Body Dysmorphic Disorder

Body Dysmorphic Disorder was previously called “Dysmorphophobia.”

Point Prevalence : 1.7 to 2.9%

BDD is characterized by distressing or impairing preoccupation with non-existent or slight defects in physical appearance. In addition, it consists of compulsive behaviours that are performed in response to appearance concerns. The compulsive behaviours are usually distressing, time consuming (3-8 hours a day) & are difficult to resist or control.

Common types of compulsive behaviours are:

  1. Comparing their appearance to others.
  2. Repeatedly checking self appearance on mirror.
  3. Excessive grooming (hair styling, make-up application).
  4. Reassurance seeking.
  5. Excessive exercise or weight lifting.
  6. Compulsive skin picking which patients do to improve the appearance of their skin.
  7. Compulsive tanning to darken pale skin or minimize perceived acne, scarring or marks.
  8. Camouflaging disliked body areas. For example: hiding perceived balding with a hat or asymmetrical eyes with sunglasses.

Clinical Features :

Patients with BDD are preoccupied with the idea that some aspect of their appearance is ugly, unattractive, deformed or defective when it actually is not.

Most common concerns involve face & head particularly skin (acne, scars or pale skin), hair (thinning or excessive body or facial hair) & nose (size and shape).

They are also concerned about asymmetry of body/ body parts (hair, chest, eyes, face, lips etc.)

Muscle Dysmorphia:

This is a severe form of BDD which is characterized by distress over a perceived small & insufficiently muscular body build. It occurs primarily in men. They have higher rate of suicidality & substance use disorders (especially anabolic steroid use). They may also be associated with increased risk of violent behaviour (may be due to anabolic-androgenic steroid abuse).

Insight:

Insight is typically poor but can range from good to absent insight (delusional belief). About 36-60% of patients with BDD have delusional belief about their appearance. They also have delusions of reference, believing that others stare at them because of their appearances.

Gender:

Body dysmorphic disorder is more common in women than men.

Men : In men, it is most likely associated with thoughts thinning of hair, small body build (Muscle Dysmorphia) & concerns about genitals.

Women : In women, most likely associated with thoughts about their weight, hips, breasts, excessive body hair & are more likely to pick their skin. They also use make-up for camouflaging.

Psychosocial Functioning:

BDD is associated with very poor quality of life & marked functional impairment. Social Functioning is poor. They avoid meeting people & may housebound themselves. They are mostly unemployed and have very low education qualification. They are also preoccupied with feelings of shame, low self-esteem, anger and rejection.

BDD in children & adolescents:

BDD often causes academic underachievement & social avoidance which may lead to school refusal and school dropouts. Studies suggest that this disorder is more severe in youth than in adults. They are more likely to have substance use disorder, delusional beliefs & higher lifetime suicidal attempt rates (44%).

Co-Morbidity:

  1. Major Depressive Disorder: MDD is the most common co-morbid disorder & is seen in 75% of individuals with BDD.
  2. Social Anxiety Disorder.
  3. Obsessive Compulsive Disorder.
  4. Substance Use Disorder.
  5. Avoidant/ Anxious Personality Disorder.

Suicidality:

Lifetime Suicidal ideation : 78-81%

Lifetime Suicidal Attempts : 24-28%

Adolescents & those with Muscle Dysmorphia have higher rates of suicidality.

Course & Prognosis:

  • BDD is usually chronic.
  • Lower Remission Rates.
  • Higher Relapse Rates.

***However, when Body Dysmorphic Disorder is accuratelty diagnosed & proper treated, the prognosis is much favourable.

Reference:

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