Prevalence of body dysmorphic disorder: A systematic review and meta-analysis

Prevalence of Body Dysmorphic Disorder: A Systematic Review and Meta-Analysis

BACKGROUND

Body dysmorphic disorder (BDD) is characterized by a preoccupation with ≥ 1 perceived defects in physical appearance, which leads to social anxiety and avoidance. This excessive focus on appearance is linked to dissatisfaction with physical features, disappointment with cosmetic treatments, or frustration from not meeting perceived beauty standards.

OBJECTIVE

The aim of this study was to determine the prevalence of BDD in dermatology, psychiatric, plastic surgery, general population, and world regions, as well as the prevalence of BDD using different diagnostic tools.

METHODS

The authors conducted a systematic review of the literature in Medline via PubMed, Embase, and Latin American databases using MeSH terms "body dysmorphic disorder" and "prevalence" with filters for original and cross-sectional studies. Statistical analysis was performed using RStudio, and bias assessment was made using JBI Critical appraisal.

RESULTS

The overall prevalence of BDD in the general population was 17%, with higher rates in females than in males. The prevalence in plastic surgery patients was 24%. The highest prevalence of BDD was found in Latin America compared to other world regions.

CONCLUSIONS

BDD is a highly prevalent disorder, and increased awareness of the disease could improve its approach in plastic surgery and other medical fields.

The Quality of Information About Body Dysmorphia on TikTok

BACKGROUND

With the rise of social media as a knowledge sharing resource, patients increasingly obtain information regarding plastic surgery online. Publicly shared posts may influence active users' desire to undergo procedures and misinform their expectations, which is of particular importance in patients with body dysmorphic disorder (BDD), who may already suffer from an altered mentality of their appearance. To date, no study has assessed the quality of information about BDD on TikTok. Thus, our study aims to evaluate the usefulness and quality of the most trending TikTok videos related to BDD and plastic surgery.

METHODS

A search was conducted on TikTok using keywords "body dysmorphia," "body dysmorphia plastic surgery," and "dysmorphophobia," and the top 15 trending videos in each category were selected. Two expert reviewers assessed the videos using the DISCERN and Global Quality Score evaluation tools.

RESULTS

The mean ± SD DISCERN score across all videos was 22.66 ± 8.62. Videos uploaded by certified healthcare accounts (11/45) had a mean ± SD score of 29.87 ± 8.85, indicating a "poor" grade. These scores were significantly higher than those uploaded by nonhealthcare accounts, which received a mean ± SD score of 20.32 ± 7.17, reflecting a "very poor" grade (P < 0.0001). The overall Global Quality Score mean ± SD was 1.96 ± 1.11, with uploads from healthcare professionals scoring significantly higher than uploads from nonhealthcare professionals (3.00 ± 1.34 vs 1.62 ± 0.78, P < 0.0001).

CONCLUSIONS

With the increasing prevalence of BDD and social media usage, vulnerable individuals may be prone to comparing themselves to others, potentially further impacting their self-image and driving them toward a more permanent, surgical solution. These findings highlight the suboptimal BDD-related content on TikTok, stressing the potential for further disease development in this at-risk population. As plastic surgeons ascertain whether a patient is a candidate for cosmetic surgery, directing them to reliable resources can ensure proper education and foster realistic expectations.

Exploring the Prevalence and Etiological Factors of Body Dysmorphic Disorder in Cosmetic Surgery Populations: Implications for Enhanced Clinical Assessment

BACKGROUND

The prevalence of body dysmorphic disorder (BDD) varies across different clinical settings, with evidence indicating its notable presence not only in psychiatric environments but also in dermatology and plastic surgery. This article aims to investigate the etiological factors associated with the elevated incidence of BDD in plastic surgery outpatient settings, with the ultimate objective of enhancing the assessment process for potential cosmetic procedure candidates.

METHODS

We recruited 531 patients seeking consultations or surgeries at the Department of Plastic Surgery, Peking University Shenzhen Hospital, from October 2022 to February 2024. The Yale-Brown Obsessive-Compulsive Scale Modified for Body Dysmorphic Disorder (BDD-YBOCS) was utilized to diagnose BDD, and the Hospital Anxiety and Depression Scale (HADS) assessed psychological comorbidities. Statistical analyses included Spearman's correlation, Kruskal-Wallis, and chi-square tests.

RESULTS

BDD was diagnosed in 11.3% of the participants, with significant variations related to gender (p = 0.042) and marital status (p = 0.026). A significant correlation was also displayed between BDD-YBOCS and HADS (Spearman's rho = 0.266, p < 0.001). Notably, BDD prevalence was higher during the COVID-19 pandemic (13.6%) compared to post-pandemic period (3.4%) (p = 0.003).

CONCLUSION

This study elucidates the significant prevalence of body dysmorphic disorder (BDD) among patients seeking cosmetic surgery, highlighting critical demographic, psychological and environmental factors that contribute to its manifestation. Given the significant prevalence and the multifactorial nature of BDD, it is important to develop comprehensive assessment tools before cosmetic consultation that prioritize mental health alongside aesthetic considerations in the future.

LEVEL OF EVIDENCE IV

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 .

Staying isolated indoors means that nobody sees me": ontological (in)security and living with significant appearance concerns before, during, and 'since' COVID-19

PURPOSE

Though a worldwide period of uncertainty (COVID-19) has 'ended', there exists a legacy of maladaptive experiences among people with significant appearance concerns (SAC) that requires care and attention.

METHODS

Using Giddens' concept of ontological security, we explored how people experienced their SAC before, during and "since" COVID-19. Qualitative surveys allowed us to capture diverse perspectives from individuals transnationally, analysed with deductive reflexive thematic analysis using ontological security as our theoretical foundation.

RESULTS

Themes named "More Mirror(ed) Time" and "Locked Out, Shut Down, and Shut Out" gave a contextual grounding for the embodied experiences of this group through times of social restrictions, and the theme "Redefining Relevance" explored the continued legacy of COVID-19 - and continued global uncertainties such as economic hardship and warfare - that impact the wellbeing of people with SAC.

CONCLUSIONS

People with SAC are still 'locked out' from essential healthcare support as those providing healthcare are overworked, under-resourced and rely on efficient interactive methods such as tele-health that may be triggers for people with SAC. Care providers may consider expanding appearance concerns verbiage, look to involve trusted others in the care-seeking process, and utilize modalities beyond digital health to support people with SAC.

The prevalence of body dysmorphic disorder in outpatient dermatology clinics: a systematic review

BACKGROUND

Body dysmorphic disorder (BDD) is a psychiatric condition involving a preoccupation with physical appearance disproportionate to physical findings, which are often absent altogether. Previously published data have estimated its prevalence at approximately 11.3-11.9%, across various medical specialties. No recent systematic reviews strictly related to dermatology clinics and the prevalence of BDD have been published to the best of our knowledge.

OBJECTIVES

To gather a pooled prevalence for BDD in outpatient dermatology clinics around the world.

METHODS

A literature review was completed as per PRISMA guidelines. Studies had to meet the following inclusion criteria: (i) observational studies (either prospective, cross-sectional or case-controlled), (ii) include patients aged ≥ 13 years of age; (iii) undertaken in dermatology clinics (medical, cosmetic or specialty clinics); (iv) use validated, or translations of validated screening tools, used for BDD [such as the Body Dysmorphic Disorder Questionnaire (BDDQ), the Structured Clinical Interview for DSM-5, BDDQ-Dermatology Version (DV), the Yale-Brown Obsessive-Compulsive Scale modified for Body Dysmorphic Disorder]; (v) report a point prevalence for BDD; and (vi) be written in either English, French or Arabic, the three languages fluently spoken by the Lebanese researchers.

RESULTS

Twenty-one articles tackling BDD in outpatient cosmetic and general dermatology clinics were selected. Studies were graded based on the Newcastle-Ottawa Scale and a mean for the pooled prevalence was calculated, yielding a weighted mean prevalence of 12.5% among general dermatology patients (n = 1082) and 25.0% among cosmetic dermatology patients (n = 218). The mean prevalence of BDD among general dermatology patients is similar to previously reported numbers. For cosmetic dermatology patients, the findings are markedly higher than previously reported, which we postulate could be owing to dermatologists being at the forefront of noninvasive cosmetic procedures.

CONCLUSIONS

Given the high prevalence of BDD among dermatology patients, we highlight the importance of having a high index of suspicion for BDD and identifying it in the clinical setting and also emphasize the importance of psychiatric treatment for these patients to improve outcomes, all while avoiding unnecessary interventions.

Exploring the Intersection of Body Dysmorphic Disorder (BDD) and Dermatological Conditions: A Narrative Review

This narrative literature review examined the intricate relationship between body dysmorphic disorder (BDD) and dermatological conditions, with a brief focus on those characterized by conspicuous skin irregularities such as acne vulgaris, psoriasis, and vitiligo. Highlighting the significant prevalence of BDD among individuals afflicted with dermatological issues, our analysis illuminated the profound psychological repercussions stemming from an exaggerated preoccupation with perceived skin imperfections. Through an exploration of the underlying BDD symptoms, we analyzed the complex dynamics between skin health and mental well-being, emphasizing the disorder's impact on patients' psychological and social functioning. This narrative review further investigated the consequential effects of BDD on essential aspects of dermatological treatment, including patient adherence to therapeutic regimens, overall quality of life (QOL), and the effectiveness of available treatments. In addition to presenting current therapeutic approaches, we advocate for the integration of psycho-dermatological interventions tailored to mitigate the dual burden of skin conditions and psychological distress. Future research directions proposed include longitudinal studies to assess the long-term effects of BDD on skin disease prognosis and psychosocial well-being, which aim to refine and optimize treatment modalities to contribute to a more holistic understanding of BDD within dermatological practice.

Prevalence of body dysmorphic disorder, its clinical characteristics and psychiatric comorbidities in patients admitted to a plastic surgery outpatient clinic

PURPOSE

The present study aimed to determine the prevalence of body dysmorphic disorder (BDD), its clinical features, and comorbidities in patients applying for plastic and reconstructive surgery.

METHOD

Five-hundred and seventy nine participants who applied to the plastic and reconstructive surgery outpatient clinic completed a sociodemographic data form, and were subjected to the Body Perception Scale (seventy-nineBPS), Social Appearance Anxiety Scale (SAAS), TEMPS-A Temperament Scale, and Beck Depression Inventory (BDI). Participants who scored 135 or more on the BPS were included in a psychiatric interview. Next, the participants diagnosed with BDD were compared with participants with a high BPS scores but without a BDD diagnosis, along with a control group.

RESULTS

The prevalence of BDD among all patients attending the plastic surgery outpatient clinic was found to be 4.7%, whereas the prevalence was 8.6% among those specifically seeking cosmetic procedures. The mean SAAS, BDI, TEMPS-A depressive, and anxious scores were higher in the BDD group compared to the controls (p < 0.001). The difference in the mean SAAS, BDI, TEMPS-A depressive, and anxious scores of the patients with a high BPS scores and the control group was comparable to the difference observed between the BDD and control groups. A regression analysis revealed that the SAAS and depressive temperament scores have an effect on the BPS score.

CONCLUSION

The significantly high comorbidity of BDD in patients seeking plastic and reconstructive surgery underscores the importance of identifying these patients to prevent unnecessary surgical procedures.

Investigating the prevalence of body dysmorphic disorder among Jordanian adults with dermatologic and cosmetic concerns: a case-control study

Body Dysmorphic Disorder (BDD) is an underexplored psychiatric condition in Middle Eastern countries, particularly in patients with dermatologic concerns, where alterations in appearance may elevate the risk of BDD. We studied patients at Jordan University Hospital's general dermatology and cosmetic clinics from July to September 2022, comparing them to healthy controls. Patients with dermatologic conditions were evaluated per the International Classification of Diseases (ICD-10) criteria by trained dermatologists. All participants completed the Dysmorphic Concerns Questionnaire (DCQ), Perceived Stress Scale, Patient Health Questionnaire-2, General Anxiety Disorder Assessment tool-2. We assessed BDD prevalence using four DCQ cutoffs: 9, 11, 14, and 17, reporting effect sizes as odds ratios (OR). Our study involved 1500 participants, with an average age of 29.3 (± 14.8) years and a female-to-male ratio of 3.15-to-1. At the 9, 11, 14, and 17 DCQ cutoffs, BDD prevalence was 78.2%, 54.2%, 26.5%, and 11.7%, respectively. Patients with dermatologic concerns were more likely to exhibit clinical BDD symptoms than controls at the 11-cutoff (OR: 1.26; 95% CI 1.01-1.58; p < 0.05). Conversely, those with cosmetic concerns were more prone to clinical BDD than controls at cutoffs 9 (OR: 2.26; 95% CI 1.28-3.97; p < 0.05) and 11 (OR: 1.50; 95% CI 1.03-2.20; p < 0.05). Our logistic regression revealed consistent associations between higher DCQ scores and elevated anxiety, depression, perceived skin disease-related stigma, and reduced quality of life (p < 0.05). In conclusion, patients with dermatologic issues and those seeking cosmetic procedures are at significant risk of developing BDD, necessitating proactive screening and referrals for specialized care by dermatologists due to the associated psychological distress and unproductive consultations. Providing specialized training for healthcare professionals to establish an integrated care approach to address the needs of patients with BDD should be the focus of future research projects.

Going deeper into eating and body image pathology in males: Prevalence of muscle dysmorphia and eating disorders in a university representative sample

Disorders associated with body dissatisfaction such eating disorders (ED) and muscle dysmorphia (MD) in males are understudied and surrounded by controversy regarding their nosological aspects. The current study examined the prevalence rates of clinical cases of ED and MD through a two-phase study with gold standard clinical interview in a representative sample of 850 Spanish undergraduate men, of whom 141 were interviewed. Levels of body dissatisfaction, compulsive exercise, anxious-depressive symptoms and the amount of physical activity were also explored. A prevalence rate for ED of 1.4% and 1.3% for MD was found. No differences were observed between the clinical groups on scales related to body image, supporting the current perspective that MD as well as ED and Body Dysmorphic Disorder could be clustered in a new spectrum of body image disorders, where the behaviours performed to achieve body change could range from restriction or muscularity-oriented eating alterations to pathological exercise or cosmetic surgery. The usefulness of the cut-off points of the screening questionnaires in MD and ED in males are discussed.

Prevalence and Severity of Social Anxiety Symptoms and Their Relationship With Body Dysmorphic Symptoms

Background Social anxiety disorder (SAD) is a subtype of anxiety characterized by avoidance, fear, and physical symptoms such as dry mouth, sweating, palpitations, and blushing. SAD is one of the most common mental disorders. Body dysmorphic disorder (BDD) is a mental disorder marked by a distressing or impairing preoccupation with imagined or minor flaws in one's physical appearance. Both disorders share similar symptoms. No satisfactory data have been provided about the prevalence of social anxiety symptoms in our region. In our study, we measured the prevalence and severity of SAD symptoms among adults in Riyadh City, as well as the sociodemographic factors associated with it. Additionally, the correlation between SAD and BDD was assessed. Methods Our study is quantitative, observational, and cross-sectional. It was conducted by administering a translated Arabic version of the Severity Measure for Social Anxiety Disorder scale and BDD scales in five locations in Riyadh, which include two general hospitals and three shopping malls. Data were analyzed using the SPSS version 22 (IBM Corp., Armonk, NY, USA). Descriptive statistical data are presented through mean values, standard deviations, and percentages. Results A total of 752 responses were received, of which 509 (68.32%) were from females with a mean age of 30.12 years. The majority of the sample had a low to middle family income, with 64% earning less than $2555 monthly. The sample possessed a good educational level; 63% had a bachelor's degree or higher. Our study also shows that 233 subjects (30.98%) had scores indicating a moderate to severe form of SAD. Among these participants, 86 (36.9%) had scores indicating a moderate to severe form of BDD. There was a significant positive correlation between SAD and BDD (r = 0.496). Conclusion The prevalence of SAD was 30.98%, which is higher compared to Western countries. Low income, education, and female gender have roles in the disease condition. Moreover, there was a linear relationship between SAD and BDD.

Prevalence and Characteristics Associated with Positive Body Dysmorphic Disorder Screening Among Patients Presenting for Cosmetic Facial Plastic Surgery

Background: Many patients with body dysmorphic disorder (BDD) seek out cosmetic surgery to alleviate their symptoms of distress related to a perceived defect in their appearance; however, the prevalence and risk factors for BDD among patients with cosmetic concerns have not been well characterized. Methods: We screened adult patients presenting to the clinic from June 2021 through September 2022 for BDD using the BDD Questionnaire-Aesthetic Surgery (BDDQ-AS) who were seen in consultation for rhinoplasty, aging face, and injectables. Results: Among 488 patients, the prevalence of screening positive for BDD was 41.0%. The prevalence of a positive BDD screen was highest among patients who were younger (p = 0.02), and those who had a positive self-reported psychiatric history (p = 0.02). Among rhinoplasty patients, those with aesthetic/cosmetic motivations, and those seeking revision rhinoplasty had higher rates of positive BDD screen. Higher scores on the Standardized Cosmesis and Health Nasal Outcomes Survey-Nasal Obstruction Score (SCHNOS-O) (p = 0.01) and Standardized Cosmesis and Health Nasal Outcomes Survey-Nasal Obstruction Score-Nasal Cosmesis Score (SCHNOS-C) (p < 0.0001) were predictive of a positive BDD screen, while question 5 of the SCHNOS was highly predictive of positive BDD screening (p < 0.0001). Conclusions: Our study characterizes relationships between positive BDD screening and age, gender, self-reported psychiatric history, and motivations for consultation, among patients seen for cosmetic surgery evaluation in a facial plastic and reconstructive surgery setting.

Guided versus self-guided internet delivered cognitive behavioural therapy for diagnosed anxiety and related disorders: a preliminary meta-analysis

Guided and self-guided internet-delivered cognitive-behavioural therapy (ICBT) has been demonstrated to be efficacious in the treatment of anxiety and related disorders (ARDs). The aim of the current study was to examine the efficacy of guided and self-guided ICBT for adults diagnosed with ARDs using a meta-analytic synthesis of randomised controlled trials directly comparing the two treatment approaches. Eleven studies (n = 1414) were included. There was a small, but significantly pooled between-group effect size at post-treatment (g = 0.16; 95% CI: 0.03-0.28) favouring guided ICBT. At follow-up, the between-group effect size was small and non-significant (g = 0.13; 95% CI: -0.04-0.30). Gender distribution moderated outcome at post-treatment (higher proportions of females resulted in a smaller between-group effect size). Type of support provided in the guided-treatment arm moderated treatment outcome at follow-up (those receiving synchronous support had a larger between-group effect size). Amount of guidance in the guided-treatment arm moderated effect sizes at post-treatment and follow-up (more guidance leading to larger between-group effect sizes). Automated reminders, disorder type, and treatment length did not moderate outcomes. The results suggest that guided and self-guided ICBT interventions result in similar outcomes, however guided interventions may be marginally more effective in the short term.