Are body dysmorphic symptoms dimensional or categorical in nature? A taxometric investigation in adolescents

Age-Related Effects on Self-Focused Attention Across Adolescence and the Relationship With Symptoms of Body Dysmorphia, Social Anxiety and Depression

INTRODUCTION

Adolescence is a critical period for the development of several emotional disorders, including body dysmorphic disorder (BDD), social anxiety disorder (SAD) and depression. It has been suggested that this may be partly due to developmental changes in self-referential processing, including self-focused attention (SFA). However, to date little is known about normative changes in self-focused attention across adolescence. This study investigated age-related effects on SFA during adolescence, and its relationship with symptoms of BDD, SAD and depression.

METHODS

A sample of 638 adolescents aged 11-18 years (53% male) were recruited through government-funded secondary school students in the United Kingdom and completed validated self-reported measures of SFA, BDD, SAD and depression.

RESULTS

Age was positively associated with SFA, and with symptoms of BDD, SAD and depression. The associations of age with SFA, SAD and depression were, on average, greater in females, although this age by sex interaction effect only reached statistical significance for BDD symptoms. SFA fully mediated the effect of age on SAD symptoms, and partially mediated age effects on symptoms of BDD and depression.

CONCLUSIONS

The current findings indicate that self-focused attention increases during adolescence. Moreover, findings provide support for the notion that increased self-focused attention may partly account for the rise in symptoms of BDD, SAD and depression during this developmental period. Future research should seek to establish the direction of effects between self-focused attention and symptoms using longitudinal designs.

Epidemiology of Body Dysmorphic Disorder and Appearance Preoccupation in Youth: Prevalence, Comorbidity and Psychosocial Impairment

OBJECTIVE

Little is known about how common and impairing body dysmorphic disorder (BDD) is in the general population of youth. We evaluated the prevalence, comorbidity, and psychosocial impairment associated with BDD and more broadly defined appearance preoccupation in young people.

METHOD

Data were drawn from the 2017 Mental Health of Children and Young People in England survey. BDD and psychiatric comorbidity were assessed in individuals 5 to 19 years of age (N = 7,654) according to DSM-5 criteria, using a clinician-rated standardized diagnostic assessment. Psychosocial impairment was measured with a quantitative scale and was indexed by reported self-harm and suicide attempts, as well as service use, assessed using structured interviews.

RESULTS

The point prevalence of BDD was 1.0% (95% CI = 0.8%-1.3%). BDD was significantly more common among adolescents than children (1.9 vs 0.1%; OR = 22.5, p < .001), and among female than male participants (1.8% vs 0.3%; OR = 7.3, p < .001). Approximately 70% of young people with BDD had psychiatric comorbidity, most commonly internalizing disorders. BDD was associated with self- and parent-reported psychosocial impairment, self-harm and suicide attempts, and service utilization. Appearance preoccupation was more common than full-syndrome BDD, but showed similar age and sex effects, patterns of comorbidity, and associated impairment.

CONCLUSION

BDD and appearance preoccupation are relatively common, especially among adolescent girls, and are associated with substantial co-occurring psychopathology, impairment, and risk. Improved screening is needed to increase detection and diagnosis of BDD, and to facilitate access to evidence-based treatment.

PLAIN LANGUAGE SUMMARY

This study aimed to determine the prevalence, comorbidity, and psychosocial impairment associated with body dysmorphic disorder (BDD) and more broadly defined appearance preoccupation in young people. Data from an epidemiological survey of 7,654 youth aged 5 to19 years in England indicated that BDD affects approximately 1% of children and adolescents. BDD was significantly more common in adolescents compared to children and in females compared to males. Both BDD and broader appearance preoccupation were linked with high rates of psychiatric comorbidity and significant psychosocial impairment, indicating a need for better screening and access to treatment.

STUDY PREREGISTRATION INFORMATION

The epidemiology of body dysmorphic disorder the youth: prevalence, comorbidity and psychosocial impact; https://osf.io/; g83jy.

The association between social media use and body dysmorphic symptoms in young people

Introduction

Social media use (SMU) is highly prevalent amongst young people and previous research suggests an association with mental health problems, including poor body image. However, the potential relationship between SMU and body dysmorphic disorder (BDD) has received little attention. Furthermore, little is known about the factors that moderate the potential association between SMU and body dysmorphic symptoms. The current study tested the associations between three facets of SMU and body dysmorphic symptoms and explored perfectionism as a moderator in a non-clinical sample.

Method

Two-hundred and nine 16-18-year-olds (mean age = 16.5 years, 37% male) recruited from schools in London completed an online survey measuring aspects of SMU, including: frequency of image-and text-based SMU; motivations for SMU (appearance, popularity, connection or values and interests); and active and passive SMU. Participants additionally completed validated measures of body dysmorphic symptoms, perfectionism, and anxiety/depressive symptoms. Linear regression models tested the association of body dysmorphic symptoms with different facets of SMU, with and without adjustment for age, sex and anxiety/depressive symptoms.

Results

Frequency of use of image-based, but not text-based, platforms was significantly and positively associated with body dysmorphic symptoms, and this association remained significant in the adjusted models. Appearance-based motivation for SMU was the only motivator uniquely associated with body dysmorphic symptoms across the unadjusted and adjusted models. Passive, not active, SMU was associated with body dysmorphic symptoms in unadjusted models, but this association became non-significant in the adjusted models. Self-oriented perfectionism moderated the association between frequency of image-based SMU and body dysmorphic symptoms.

Discussion

Image-based SMU, and appearance-based motivations for SMU, are positively associated with body dysmorphic symptoms. Self-oriented perfectionism may amplify the relationship between SMU and body dysmorphic symptoms. Our findings highlight the importance of a nuanced approach to examining SMU, and the need for further research to determine whether specific facets of SMU contribute to the development and/or maintenance of body dysmorphic symptoms.

Identifying Splitting Through Sentiment Analysis

In Kernerg's Object Relations Theory model of personality pathology, splitting, the mutual polarization of aspects of experience, is thought to result in a failure of identity integration. The authors sought to identify a clinician-independent, automated measure of splitting by examining 54 subjects' natural speech. Splitting in these individuals, recruited from the community, was investigated and evaluated with a shortened version of the Structured Interview of Personality Organization (STIPO-R). A type of automated sentiment textual analysis called VADER was applied to transcripts from the section of the STIPO-R that probes identity integration. Higher variability in speech valence, more negative minimum valence, and more frequent shifts in valence polarity were associated with more severe identity disturbance. The authors concluded that the degree of splitting elicited during the description of self and others is related to the degree of identity disturbance, and to the degree of negativity and instability of these descriptions of self and others.