotic disorder; and 73%, an anxiety disorder. The patients generally responded poorly to surgical, dermatologic, and dental treatments and to adequate trials of most psychotropic medications, with the exception of fluoxetine and clomipramine (to which more than half had a complete or partial response). This often secret, chronic disorder can cause considerable distress and impairment, may be related to obsessive-compulsive disorder or mood disorder, and may respond to serotonin reuptake-blocking antidepressants.