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Hoeppner SS, Hall MD, Hiranandani M, Greenberg JL, Wilhelm S, Phillips KA. Time to Response in Therapy for Body Dysmorphic Disorder: A Comparison of Cognitive Behavioral Therapy and Supportive Psychotherapy. Behav Ther 2024; 55:68-79. [PMID: 38216238 PMCID: PMC10965039 DOI: 10.1016/j.beth.2023.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 05/09/2023] [Accepted: 05/11/2023] [Indexed: 01/14/2024]
Abstract
Psychotherapy has been shown to be effective for individuals with body dysmorphic disorder (BDD); however, time to treatment response for different treatments have not yet been examined. We randomized 120 patients to either weekly cognitive behavioral therapy (CBT) or supportive psychotherapy (SPT) at two academic medical research centers. In this secondary data analysis, we aimed to determine the time to first response (30% or greater reduction in BDD symptom severity) in both treatment conditions among those who attended at least one post-baseline assessment (n = 109). As previously reported, CBT for BDD was associated with more consistent improvement in symptom severity and quality of life than SPT. In a pooled analysis combining both sites, the median time to first response was shorter for CBT (76 days [10.9 weeks], 95% CI: 76-107 days) than for SPT (88 days [12.6 weeks], 95% CI: 88-nonestimable days; Χ2df=1 = 3.85, p = .0498). For CBT, the estimated 75th percentile response times were 148 days [21.1 weeks] at site 1 and 134 days [19.1 weeks] at site 2. Response times were not estimable for SPT at either site because the response rate was too low. Thus, therapy clients seeking treatment for BDD and clinicians should be aware that an initial treatment response requires more than 11 therapy sessions for the majority of clients, and that 21 or even more sessions may be required. Treatment response is likely to occur earlier with CBT for BDD (the first-line therapy for BDD) than with supportive psychotherapy.
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Affiliation(s)
| | | | | | | | - Sabine Wilhelm
- Massachusetts General Hospital and Harvard Medical School
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Lee AD, Hale EW, Mundra L, Le E, Kaoutzanis C, Mathes DW. The heart of it all: Body dysmorphic disorder in cosmetic surgery. J Plast Reconstr Aesthet Surg 2023; 87:442-448. [PMID: 37944455 DOI: 10.1016/j.bjps.2023.10.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Revised: 09/17/2023] [Accepted: 10/08/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND Body Dysmorphic Disorder (BDD) represents a prevalent mental health condition characterized by distress arising from self-perceived physical imperfections. BDD serves as a contraindication to aesthetic surgery. Recognizing BDD holds paramount importance for plastic surgeons, as it is instrumental in averting the exacerbation of this condition while ensuring appropriate referrals. OBJECTIVE This study aimed to investigate the prevalence of BDD in cosmetic surgery patients and to pinpoint key characteristics associated with BDD. This information provides plastic surgeons with specific factors to consider during preoperative evaluations. METHODS We employed TriNetX database to identify patients with BDD who underwent cosmetic surgery identified by Current Procedural Terminology codes. Demographics and patient characteristics were identified using the International Classification of Diseases 10 codes. We calculated odds ratios (OR) by using chi-squared tests to assess risk factors among patients with BDD. RESULTS Of 226,374 patients who underwent plastic surgery between August 2002 and August 2022, fewer than 0.1% were diagnosed with BDD. Of the BDD patients, 52.1% were diagnosed after cosmetic surgery. Compared with the control group, BDD patients were more likely to undergo rhinoplasty (OR=1.784, p = 0.004) and nonlocalized lipectomy (OR=1.448, p = 0.021) and less likely to undergo blepharoplasty (OR=0.451, p = 0.002). Findings indicated a strong association between BDD patients undergoing cosmetic procedures and comorbid psychiatric conditions such as depression (OR=4.279, p < 0.05), anxiety (OR=5.490, p < 0.05), and Attention-Deficit Hyperactivity Disorder (OR=3.993, p < 0.05). CONCLUSIONS These findings underscore the ongoing significance of BDD in the context of cosmetic surgery, potentially indicating a lower surgery rate among BDD patients compared with previous estimates. Nevertheless, avenues for further improvement persist. Our data affirm the noteworthy occurrence of postsurgery BDD development, thereby highlighting the ongoing necessity for psychiatric evaluation in surgical patients.
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Affiliation(s)
- Anna D Lee
- Division of Plastic and Reconstructive Surgery, University of Colorado Anschutz Medical Center, 13001 E 17th Pl, Aurora, CO 80045, United States.
| | - Elijah W Hale
- University of Colorado School of Medicine, 13001 E 17th Pl, Aurora, CO 80045, United States
| | - Leela Mundra
- Division of Plastic and Reconstructive Surgery, University of Colorado Anschutz Medical Center, 13001 E 17th Pl, Aurora, CO 80045, United States
| | - Elliot Le
- Division of Plastic and Reconstructive Surgery, University of Colorado Anschutz Medical Center, 13001 E 17th Pl, Aurora, CO 80045, United States
| | - Christodoulos Kaoutzanis
- Division of Plastic and Reconstructive Surgery, University of Colorado Anschutz Medical Center, 13001 E 17th Pl, Aurora, CO 80045, United States
| | - David W Mathes
- Division of Plastic and Reconstructive Surgery, University of Colorado Anschutz Medical Center, 13001 E 17th Pl, Aurora, CO 80045, United States
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SAAB ABDALLAH, JAMALEDDINE YOUSSEF, ISMAIL OMAR, ABOU ABBAS LINDA, DAOUD RAMA, NASSER ZEINA. Prevalence of Body Dysmorphic Disorder (BDD) among the Lebanese University students: associated risk factors and repercussion on mental health. J Prev Med Hyg 2023; 64:E481-E487. [PMID: 38379749 PMCID: PMC10876033 DOI: 10.15167/2421-4248/jpmh2023.64.4.3050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 12/11/2023] [Indexed: 02/22/2024]
Abstract
Introduction Body Dysmorphic Disorder (BDD) is a psychological illness characterized by persistent and intrusive preoccupation with an imagined or slight defect in appearance. This study aimed to determine the prevalence of BDD and investigate its association with mental health status (depression and anxiety), religiosity, eating disorder risk, and self-esteem among Lebanese University students. Methods A cross-sectional study was conducted in March 2020, involving students from the Lebanese University. Data were collected using the dysmorphic concern questionnaire (DCQ), Rosenberg self-esteem scale (RSE), religiosity scale, patient health questionnaire (PHQ-9), generalized anxiety disorder assessment (GAD-7), Eating Attitude test-26 scale (EAT-26). Results A total of 6,448 participants were enrolled in our study. The overall prevalence of BDD among university students was (6.4%).Our results showed that Lebanese students with BDD were more likely to have anxiety ORadj 1.3 (95% CI: 1.2-1.7) p-value 0.001, depression ORadj 1.2 (95% CI: 1.15-1.5) p-value 0.007, and eating disorder (Bulimia & Food preoccupation ORadj 1.06 (95% CI: 1.03-1.2) p-value 0.0, and oral control ORadj 1.09 (95% CI: 1.05-1.1) p-value < 0.001) compared to those with no BDD. We also found that students with BDD had Lower Self-esteem ORadj 0.88 (95% CI: 0.78-0.9) p-value < 0.001), and less likely to be religious ORadj 0.88 (95% CI: 0.82-0.9) p-value 0.02) compared to those with no BDD. Conclusions This pioneering study sheds light on the prevalence of BDD among Lebanese university students and its associated factors. Our findings underscore the importance of early detection of BDD during adolescence and young adulthood, necessitating timely psychological intervention to prevent chronicity and complications.
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Affiliation(s)
- ABDALLAH SAAB
- Faculty of Medicine, Beirut Arab University, Beirut, Lebanon
| | | | - OMAR ISMAIL
- Faculty of Medical Sciences, Lebanese University, Hadath, Lebanon
| | - LINDA ABOU ABBAS
- Faculty of Medical Sciences, Neuroscience Research Center, Lebanese University, Hadath, Lebanon
| | - RAMA DAOUD
- Faculty of Medical Sciences, Lebanese University, Hadath, Lebanon
| | - ZEINA NASSER
- Faculty of Medical Sciences, Neuroscience Research Center, Lebanese University, Hadath, Lebanon
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Bala M, Quinn R, Jassi A, Monzani B, Krebs G. Are body dysmorphic symptoms dimensional or categorical in nature? A taxometric investigation in adolescents. Psychiatry Res 2021; 305:114201. [PMID: 34536694 DOI: 10.1016/j.psychres.2021.114201] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 07/12/2021] [Accepted: 08/06/2021] [Indexed: 10/20/2022]
Abstract
Body dysmorphic disorder (BDD) is a debilitating mental health condition which usually emerges during adolescence and is characterised by distressing and impairing appearance concerns. It is currently unclear whether body dysmorphic concerns represent an extreme manifestation of normal appearance concerns (a dimensional conceptualisation), or whether they are qualitatively distinct (a categorical conceptualisation). This study aimed to determine whether body dysmorphic symptoms are dimensional or categorical in nature by investigating the latent structure using taxometric procedures. Body dysmorphic symptoms were assessed using validated measures among 11-16-year-old school pupils (N=707). Items of the Body Image Questionnaire Child and Adolescent version were used to construct four indicators that broadly corresponded to the DSM-5 diagnostic criteria for BDD (appearance concerns, repetitive behaviours, impairment, and insight). Indicators were submitted to three non-redundant taxometric procedures (MAMBAC, MAXEIG and L-MODE). Overall, results of all three taxometric procedures indicated a dimensional latent structure of body dysmorphic symptoms. The current study provides preliminary evidence that body dysmorphic symptoms are continuously distributed among adolescents, with no evidence of qualitative differences between mild and severe symptoms. Implications for clinical practice and research are discussed.
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Affiliation(s)
- Manya Bala
- Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Rachel Quinn
- Adolescent At-risk & Forensic Service, South London and Maudsley NHS Foundation Trust, London, UK
| | - Amita Jassi
- OCD, BDD and Related Disorders Clinic for Young People, South London and Maudsley NHS Foundation Trust, London, UK
| | - Benedetta Monzani
- OCD, BDD and Related Disorders Clinic for Young People, South London and Maudsley NHS Foundation Trust, London, UK
| | - Georgina Krebs
- Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; OCD, BDD and Related Disorders Clinic for Young People, South London and Maudsley NHS Foundation Trust, London, UK.
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Giannopoulos AE, Zioga I, Papageorgiou PC, Kapsali F, Spantideas ST, Kapsalis NC, Capsalis CN, Kontoangelos K, Papageorgiou CC. Early auditory-evoked potentials in body dysmorphic disorder: An ERP/sLORETA study. Psychiatry Res 2021; 299:113865. [PMID: 33735739 DOI: 10.1016/j.psychres.2021.113865] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 03/07/2021] [Indexed: 01/13/2023]
Abstract
Body dysmorphic disorder (BDD) is characterized by excessive preoccupation with imagined or slight physical defects in appearance. BDD is associated with cognitive impairments (attention, visual processing). Our study aims to evaluate the early neural responses (N100, P200) to prepulse inhibition (PPI) and prepulse facilitation (PPF), to investigate attentional processing of BDD in the auditory domain. Fifty-five adults took part: 30 BDD patients and 25 healthy controls. We compared their brain responses to PPI and PPF by analyzing global field power (GFP), event-related potentials (ERPs) and their respective sources. BDD exhibited reduced N100 amplitudes compared to healthy controls in response to the startle tone elicited by both PPI and PPF, potentially suggesting impaired allocation of attention. Interestingly, the lower the GFP at the N100, the higher the BDD severity. Source reconstruction analysis showed reduced activation for BDD during the N100 time window in PPI. Scalp responses and source activations in PPI were decreased overall compared to PPF, confirming the gating effect of PPI. We provided evidence that the N100 may serve as an electrophysiological marker of BDD, predicting its severity. Our study demonstrated the potential of using ERPs combined with behavioural PPI and PPF protocols to advance our understanding of BDD pathophysiology.
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Affiliation(s)
- Anastasios E Giannopoulos
- School of Electrical & Computer Engineering, National Technical University of Athens, Athens, Greece.
| | - Ioanna Zioga
- Department of Biological and Experimental Psychology, School of Biological and Chemical Sciences, Queen Mary University of London, London, E1 4NS, United Kingdom.
| | | | - Fotini Kapsali
- Psychiatric Hospital of Attica, 374 Athinon Ave., 12462, Athens, Greece
| | - Sotirios T Spantideas
- School of Electrical & Computer Engineering, National Technical University of Athens, Athens, Greece
| | - Nikolaos C Kapsalis
- School of Electrical & Computer Engineering, National Technical University of Athens, Athens, Greece
| | - Christos N Capsalis
- School of Electrical & Computer Engineering, National Technical University of Athens, Athens, Greece
| | - Konstantinos Kontoangelos
- First Department of Psychiatry, National and Kapodistrian University of Athens Medical School, Eginition Hospital, 74 Vas. Sophias Ave., 11528, Athens, Greece
| | - Charalabos C Papageorgiou
- First Department of Psychiatry, National and Kapodistrian University of Athens Medical School, Eginition Hospital, 74 Vas. Sophias Ave., 11528, Athens, Greece; University Mental Health, Neurosciences and Precision Medicine Research Institute "COSTAS STEFANIS", (UMHRI), Athens, Greece
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Sathyanarayana HP, Padmanabhan S, Balakrishnan R, Chitharanjan AB. Prevalence of Body Dysmorphic Disorder among patients seeking orthodontic treatment. Prog Orthod 2020; 21:20. [PMID: 32743673 PMCID: PMC7396409 DOI: 10.1186/s40510-020-00322-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Accepted: 05/24/2020] [Indexed: 12/05/2022] Open
Abstract
Background Body Dysmorphic Disorder (BDD) is a psychiatric disorder with delusions about defects in appearance for which patients seek various treatments. Patients with BDD often seek cosmetic procedures, and orthodontic treatment is one among them. This is the first Indian study to determine the prevalence of BDD in an orthodontic outpatient department. Materials and method A total of 1184 patients with varying degrees of malocclusion completed the BDD-YBOCS questionnaire, while an experienced orthodontist assessed the severity of malocclusion with a rating scale. Results Sixty-two patients (5.2%) were screened positive for BDD. Most of the BDD-positive patients were single (p value of 0.02) and had multiple previous consultations for orthodontic treatment (p value of < 0.00**) with a gender predilection toward males (p value of 0.00**), and age was not statistically significant with a p value of 0.3. Conclusion From our study, the prevalence of BDD among orthodontic patients was 5.2%. The orthodontist should be aware of the high prevalence of BDD among orthodontic patients and identify the expectations of the patient at the time of history taking and refer the patient to a psychiatrist for diagnosis and appropriate management.
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Affiliation(s)
- Haritha Pottipalli Sathyanarayana
- Department of Orthodontics, Sri Ramachandra Dental College, Sri Ramachandra Institute of Higher Education and Research, Porur, Chennai, Tamil Nadu, 600116, India.
| | - Sridevi Padmanabhan
- Department of Orthodontics, Sri Ramachandra Dental College, Sri Ramachandra Institute of Higher Education and Research, Porur, Chennai, Tamil Nadu, 600116, India
| | - R Balakrishnan
- Sri Ramachandra Medical Centre, Porur, Chennai, Tamil Nadu, 600116, India
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Pastoor H, Gregory A. Penile Size Dissatisfaction. J Sex Med 2020; 17:1400-1404. [PMID: 32444341 DOI: 10.1016/j.jsxm.2020.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 03/24/2020] [Accepted: 03/29/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Men concerned about their penis size often consult professionals working in urology, andrology, surgery, and sexual medicine. AIM To inform professionals in the sexual medicine field about small penis syndrome as a clinical syndrome and to provide recommendations for treatment. METHODS This was an overview of the existing literature combined with our extensive clinical experience. RESULTS Small penis syndrome is a syndrome with psychiatric comorbidities and social consequences that impair life. Men with these concerns tend to be susceptible for treatment that is not evidence based and potentially harmful. CLINICAL IMPLICATIONS Treatment of men with concerns about penis size should start with a thorough biopsychosocial assessment, followed by extensive psychoeducation, counselling, and psychological interventions, even if surgery is being considered. STRENGTHS & LIMITATIONS The strength of this study is the concise overview of the existing literature combined with clinical experience which leads to important recommendations. Limitation is that this is not a systematic review. CONCLUSION Complaints about penis size should be taken seriously, and a thorough biopsychosocial and multidisciplinary assessment is required.
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Affiliation(s)
- Hester Pastoor
- Registered Psychotherapist, Registered Sexologist, ECPS, PhD Student, Division of Reproductive Medicine, Department of Obstetrics and Gynecology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
| | - Angela Gregory
- COSRT Accredited Psychosexual Therapist, Division of Family Health, Department of Sexual Health, Chandos Clinic, Nottingham University Hospital Trust, Nottingham, United Kingdom
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Chatelain S, Mimoun M, Chaouat M, Fournier M, Boccara D. [Quick screening for Body Dysmorphic Disorder in a plastic surgery population in France]. Encephale 2020; 46:190-192. [PMID: 32151455 DOI: 10.1016/j.encep.2019.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 10/18/2019] [Accepted: 10/20/2019] [Indexed: 10/24/2022]
Abstract
INTRODUCTION All plastic surgeons are frequently faced with patients with Body Dysmorphic Disorder (BDD). However, no screening test exists in French to help the plastic surgeons to diagnose this disease. The Body Dysmorphic Disorder Questionnaire (BDDQ) is the Gold Standard to easily detect BDD in consultation with any non-psychiatric physician. The aim of this study was to translate and validate the BDDQ into French to help plastic surgeons to detect BDD before the surgery. This way, plastic surgeons will be able to provide an optimal medical care and to reduce the risk of psychiatric collapse. METHODS We asked Katherine Philipps for her approval to use her BDDQ for our study, and thereafter we translated it respecting the criteria of the World Health Organization. We first evaluated the psychometric qualities of the BDDQ in French and then its reproducibility and its sensitivity to change. RESULTS A French version of the BDDQ appeared to be reliable and comprehensible. The questionnaire has been tested on a sample of patients in plastic surgery consultation, at a T moment and a T plus one month to certify its reproducibility and its sensitivity to change. CONCLUSION These results permit to claim that the French version of the BDDQ is now validated to detect patients with a BDD in a plastic surgery consultation.
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Affiliation(s)
- S Chatelain
- Service de chirurgie plastique, reconstructrice et esthétique, centre de traitement des brulés, hôpital Saint Louis, 1, avenue Claude Vellefaux, 75010 Paris, France.
| | - M Mimoun
- Service de chirurgie plastique, reconstructrice et esthétique, centre de traitement des brulés, hôpital Saint Louis, 1, avenue Claude Vellefaux, 75010 Paris, France
| | - M Chaouat
- Service de chirurgie plastique, reconstructrice et esthétique, centre de traitement des brulés, hôpital Saint Louis, 1, avenue Claude Vellefaux, 75010 Paris, France
| | - M Fournier
- Service de chirurgie plastique, reconstructrice et esthétique, centre de traitement des brulés, hôpital Saint Louis, 1, avenue Claude Vellefaux, 75010 Paris, France
| | - D Boccara
- Service de chirurgie plastique, reconstructrice et esthétique, centre de traitement des brulés, hôpital Saint Louis, 1, avenue Claude Vellefaux, 75010 Paris, France
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Cerea S, Bottesi G, Grisham JR, Ghisi M. Non-weight-related body image concerns and Body Dysmorphic Disorder prevalence in patients with Anorexia Nervosa. Psychiatry Res 2018; 267:120-125. [PMID: 29886274 DOI: 10.1016/j.psychres.2018.05.068] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 05/22/2018] [Accepted: 05/26/2018] [Indexed: 01/08/2023]
Abstract
Patients with Anorexia Nervosa (AN) and patients with Body Dysmorphic Disorder (BDD) are both characterized by body image disturbance and dissatisfaction; furthermore, these disorders share clinical features and frequently co-occur. However, few studies have explored the relation between AN and BDD. Therefore, the first aim of the study was assessing the prevalence of BDD and presence of non-weight-related body image concerns in patients with AN. Second, we were interested in comparing patients with AN and non-weight-related body image concerns, patients with weight-related body image concerns only, and a healthy control group with respect to several psychological and psychopathological features. Sixty-one female patients with AN were divided in two subgroups: 39 with non-weight-related body image concerns and 22 with weight-related body image concerns only. Sixteen (26.23%) patients with AN had probable comorbid BDD. Moreover, patients with AN and non-weight-related body image concerns reported, overall, greater psychopathology than patients with AN and weight-related body image concerns only, with the exception of AN core features and general distress. In conclusion, patients with AN and non-weight-related body image concerns showed a more severe body image disturbance unrelated to a more severe eating disorder pathology.
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Affiliation(s)
- Silvia Cerea
- Department of General Psychology, University of Padova, Padova, Italy.
| | - Gioia Bottesi
- Department of General Psychology, University of Padova, Padova, Italy
| | - Jessica R Grisham
- School of Psychology, University of New South Wales, Sydney, Australia
| | - Marta Ghisi
- Department of General Psychology, University of Padova, Padova, Italy
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Giraldo-O'Meara M, Belloch A. Escalation from normal appearance related intrusive cognitions to clinical preoccupations in Body Dysmorphic Disorder: A cross-sectional study. Psychiatry Res 2018; 265:137-143. [PMID: 29704773 DOI: 10.1016/j.psychres.2018.04.047] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 03/22/2018] [Accepted: 04/13/2018] [Indexed: 10/17/2022]
Abstract
Current cognitive approaches to Body Dysmorphic Disorder (BDD) assume that appearance-related intrusive cognitions and their functional consequences characterize the disorder, in a similar way that obsessive intrusive thoughts characterize the Obsessive-Compulsive Disorder (OCD). This study explores whether normal but unwanted appearance-related intrusive thoughts (AITs), escalate to clinical AITs when they are dysfunctionally appraised and instigate counterproductive neutralizing strategies. From a sample of 344 non-clinical individuals who reported a highly upsetting AIT during the past three months two subgroups were extracted according to their high (n = 68) and low (n = 276) vulnerability to BDD. The subjects in the high-risk group obtained significantly higher scores on the frequency of the most disturbing AIT and its emotional impact, interference, and appraisals evaluated with the Appearance Intrusions Questionnaire (AIQ). Additionally, two subgroups of 15 subjects each, with high and low risk to BDD, were formed and their scores were compared to 10 patients with BDD. The AIT had a greater emotional negative impact and more severe consequences on individuals with BDD compared to individuals at high-risk of BDD, which in turn, reported worse consequences of the AIT than those at low-risk. These results empirically support the similarities between BDD and OCD regarding their functional and phenomenological characteristics.
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Affiliation(s)
- Martha Giraldo-O'Meara
- Department of Personality Psychology, Research Unit for Obsessive-Compulsive and Related Disorders (I'TOC), Facultad de Psicología, Universidad de Valencia, Spain. http://www.itoc.org.es
| | - Amparo Belloch
- Department of Personality Psychology, Research Unit for Obsessive-Compulsive and Related Disorders (I'TOC), Facultad de Psicología, Universidad de Valencia, Spain.
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Meretuk D, Plück J, Petermann F, Lehmkuhl G. ["How Beautiful Must I be?"- Physical Attractiveness and Mental Health in Adolescents]. Prax Kinderpsychol Kinderpsychiatr 2018; 67:18-30. [PMID: 29347893 DOI: 10.13109/prkk.2018.67.1.18] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
"How Beautiful Must I be?"- Physical Attractiveness and Mental Health in Adolescents Physical attractiveness is a high priority for young people. The beauty ideals and presentations spread in the media often reinforce self-doubt and self-insecurity. In 730 adolescents (age 13 to 20 years) it was measured, how they experience appearance-related social pressure (FASD), the extent to which physical deficits are perceived (BDDQ), and how these features are related to mental symptoms (SDQ). The results demonstrate that young people are very concerned about their appearance (30.7 %) and are overly concerned with perceived physical defects (29.5 %). In addition, there is a strong appearance-related social pressure through peers and parents. The young people particularly affected in these areas report more emotional and behavioral problems. The results suggest that attention should be given to physical self-assessment as an important factor in diagnosis and therapy.
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12
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Weingarden H, Renshaw KD, Davidson E, Wilhelm S. Relative relationships of general shame and body shame with body dysmorphic phenomenology and psychosocial outcomes. J Obsessive Compuls Relat Disord 2017; 14:1-6. [PMID: 29057211 PMCID: PMC5648067 DOI: 10.1016/j.jocrd.2017.04.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Body Dysmorphic Disorder (BDD) is characterized by a preoccupation with a perceived flaw in appearance and repetitive avoidance behaviors. BDD involves severe psychosocial outcomes (e.g., depression, suicidality, functional impairment). Identifying correlates of BDD symptoms and outcomes can inform treatment. Shame, a painful emotion felt in response to critical self-judgment, may be one key correlate. However, research on shame in BDD is scarce and previous studies have not distinguished general shame from body shame. This study examines the relative relationships between body shame and general shame with body dysmorphic phenomenology and psychosocial outcomes. Participants (N = 184) were recruited online via BDD organizations and completed a survey. Path analysis was used to examine associations between body and general shame with 1) body dysmorphic phenomenology and 2) depression severity, suicide risk, and functional impairment. Both types of shame were differentially related to outcomes. Body shame was more strongly related to phenomenology, whereas general shame was more strongly related to psychosocial outcomes. Thus, it may be important for BDD treatment to focus on reducing both general and body shame. Further research should evaluate whether current treatments adequately address and reduce general and body shame, and whether addressing shame promotes better treatment outcomes.
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Affiliation(s)
- Hilary Weingarden
- Department of Psychiatry, Massachusetts General Hospital & Harvard Medical School, 185 Cambridge Street, Suite 2000, Boston, MA, USA, 02114
| | - Keith D Renshaw
- Department of Psychology, George Mason University, 4400 University Drive, Fairfax, VA, USA 22030
| | - Eliza Davidson
- Department of Psychiatry, Massachusetts General Hospital & Harvard Medical School, 185 Cambridge Street, Suite 2000, Boston, MA, USA, 02114
| | - Sabine Wilhelm
- Department of Psychiatry, Massachusetts General Hospital & Harvard Medical School, 185 Cambridge Street, Suite 2000, Boston, MA, USA, 02114
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Senín-Calderón C, Valdés-Díaz M, Benítez-Hernández MM, Núñez-Gaitán MC, Perona-Garcelán S, Martínez-Cervantes R, Rodríguez-Testal JF. Validation of Spanish Language Evaluation Instruments for Body Dysmorphic Disorder and the Dysmorphic Concern Construct. Front Psychol 2017; 8:1107. [PMID: 28713311 PMCID: PMC5492913 DOI: 10.3389/fpsyg.2017.01107] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 06/15/2017] [Indexed: 11/17/2022] Open
Abstract
Dysmorphic concern (DC) refers to excessive preoccupation with a slight or imagined defect in physical appearance with social avoidance and behavior directed at controlling the defect in appearance. This study attempted to adapt the factor structure of two instruments that cover the DC construct, the Dysmorphic Concern Questionnaire (DCQ) and the Body Dysmorphic Disorder Examination Self-Report (BDDE-SR), to Spanish and establish their psychometric properties. A total of 920 subjects (62.7% women, Mage = 32.44 years) participated. Exploratory and Confirmatory Factor Analysis of both scales found adequate goodness of fit indices. A one-dimensional structure was found for the DCQ and two first-order factors (dissatisfaction/preoccupation with body image (BI) and BI avoidance behavior) were identified for the BDDE-SR. The psychometric test–retest reliability and validity properties (content, convergent, and discriminant) were satisfactory. It is suggested that the DC construct includes both cognitive and behavioral aspects and may represent a continuum of severity with Body Dysmorphic Disorder at the end.
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Affiliation(s)
| | - María Valdés-Díaz
- Personality, Evaluation and Psychological Treatment Department, University of SevilleSeville, Spain
| | - Ma M Benítez-Hernández
- Personality, Evaluation and Psychological Treatment Department, University of SevilleSeville, Spain
| | - Ma C Núñez-Gaitán
- Personality, Evaluation and Psychological Treatment Department, University of SevilleSeville, Spain
| | - Salvador Perona-Garcelán
- Personality, Evaluation and Psychological Treatment Department, University of SevilleSeville, Spain.,Virgen del Rocío Outpatient Mental Hospital, Andalusian Health-CareSeville, Spain
| | | | - Juan F Rodríguez-Testal
- Personality, Evaluation and Psychological Treatment Department, University of SevilleSeville, Spain
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Affiliation(s)
- Sara B Vasudeva
- From the Department of Psychiatry, Albert Einstein College of Medicine, and Montefiore Medical Center, Bronx, N.Y
| | - Eric Hollander
- From the Department of Psychiatry, Albert Einstein College of Medicine, and Montefiore Medical Center, Bronx, N.Y
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Shaffi Ahamed S, Enani J, Alfaraidi L, Sannari L, Algain R, Alsawah Z, Al Hazmi A. Prevalence of Body Dysmorphic Disorder and its Association With Body Features in Female Medical Students. Iran J Psychiatry Behav Sci 2016; 10:e3868. [PMID: 27803720 PMCID: PMC5088358 DOI: 10.17795/ijpbs-3868] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Revised: 12/16/2015] [Accepted: 04/10/2016] [Indexed: 11/25/2022]
Abstract
Background Body dysmorphic disorder (BDD) is a distressing psychiatric disorder. So far there have not been any studies on BDD in Saudi Arabia. Objectives The 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 Methods A 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. Results Out 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). Conclusions This 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.
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Affiliation(s)
- Shaik Shaffi Ahamed
- Prince Sattam Chair for Epidemiology and Public Health Chair, Department of Family & Community Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Jawaher Enani
- Prince Sattam Chair for Epidemiology and Public Health Chair, Department of Family & Community Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Lama Alfaraidi
- Prince Sattam Chair for Epidemiology and Public Health Chair, Department of Family & Community Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Lujain Sannari
- Prince Sattam Chair for Epidemiology and Public Health Chair, Department of Family & Community Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Rihaf Algain
- Prince Sattam Chair for Epidemiology and Public Health Chair, Department of Family & Community Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Zainah Alsawah
- Prince Sattam Chair for Epidemiology and Public Health Chair, Department of Family & Community Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Ali Al Hazmi
- Prince Sattam Chair for Epidemiology and Public Health Chair, Department of Family & Community Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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Veale D, Miles S, Read J, Troglia A, Wylie K, Muir G. Sexual Functioning and Behavior of Men with Body Dysmorphic Disorder Concerning Penis Size Compared with Men Anxious about Penis Size and with Controls: A Cohort Study. Sex Med 2015; 3:147-55. [PMID: 26468378 PMCID: PMC4599552 DOI: 10.1002/sm2.63] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Introduction Little is known about the sexual functioning and behavior of men anxious about the size of their penis and the means that they might use to try to alter the size of their penis. Aim To compare sexual functioning and behavior in men with body dysmorphic disorder (BDD) concerning penis size and in men with small penis anxiety (SPA without BDD) and in a control group of men who do not have any concerns. Methods An opportunistic sample of 90 men from the community were recruited and divided into three groups: BDD (n = 26); SPA (n = 31) and controls (n = 33). Main Outcome Measures The Index of Erectile Function (IEF), sexual identity and history; and interventions to alter the size of their penis. Results Men with BDD compared with controls had reduced erectile dysfunction, orgasmic function, intercourse satisfaction and overall satisfaction on the IEF. Men with SPA compared with controls had reduced intercourse satisfaction. There were no differences in sexual desire, the frequency of intercourse or masturbation across any of the three groups. Men with BDD and SPA were more likely than the controls to attempt to alter the shape or size of their penis (for example jelqing, vacuum pumps or stretching devices) with poor reported success. Conclusion Men with BDD are more likely to have erectile dysfunction and less satisfaction with intercourse than controls but maintain their libido. Further research is required to develop and evaluate a psychological intervention for such men with adequate outcome measures.
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Affiliation(s)
- David Veale
- Institute of Psychiatry, Psychology and Neurosciences, Kings College London, South London and Maudsley NHS Foundation Trust London, UK
| | - Sarah Miles
- Institute of Psychiatry, Psychology and Neurosciences, Kings College London, South London and Maudsley NHS Foundation Trust London, UK
| | - Julie Read
- Institute of Psychiatry, Psychology and Neurosciences, Kings College London, South London and Maudsley NHS Foundation Trust London, UK
| | - Andrea Troglia
- Institute of Psychiatry, Psychology and Neurosciences, Kings College London, South London and Maudsley NHS Foundation Trust London, UK
| | - Kevan Wylie
- Porterbrook Clinic, Sheffield Health and Social Care NHS Foundation Trust Sheffield, UK
| | - Gordon Muir
- King's College Hospital, NHS Foundation Trust London, UK
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Rossell SL, Labuschagne I, Dunai J, Kyrios M, Castle DJ. Using theories of delusion formation to explain abnormal beliefs in Body Dysmorphic Disorder (BDD). Psychiatry Res 2014; 215:599-605. [PMID: 24412353 DOI: 10.1016/j.psychres.2013.12.030] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2013] [Revised: 12/09/2013] [Accepted: 12/16/2013] [Indexed: 11/23/2022]
Abstract
Body Dysmorphic Disorder (BDD) is characterised by overvalued or delusional beliefs of 'imagined ugliness'. Delusional beliefs have been explained by a number of cognitive theories, including faulty perceptions, biases in attention, and corruption of semantic memory. Atypical aesthetics may also influence beliefs in BDD. In fourteen BDD patients, compared to controls (n=14), we examined these theories of beliefs in a cognitive test battery consisting of perceptual organisation and visual affect perception tasks, a Stroop task using body words, a sentence verification task, a fluency task, and an attractiveness task. BDD patients performed similar to controls on tasks measuring information (bias) processing and aesthetics. However, BDD showed abnormal abilities on semantic processing involving sentence verification and category fluency. There was only a trend finding of impaired performance on perceptual processing tasks in BDD. The findings suggest that the delusional beliefs in BDD may be explained by impaired semantic processing.
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Abstract
INTRODUCTION Disturbances in testicular integrity have the potential to cause severe concerns about masculinity, body image, and sexual function. Testicular volume replacement surgery with prosthesis has been known about since 1941, although esthetic procedures for testicular augmentation have not been satisfactory. AIM To describe an unprecedented testicular augmentation surgical technique that is specially focused on preserving testicular function and providing a favorable esthetic outcome. METHODS We present a case of a 45-year-old man with body dysmorphic disorder. Surgical treatment using a new technique by placing a chin implant on the testicle was offered and accepted. RESULTS Good symmetry between both testicles was achieved. No complications were reported. One month after the procedure, the patient started a satisfactory sex life. Functional monitoring was normal during the year after the procedure. CONCLUSIONS This technique is unprecedented in literature, it represents a safe and effective therapeutic alternative; nevertheless, more experience in performing this procedure is needed.
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Affiliation(s)
- Fernando Ugarte y Romano
- Department of Urology, Hospital Ángeles del Pedregal, México, México Department of Sexology, Universidad Nacional Autónoma de México, México, México
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Weingarden H, Marques L, Fang A, LeBlanc N, Buhlmann U, Phillips KA, Wilhelm S. Culturally Adapted Cognitive Behavioral Therapy for Body Dysmorphic Disorder: Case Examples. Int J Cogn Ther 2011; 4:381-396. [PMID: 25346783 DOI: 10.1521/ijct.2011.4.4.381] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Individuals with Body Dysmorphic Disorder (BDD) have distressing or impairing preoccupations with imagined or slight defects in their appearance (e.g., nose too big). BDD is a severe psychiatric disorder often associated with high rates of suicidality as well as social and occupational impairment (Phillips, Coles et al., 2005). Researchers have only recently begun to investigate psychological treatments for BDD, with available data suggesting that cognitive behavioral therapy (CBT) appears efficacious for BDD (Williams, Hadjistavropoulos, & Sharpe, 2006). To our knowledge, however, there are no reports of whether CBT for BDD can be effectively generalized to ethnic minority and other special populations. The current report suggests specific modifications within the CBT for BDD framework that might improve the effectiveness and retention rates of CBT among ethnic minority patients with BDD. Specifically, the present study describes the cases of Ben, a 40-year-old, Jewish, married male, and John, a 30-year-old, African American, single male, both with a primary diagnosis of BDD. Various treatment techniques were used to make the course of CBT more culturally responsive. This case report illustrates the challenges and benefits of integrating cultural variables into a CBT framework for BDD, and it highlights the need for more work in this area.
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Affiliation(s)
| | - Luana Marques
- Massachusetts General Hospital and Harvard Medical School
| | | | - Nicole LeBlanc
- Massachusetts General Hospital and Harvard Medical School
| | - Ulrike Buhlmann
- Humboldt-Universität zu Berlin, Rhode Island Hospital and Alpert Medical School of Brown University
| | - Katharine A Phillips
- Humboldt-Universität zu Berlin, Rhode Island Hospital and Alpert Medical School of Brown University
| | - Sabine Wilhelm
- Massachusetts General Hospital and Harvard Medical School
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