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Jenkinson PM, Rossell SL. Disturbed interoception in body dysmorphic disorder: A framework for future research. Aust N Z J Psychiatry 2024; 58:300-307. [PMID: 38054446 DOI: 10.1177/00048674231215030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/07/2023]
Abstract
Body dysmorphic disorder is a severe psychiatric condition characterised by a preoccupation with a perceived appearance flaw or flaws that are typically not observable to others. Although significant advances in understanding the disorder have been made in the past decade, current explanations focus on cognitive, behavioural and visual perceptual disturbances that contribute to the disorder. Such a focus does not consider how perception of the internal body or interoception may be involved, despite (1) clinical observations of disturbed perception of the body in body dysmorphic disorder and (2) disturbed interoception being increasingly recognised as a transdiagnostic factor underlying a wide range of psychopathologies. In this paper, we use an existing model of hierarchical brain function and neural (predictive) processing to propose that body dysmorphic disorder involves defective interoception, with perceived appearance flaws being the result of 'interoceptive prediction errors' that cause body parts to be experienced as 'not just right'. We aim to provide a framework for interoceptive research into body dysmorphic disorder, and outline areas for future research.
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Affiliation(s)
- Paul M Jenkinson
- Institute for Social Neuroscience (ISN) Psychology, Melbourne, VIC, Australia
| | - Susan L Rossell
- Department of Psychological Sciences, Swinburne University of Technology, Melbourne, VIC, Australia
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Mandavia R, D'Souza H, Rupasinghe T, Cariati M, Mandavia T. An Evidence-based Pathway for Body Dysmorphic Disorder in Facial Aesthetics. Facial Plast Surg 2024. [PMID: 38216141 DOI: 10.1055/a-2244-1066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2024] Open
Abstract
Aesthetic procedures should be avoided in patients with body dysmorphic disorder (BDD) since they can negatively impact mental health and lead to further aesthetic dissatisfaction. There are no evidence-based patient pathways for BDD in facial aesthetics which can result in the failure to identify patients with BDD, leading to unsuitable treatments and suboptimal patient care. We aim to construct the first evidence-based patient pathway for BDD in surgical and nonsurgical facial aesthetics. A systematic review was performed and articles that discussed screening or patient pathways for BDD in field of facial aesthetics were included. We extracted relevant information from each article on screening tools and pathways for BDD. Data were synthesized by summarizing the data under column headings into a structured narrative and into new tables. Based on this synthesis, a practical pathway for BDD was constructed. Forty articles fulfilled the criteria for inclusion. Twenty-eight BDD screening tools were discussed in the included articles, and we provide an overview of these tools. Thirty-one articles discussed patient pathways for BDD, and we synthesized this information into a structured narrative. Combining these findings, we present an evidence-based patient pathway for BDD for patients presenting for facial aesthetic treatments. This systematic review has resulted in the first, evidence-based, patient pathway for BDD in surgical and nonsurgical facial aesthetics. This practical pathway can be used by aesthetic clinicians to identify patients with potential BDD and provide clear guidance for managing cases where BDD is suspected. It will help reduce the number of facial aesthetic procedures performed on patients with BDD, safeguard patient mental well-being, and prevent further aesthetic dissatisfaction.
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Affiliation(s)
- Rishi Mandavia
- Drs Tatiana+Rishi Advanced Aesthetics, Non-Surgical Aesthetics, London, United Kingdom
| | - Hanna D'Souza
- King's College London, School of Medicine, London, United Kingdom
| | - Thiara Rupasinghe
- University College London, School of Medicine, London, United Kingdom
| | - Massimiliano Cariati
- Drs Tatiana+Rishi Advanced Aesthetics, Non-Surgical Aesthetics, London, United Kingdom
| | - Tatiana Mandavia
- Drs Tatiana+Rishi Advanced Aesthetics, Non-Surgical Aesthetics, London, United Kingdom
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Wang YJ, Wang X, Chen JL, Yang YH, An Y, Liu N. Appearance anxiety and its influencing factors in cosmetic injection patients. J Plast Reconstr Aesthet Surg 2023; 87:467-469. [PMID: 37950947 DOI: 10.1016/j.bjps.2023.10.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 09/15/2023] [Accepted: 10/08/2023] [Indexed: 11/13/2023]
Affiliation(s)
- Ying-Jie Wang
- Research Ward, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100144, China
| | - Xue Wang
- Outpatient Center, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100144, China
| | - Jing-Li Chen
- School of Nursing, Peking Union Medical College, Beijing 100144, China
| | - Yan-Hua Yang
- Outpatient Center, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100144, China
| | - Yan An
- Outpatient Center, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100144, China
| | - Na Liu
- Nursing Department, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100144, China.
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Rossell SL, Castle DJ, Pikoos T, Malcolm A. Body dysmorphic disorder and the ugly truth of Australian healthcare. Aust N Z J Psychiatry 2023; 57:1407-1409. [PMID: 37077026 PMCID: PMC10619174 DOI: 10.1177/00048674231169441] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/21/2023]
Affiliation(s)
- Susan L Rossell
- Centre for Mental Health, School of Health Sciences, Swinburne University of Technology, Hawthorn, VIC, Australia
- Department of Mental Health, St Vincent’s Hospital, Melbourne, VIC, Australia
| | - David J Castle
- Centre for Addiction and Mental Health and the Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Toni Pikoos
- Centre for Mental Health, School of Health Sciences, Swinburne University of Technology, Hawthorn, VIC, Australia
| | - Amy Malcolm
- Centre for Mental Health, School of Health Sciences, Swinburne University of Technology, Hawthorn, VIC, Australia
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Pereira IN, Chattopadhyay R, Fitzpatrick S, Nguyen S, Hassan H. Evidence-based review: Screening body dysmorphic disorder in aesthetic clinical settings. J Cosmet Dermatol 2023. [PMID: 36847707 DOI: 10.1111/jocd.15685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 10/26/2022] [Accepted: 02/02/2023] [Indexed: 03/01/2023]
Abstract
BACKGROUND Body dysmorphic disorder (BDD) is a psychiatric disturbance with high incidence in aesthetic clinical settings. Early recognition may avoid unnecessary elective procedures with ethical and medicolegal consequences. AIMS To identify validated BDD screening tools and critically appraise current literature regarding its implementation and efficacy in aesthetic medicine and surgery scenarios, with the purpose of transposing the findings to the broad clinical settings in the field. METHODS Data was collected using advanced search from PubMed (MEDLINE). Having satisfied the search parameters, 12 studies referring BDD definition according to Diagnostic and Statistical Manual of Mental Disorder (DSM-5) criteria and including a BDD screening tool in clinical aesthetic settings were selected. RESULTS While BDD screening enables the recognition of at-risk individuals, further work is required to uncover the best screening tool for general aesthetic clinical practice. Level III evidence favored BDD Questionnaire (BDDQ)/BDDQ-Dermatology Version (DV), and The Dysmorphic Concern Questionnaire (DCQ) among the limited available validated screening instruments to be used outside the psychiatric environment. Based on level II self-classification, one study selected BDDQ-Aesthetic Surgery (AS) version for rhinoplasty patients. The validation process of both BDDQ-AS and Cosmetic Procedure Screening Questionnaire (COPS) had limitations. For BDD screening potential in avoiding postoperative complications, the limited studies found evaluating the outcomes following aesthetic treatments using validated BDD screening measures showed a trend toward less satisfaction with aesthetic treatment outcome among positive screening population against non-BDD counterparts. CONCLUSION Further research is necessary to establish more effective methods to identify BDD and evaluate the impact of positive findings on aesthetic intervention outcomes. Future studies may elucidate which BDD characteristics best predict a favorable outcome and provide high-quality evidence for standardized protocols in research and clinical practice.
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Affiliation(s)
| | - Rashmi Chattopadhyay
- Barts & The London School of Medicine & Dentistry, Centre for Cutaneous Research, Blizard Institute of Cell and Molecular Science, Queen Mary University, London, UK
| | - Sean Fitzpatrick
- Barts & The London School of Medicine & Dentistry, Centre for Cutaneous Research, Blizard Institute of Cell and Molecular Science, Queen Mary University, London, UK
| | - Sheila Nguyen
- Barts & The London School of Medicine & Dentistry, Centre for Cutaneous Research, Blizard Institute of Cell and Molecular Science, Queen Mary University, London, UK
| | - Haidar Hassan
- Barts & The London School of Medicine & Dentistry, Centre for Cutaneous Research, Blizard Institute of Cell and Molecular Science, Queen Mary University, London, UK
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Rossell S. Understanding and treating body dysmorphic disorder. Psychiatry Res 2023; 319:114980. [PMID: 36470162 DOI: 10.1016/j.psychres.2022.114980] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 11/18/2022] [Accepted: 11/20/2022] [Indexed: 11/23/2022]
Abstract
Body dysmorphic disorder (BDD) is a mental disorder that involves a distressing preoccupation with a perceived defect in physical appearance, associated with excessive or repetitive behaviours or mental acts aimed at camouflaging, checking or 'improving' the perceived area of concern. BDD is relatively common, affecting at least 2% of the population world-wide, yet is poorly understood. Professor Susan Rossell has produced a substantial body of influential research, which has improved our understanding of BDD. This includes a more comprehensive understanding of the phenomenology, neurocognition and neurobiology, as well as significant treatment advances. This work will be reviewed in this commentary.
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Affiliation(s)
- Susan Rossell
- Centre for Mental Health, School of Health Sciences, Swinburne University of Technology, Melbourne, VIC, Australia; Department of Mental Health, St Vincent's Hospital, Melbourne, VIC, Australia.
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Pikoos TD, Buzwell S, Sharp G, Rossell SL. The COVID-19 pandemic: Psychological and behavioral responses to the shutdown of the beauty industry. Int J Eat Disord 2020; 53:1993-2002. [PMID: 32936467 DOI: 10.1002/eat.23385] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 09/02/2020] [Accepted: 09/02/2020] [Indexed: 01/14/2023]
Abstract
OBJECTIVE During the COVID-19 pandemic, Australia implemented widespread closure of beauty and cosmetic services to control the virus spread. The effect of these restrictions is unknown, given that beauty services are widely used for stress relief or to enhance confidence. The current study explored the relationship between engagement in appearance-focused behaviors and distress regarding beauty service closure. Participants with high and low levels of dysmorphic concern were compared to determine whether COVID-19 restrictions may affect these groups differently. METHOD An online survey was completed by 216 participants living in Australia. Questions addressed engagement in appearance-focused behaviors during the COVID-19 pandemic and attitudes toward beauty service closure. The Dysmorphic Concern Questionnaire (DCQ) was used to group participants by low and high dysmorphic concern. RESULTS Appearance-focused behaviors decreased in the low DCQ group (n = 163) during the COVID-19 pandemic, while such behaviors in the high DCQ group (n = 53) remained unchanged. Individuals who were living alone, younger, reported higher dysmorphic concern and greater distress over beauty service closure engaged in more frequent appearance-focused behaviors (R2 = .57, p < .001). The high DCQ group reported greater distress over beauty service closure and increased desire to obtain future beauty treatments. DISCUSSION While COVID-19 restrictions may have provided a break from societal appearance pressure for those with low dysmorphic concern, appearance-focused behaviors persisted in individuals with high dysmorphic concern. A greater understanding of the long-term impacts on appearance-related distress is needed to determine mental health priorities emerging from the COVID-19 pandemic.
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Affiliation(s)
- Toni D Pikoos
- Centre for Mental Health, Swinburne University of Technology, Melbourne, Australia
| | - Simone Buzwell
- Centre for Mental Health, Swinburne University of Technology, Melbourne, Australia
| | - Gemma Sharp
- Monash Alfred Psychiatry Research Centre, Melbourne, Australia
| | - Susan L Rossell
- Centre for Mental Health, Swinburne University of Technology, Melbourne, Australia.,Department of Psychiatry, St Vincent's Hospital, Melbourne, Australia
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