The prevalence of body dysmorphic disorder: A population-based survey. Psychological Medicine, 36, 877-885

Philipps University of Marburg, Marburg, Hesse, Germany
Psychological Medicine (Impact Factor: 5.94). 07/2006; 36(6):877-85. DOI: 10.1017/S0033291706007264
Source: PubMed


Body dysmorphic disorder (BDD) is a highly distressing and impairing disorder characterized by a preoccupation with imagined or slight physical defects in appearance. Well designed studies on its prevalence and on base rates for diagnostic criteria are rare. Therefore this study aimed to reveal prevalence rates of BDD in the general population and to examine clinical features associated with BDD.
Of 4152 selected participants 2552, aged 14-99 years, participated in this German nationwide survey. Participants were carefully selected to ensure that the sample was representative; they were visited by a study assistant who provided instructions and help if needed. Participation rate was 62.3%. DSM-IV criteria for BDD, as well as subthreshold features (e.g. individuals who consider some part(s) of their body as ugly or disfigured, but do not fulfill all BDD criteria) were examined. We also assessed suicidal ideation associated with the belief of having an ugly body part, as well as the desire for cosmetic surgery. Furthermore, somatization symptoms were assessed.
The prevalence of current BDD was 1.7% (CI 1.2-2.1%). Individuals with BDD reported higher rates of suicidal ideation (19% v. 3%) and suicide attempts due to appearance concerns (7% v. 1%) than individuals who did not meet criteria for BDD. Somatization scores were also increased in individuals with BDD, relative to those without. BDD was associated with lower financial income, lower rates of living with a partner, and higher rates of unemployment.
Our study shows that self-reported BDD is relatively common and associated with significant morbidity.

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    • "Insight varies along a continuum, with 27e60% holding their belief with delusional intensity (Mancuso et al., 2010). The prevalence of BDD in community samples is estimated to be between 0.7% and 2.4% (Koran et al., 2008; Otto et al., 2001; Rief et al., 2006). Although highly debilitating and relatively common, BDD remains underrecognized and under-studied. "
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    ABSTRACT: Body dysmorphic disorder (BDD) is characterized by distressing and often debilitating preoccupations with misperceived defects in appearance. Research suggests that aberrant visual processing may contribute to these misperceptions. This study used two tasks to probe global and local visual processing as well as set shifting in individuals with BDD. Eighteen unmedicated individuals with BDD and 17 non-clinical controls completed two global-local tasks. The embedded figures task requires participants to determine which of three complex figures contained a simpler figure embedded within it. The Navon task utilizes incongruent stimuli comprised of a large letter (global level) made up of smaller letters (local level). The outcome measures were response time and accuracy rate. On the embedded figures task, BDD individuals were slower and less accurate than controls. On the Navon task, BDD individuals processed both global and local stimuli slower and less accurately than controls, and there was a further decrement in performance when shifting attention between the different levels of stimuli. Worse insight correlated with poorer performance on both tasks. Taken together, these results suggest abnormal global and local processing for non-appearance related stimuli among BDD individuals, in addition to evidence of poor set-shifting abilities. Moreover, these abnormalities appear to relate to the important clinical variable of poor insight. Further research is needed to explore these abnormalities and elucidate their possible role in the development and/or persistence of BDD symptoms.
    Journal of Psychiatric Research 10/2014; 57(1). DOI:10.1016/j.jpsychires.2014.06.003 · 3.96 Impact Factor
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    • "In particular, BDD and obsessive compulsive disorder (OCD) have been linked in terms of symptomatology, familial prevalence and the high degree of comorbidity (Bienvenu et al., 2000; Marazziti et al., 2006). The prevalence of BDD is high, with an Australian study showing 2.3% met diagnostic criteria in a student sample (Bartsch, 2007) and international community samples showing similar rates (Rief et al., 2006). "
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    ABSTRACT: Objectives: Body dysmorphic disorder (BDD) is characterized by a preoccupation with a misperceived flaw in appearance, causing significant distress and disability. Neuropsychological research has revealed deficits in executive function and inhibitory control of emotional responses. The few previous structural neuroimaging studies have had inconclusive findings and we aimed to take this field of research forward by contributing high quality structural data. Methods: To investigate regional brain volumes we compared 20 BDD participants and 20 matched controls using high-resolution structural T1-weighted magnetic resonance imaging (MRI). The MRI data was subjected to cortical reconstruction and volumetric segmentation using Freesurfer software. Results: Results showed the right orbitofrontal cortex, bilateral thalamus, left anterior cingulate cortex, hippocampus and amygdala were significantly smaller in the BDD sample compared to controls. The most pronounced differences were in the right orbitofrontal cortex and left anterior cingulate cortex, as these areas were smaller in BDD participants independent of reduced global brain volumes. Duration of illness significantly negatively correlated with right orbitofrontal cortex volumes. Conclusions: This is the largest volumetric neuroimaging study in BDD to date and provides important data on volumetric differences that implicate fronto-limbic circuits.
    Australian and New Zealand Journal of Psychiatry 02/2014; 48(7). DOI:10.1177/0004867413520253 · 3.41 Impact Factor
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    • "The few studies that have directly compared AN and BDD found similarities on clinical and psychological measures, with both groups exhibiting severe body image symptoms and low self-esteem compared to healthy controls (Hrabosky et al., 2009; Kollei, Brunhoeber, Rauh, de Zwaan, & Martin, 2012; Rosen and Ramirez, 1998). There are also important differences, most notably that the gender distribution is less skewed toward females in BDD (Buhlmann et al., 2010; Koran et al., 2008; Rief et al., 2006). The similarities in clinical features suggest that AN and BDD may represent overlapping body image disorders (Cororve and Gleaves, 2001). "
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    ABSTRACT: Anorexia nervosa (AN) and body dysmorphic disorder (BDD) are psychiatric disorders that involve distortion of the experience of one's physical appearance. In AN, individuals believe that they are overweight, perceive their body as "fat," and are preoccupied with maintaining a low body weight. In BDD, individuals are preoccupied with misperceived defects in physical appearance, most often of the face. Distorted visual perception may contribute to these cardinal symptoms, and may be a common underlying phenotype. This review surveys the current literature on visual processing in AN and BDD, addressing lower- to higher-order stages of visual information processing and perception. We focus on peer-reviewed studies of AN and BDD that address ophthalmologic abnormalities, basic neural processing of visual input, integration of visual input with other systems, neuropsychological tests of visual processing, and representations of whole percepts (such as images of faces, bodies, and other objects). The literature suggests a pattern in both groups of over-attention to detail, reduced processing of global features, and a tendency to focus on symptom-specific details in their own images (body parts in AN, facial features in BDD), with cognitive strategy at least partially mediating the abnormalities. Visuospatial abnormalities were also evident when viewing images of others and for non-appearance related stimuli. Unfortunately no study has directly compared AN and BDD, and most studies were not designed to disentangle disease-related emotional responses from lower-order visual processing. We make recommendations for future studies to improve the understanding of visual processing abnormalities in AN and BDD.
    Journal of Psychiatric Research 06/2013; 47(10). DOI:10.1016/j.jpsychires.2013.06.003 · 3.96 Impact Factor
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