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The prevalence and determinants of body dysmorphic disorder among young social media users: A cross-sectional study

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Social media that is heavily used in Saudi Arabia has been linked to a negative impact on body image satisfaction. The objective of the current study was to examine the burden, determinants, and impacts of Body Dysmorphic Disorder (BDD) among a community sample of social media users in Saudi Arabia. The Internet-based cross-sectional study was conducted among social media users during January and February 2020. BDD was assessed using a validated BDD Questionnaire. A total of 1010 participants were included in the current analysis. A total of 42 (4.2%) met the criteria of BDD, with higher prevalence in younger participants. The defects of high concerns were skin disfigurements (64.2%) and hair issues (42.3%). BDD was significantly associated with spending a longer time on Snapchat and Instagram and less interest in religious topics. BDD group was more likely to compare their appearance with famous people in social media. BDD group reported more harassment and more history of psychiatric problems. There is a need to educate the public about the risk of BDD and to promote safe social networking.
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[Dermatology Reports 2020; 12:8774] [page 70]
The prevalence and determi-
nants of body dysmorphic
disorder among young social
media users: A cross-sectional
study
Mohammed Saud Alsaidan,1
Nawaf Saad Altayar,2Saqer Habeeb
Alshmmari,2Meshari Mahud
Alshammari,2Faisal Turki Alqahtani,2
Khaled Abdullah Mohajer,3,4
1Internal Medicine Department, College
of Medicine, Prince Sattam bin
Abdulaziz University; 2Internal
Medicine Department, Prince Sattam
bin Abdulaziz University, Al-Kharj;
3Department of Dermatology, King Saud
Medical City, Riyadh; 4College of
Medicine, Dar Al Uloom University,
Riyadh, Saudi Arabia
Abstract
Social media that is heavily used in
Saudi Arabia has been linked to a negative
impact on body image satisfaction. The
objective of the current study was to examine
the burden, determinants, and impacts of
Body Dysmorphic Disorder (BDD) among a
community sample of social media users in
Saudi Arabia. The Internet-based cross-sec-
tional study was conducted among social
media users during January and February
2020. BDD was assessed using a validated
BDD Questionnaire. A total of 1010 partici-
pants were included in the current analysis. A
total of 42 (4.2%) met the criteria of BDD,
with higher prevalence in younger partici-
pants. The defects of high concerns were
skin disfigurements (64.2%) and hair issues
(42.3%). BDD was significantly associated
with spending a longer time on Snapchat and
Instagram and less interest in religious top-
ics. BDD group was more likely to compare
their appearance with famous people in
social media. BDD group reported more
harassment and more history of psychiatric
problems. There is a need to educate the pub-
lic about the risk of BDD and to promote safe
social networking.
Introduction
While most of the people may feel some
degree of dissatisfaction with their appear-
ance at times,1individuals with Body
Dysmorphic Disorder (BDD) experience
persistent and intrusive thoughts about illu-
sory flaws or defects in their appearance.2
BDD is categorized under obsessive-com-
pulsive and related disorders, and the etiol-
ogy is probably multifactorial, including
cognitive deficits, psychological impair-
ment, and neurochemical abnormalities.3,4
BDD is a relatively common but often
underdiagnosed disorder. The prevalence in
the general population has been estimated
internationally between 1.9% and 3.3%.5
BDD is usually manifested as excessive
mirror checking or mirror avoidance, cam-
ouflaging certain body parts, seeking reas-
surance, and excessive evaluation.2Patients
with BDD are frequently seen seeking cor-
rection at plastic surgery and dermatology
clinics.6Additionally, they are more fre-
quently seen at psychiatric clinics with
mood and anxiety disorders.7The preva-
lence is several folds higher among cosmet-
ic, dermatology, and psychiatric patients
compared to the general population.5
Patients with BDD have a poor quality of
life and impaired psychosocial functioning,
irrespective of the presence of psychologi-
cal comorbidity.8,9
Saudi Arabia is considered a leading
country in the Middle East in using social
media.10 Social media could have a negative
impact on body image satisfaction.11-13 The
prevalence of BDD in Saudi Arabia has
been examined only in female students,14,15
and dermatology patients.16,17 There is a
lack of data estimating the prevalence of
BDD in the general population.
Additionally, BDD determinants and
impacts received little attention.16
Moreover, the association of social media
use and interest with BDD has never been
examined. The objective of the current
study was to examine the burden, determi-
nants, and impacts of BDD among a com-
munity sample of social media users in
Saudi Arabia. Additionally, to examine the
association between BDD and the use of
different social media applications.
Materials and Methods
Population
The current study was a community-
based study among medical students, uni-
versity employees, families, and friends.
The students and employees were enrolled
in Prince Sattam bin Abdulaziz University
at Al-Kharj city, Saudi Arabia. The popula-
tion was residents of Al-Kharj and Riyadh
cities who agreed to join an internet-based
study.
Design
It was a cross-sectional internet-based
study conducted during January and
February 2020. The study design obtained
the required ethical approvals of the ethical
committee of the Prince Sattam bin
Abdulaziz University.
Sample size and sampling
Previous studies done internationally
showed that the prevalence of BDD in the
general population is around 2%-3%,5while
the studies done in Saudi Arabia showed
that the prevalence of BDD in students is
around 4%-12%.14,15 It was estimated that a
total of 811 patients would be required to
detect a prevalence of BDD of 5% with a
confidence limit of 1.5%, using a 95% con-
fidence level and 80% power. The partici-
pants were recruited by medical students
who sent text messages to friends, families,
and relatives, inviting them to join the study
and sending an electronic link to fill the
questionnaire. A total of 1034 participants
responded to the study questionnaire. Out of
them, 24 participants were excluded due to
non-Saudi nationality (N=16), age <15
years (N=7), and not using the internet
(N=1).
Dermatology Reports 2020; volume 12:8774
Correspondence: Mohammed Saud Alsaidan,
Internal Medicine Department, College of
Medicine, Prince Sattam bin Abdulaziz
University, Al-Kharj, Saudi Arabia.
Tel.: +966115886144, +966551113300
E-mail: dr.saidan@hotmail.com
Key words: Body dysmorphic disorder; body
image; social media; psychiatry; dermatology.
Acknowledgements: The authors acknowl-
edge the Deanship of Scientific Research at
Prince Sattam bin Abdulaziz University,
Alkharj, Saudi Arabia for supporting the pub-
lication.
Conflict of interests: The authors declare no
potential conflict of interests.
Ethics approval and consent to participate:
The study design obtained the required ethical
approvals of the ethical committee of the
Prince Sattam bin Abdulaziz University. The
consent to participate was a part of the ques-
tionnaire.
Received for publication: 3 July 2020.
Accepted for publication: 28 October 2020.
This work is licensed u nder a Cr eative
Commons Attribution-NonCommercial 4.0
International License (CC BY-NC 4.0).
©Copyright: the Author(s), 2020
Licensee PAGEPress, Italy
Dermatology Reports 2020; 12:8774
doi:10.4081/dr.2020.8774
Data collection tool
Internet-based study questionnaire was
created in Arabic language. It included
questions about the socio-demographic
characteristics of the participants as well as
their social media use and interest, and pos-
sible BDD-related concerns, harassment,
and psychiatric problems. The study ques-
tionnaire was validated by two experts and
by doing a pilot study on 22 persons. BDD
was assessed using the Body Dysmorphic
Disorder Questionnaire (BDDQ), which is a
brief, self-reported measure derived from
the Diagnostic and Statistical Manual of
Mental Disorders, 4th Edition (DSM-IV)
diagnostic criteria for BDD.18 The question-
naire was developed as a screening instru-
ment for BDD in psychiatric settings and
has been validated in different patient and
community settings.19,20 The BDDQ is
formed of 5 close-ended questions which
ask the respondents whether their appear-
ance concerns are sources of preoccupation
and, if so, it assesses the degree to which
they cause distress or interfere with the per-
son’s social or occupational functioning.
The BDD diagnosis is met when the indi-
vidual answer yes to the first two questions,
any of the four items of the third question,
and to bor citems of the fourth question,
and no to the last question (Table 1). The
study questionnaire and the BDDQ were
translated from English to Arabic by a bilin-
gual colleague and then back to English by
another bilingual colleague. The original
and back-translated questionnaires showed
no difference.
Statistical analysis
Categorical variables were presented as
frequencies and percentages. Continuous
variables were presented as means and
Standard Deviations (SD). The differences
in socio-demographic characteristics, social
media use and interest, and possible BDD-
related concerns, harassment, and psychi-
atric problems were compared between par-
ticipants who had BDD and those who did
not. Chi-squared test or Fisher’s exact test,
as appropriate, were used to evaluate cate-
gorical differences, and t-test or Mann
Whitney test, as appropriate, were used to
evaluate continuous differences. All p-val-
ues were two-tailed. A p-value <0.05 was
considered significant. Statistical Package
for the Social Sciences software (SPSS
Version 25.0. Armonk, NY: IBM Corp) was
used for all statistical analyses.
Results
A total of 1010 participants were
included in the current analysis. Table 1
shows the criteria used for diagnosing BDD
and its prevalence among the included par-
ticipants. Approximately 614 (60.8%) par-
ticipants were very concerned about the
appearance of some part(s) of their bodies
that they considered especially unattractive.
Of them, 396 (64.5%) participants were
Article
Table 1. Prevalence and criteria of Body Dysmorphic Disorder (BDD) among included participants (N=1010).
Criteria Number Meeting
(%) BDD definition
1. Are you very concerned about the appearance of some part(s) of your body that you consider especially unattractive? 396 (39.2)
No 396 (39.2)
Yes 614 (60.8)
2. Do these concerns preoccupy you? That is, do you think about them a lot and wish you could think about them less?
No 218 (35.5)
Yes 396 (64.5)
Responded positively to the above two questions
No 614 (60.8)
Yes 396 (39.2)
3a. Has your defect(s) caused you a lot of distress, torment, or pain? 321 (81.1)
No 157 (39.6)
Yes 239 (60.4)
3b. Has your defect(s) significantly interfered with your social life?
No 217 (54.8)
Yes 179 (45.2)
3c. Has your defect(s) significantly interfered with your schoolwork, your job, or your ability to function in your role?
No 272 (68.7)
Yes 124 (31.3)
3d. Are there things you avoid because of your defect(s)?
No 156 (39.4)
Yes 240 (60.6)
Having one of the above four impacts
No 75 (19.9)
Yes 321 (81.1)
Total 396 (100.0)
4. How much time do you spend thinking about your defect(s) per day on average? 134 (41.7)
a. Less than 1 hour a day 187 (58.3)
b. 1-3 hours a day 91 (28.3)
c. More than 3 hours a day 43 (13.4)
Total 321 (100.0)
5. Is your main concern with your appearance that you aren't thin enough or that you might become fat? 42 (31.3)
No 42 (31.3)
Yes 92 (68.7)
Total 134 (100.0)
[page 71] [Dermatology Reports 2020; 12:8774]
[Dermatology Reports 2020; 12:8774] [page 72]
preoccupied with these concerns to the
extent they thought about them a lot and
wished they could think about them less. Of
the 396 participants who responded posi-
tively to the previous two questions, 321
(81.1%) had one or more of the four exam-
ined impacts of the above-mentioned
defects. These include 239 (60.4%) partici-
pants who had a lot of distress, torment, or
pain; 179 (45.2%) who had significant
interference with social life, 124 (31.3%)
who had significant interference with
school work, job, or ability to function in
their role, 240 (60.6%) who had to avoid
things because of their defect(s). Of the 321
participants who had one or more of the
four above mentioned impacts, 134 (41.7%)
spent on average one hour or more per day
thinking about their defect(s). However, 92
(68.7%) of those thinking about their
defect(s) had the main concern with their
appearance as being not thin enough or
becoming fat, indicating an eating disorder
rather than BDD. Therefore, the prevalence
of BDD was 4.2% (42/1010) when consid-
ering all participants (Figure 1).
Table 2 shows the socio-demographic
characteristics of the participants by BDD
status. The average age was 22.9±7.1 years,
and 54.0% of the participants were females.
The majority of the participants were single
(84.3%) and students (68.2%). The most
common educational level was high school
or less (45.1%), followed by a bachelor
degree (41.9%) and finally diploma/post-
graduate (13.0%). The average family
income was very variable, with 24.8% of
the participants got less than 5,000 Saudi
Riyals per month, and 10.0% got at least
30,000 Saudi Riyals per month. Age was
Article
Table 2. Socio-demographic characteristics by Body Dysmorphic Disorder (BDD) status among included participants (N=1010).
BDD, N=42 (%) No BDD, N=968 (%) Total, N=1010 (%) p-value
Age (years) 20.2±3.0 23.0±7.2 22.9±7.1 0.014*
Mean±SD*
<20 22 (52.4) 310 (32.1) 332 (32.9) 0.011
20-25 18 (42.9) 501 (51.8) 519 (51.4)
>25 2 (4.8) 156 (16.1) 158 (15.7)
Gender
Male 17 (40.5) 448 (46.3) 465 (46.0) 0.460
Female 25 (59.5) 520 (53.7) 545 (54.0)
Marital status
Single 39 (92.9) 812 (83.9) 851 (84.3) 0.132**
Married 2 (4.8) 140 (14.5) 142 (14.1)
Divorced/widow 1 (2.4) 16 (1.7) 17 (1.7)
Education
Elementary school 0 (0.0) 24 (2.5) 24 (2.4) 0.352**
High school 23 (54.8) 409 (42.3) 432 (42.8)
Bachelor degree 13 (31.0) 410 (42.4) 423 (41.9)
Diploma 4 (9.5) 98 (10.1) 102 (10.1)
Post-graduate 2 (4.8) 27 (2.8) 29 (2.9)
Occupation
Student 34 (81.0) 655 (67.7) 689 (68.2) 0.430**
Employee 3 (7.1) 154 (15.9) 157 (15.5)
Freelancer 0 (0.0) 18 (1.9) 18 (1.8)
Housewife 0 (0.0) 37 (3.8) 37 (3.7)
Retired 0 (0.0) 10 (1.0) 10 (1.0)
Unemployed 5 (11.9) 94 (9.7) 99 (9.8)
Monthly family income in Saudi riyal (SR)
<5,000 13 (31.0) 237 (24.5) 250 (24.8) 0.330**
5,000-9,999 10 (23.8) 277 (28.6) 287 (28.4)
10,000-19,999 7 (16.7) 253 (26.1) 260 (25.7)
20,000-29,999 5 (11.9) 107 (11.1) 112 (11.1)
30,000 7 (16.7) 94 (9.7) 101 (10.0)
Test used was chi square test except marked: * t-test; ** Fisher exact.
Figure 1. Prevalence of Body Dysmorphic Disorder (BDD) and eating disorders among
included participants (N=1010).
the only socio-demographic variable associ-
ated with BDD, with younger age in the
BDD group compared with a non-BDD
group (20.2±3.0 versus 23.0±7.2, p=0.014).
The prevalence of BDD was 6.6% among
participants less than 20 years, 3.5% in
those between 20-25 years, and 1.3% in
above 25 years.
Table 3 shows the use and interest in
social media applications among the partic-
ipants by BDD status. With the exception of
Facebook, all other social media applica-
tions were heavily used. The use of social
media was highest with Snapchat (95.8%),
followed by WhatsApp (93.2%), YouTube
(89.2%), Instagram (85.9%), Twitter
(79.2%), and finally, Facebook (4.5%). The
majority (62.3%) of participants spent, on
average more than 4 hours per day on all
social media applications. The time spent in
minutes per day was highest with Snapchat
(81.2±51.2), followed by Instagram
(57.4±51.8), YouTube (57.1±50.5),
WhatsApp (49.1±45.8), Twitter (45.8±49.3),
and finally Facebook (1.5±10.9). The aver-
age number of daily visits of social media
applications was highest with Snapchat
(14.3±18.0), followed by Instagram
(10.3±15.0), WhatsApp (10.1±12.9), Twitter
(8.9±16.0), YouTube (7.9±13.8), and finally
Facebook (0.9±4.6). The top five topics that
received the highest interest of the partici-
pants include music, songs, and movies
(76.5%), following celebrities (65.5%),
shopping (55.5%), body health and beauty
(51.4%), and nutrition, food, and cooking
(49.4%). The five topics that received the
lowest interest of the participants include
business and economy (24.0%), sex and sex
education (24.8%), politics (27.7%), sports
news and competitions (43.2%), and travel
and tourism (43.8%). Out of all the vari-
ables that characterized the use and interest
in social media applications, the following
were associated with BDD; spending longer
time on Snapchat (97.9±51.6 versus
80.4±51.1 minutes per day, p=0.036),
spending longer time on Instagram
(74.6±59.8 versus 56.7±51.3 minutes per
day, p=0.049), and less interest in religious
topics (23.8% versus 48.1%, p=0.002).
Table 4 shows the concerns, harassment,
and psychiatric problems among the partici-
pants by BDD status. Approximately 60.8%
of all participants (including 100% of those
with BDD) had one or more defects that they
were very concerned about. The defects of
high concerns were skin disfigurements
(64.2%), hair issues (42.3%), shape or size of
the belly (39.6%), face disfigurements
Article
Table 3. Use and interest in social media applications by Body Dysmorphic Disorder (BDD) status among included participants
(N=1010).
BDD, N=42 (%) No BDD, N=968 (%) Total, N=1010 (%) p-value
Use of social media
WhatsApp 39 (92.9) 902 (93.2) 941 (93.2) 0.761*
Snapchat 42 (100.0) 926 (95.7) 968 (95.8) 0.414*
Instagram 40 (95.2) 828 (85.5) 868 (85.9) 0.077
Twitter 32 (76.2) 768 (79.3) 800 (79.2) 0.623
Facebook 0 (0.0) 45 (4.6) 45 (4.5) 0.253*
YouTube 36 (85.7) 865 (89.4) 901 (89.2) 0.444*
Time spent on all social media applications
4 hours 11 (26.2) 370 (38.2) 381 (37.7) 0.115
>4 hours 31 (73.8) 598 (61.8) 629 (62.3)
Time spent in minutes per day
WhatsApp 45.4±41.8 49.2±46.0 49.1±45.8 0.871
Snapchat 97.9±51.6 80.4±51.1 81.2±51.2 0.036
Instagram 74.6±59.8 56.7±51.3 57.4±51.8 0.049
Twitter 55.4±56.4 45.4±48.9 45.8±49.3 0.399
Facebook 0.0±0.0 1.6±11.1 1.5±10.9 0.153
YouTube 59.3±50.1 57.0±50.6 57.1±50.5 0.793
Number of visits per day
WhatsApp 6.5±5.6 10.2±13.1 10.1±12.9 0.119
Snapchat 15.0±17.5 14.3±18.0 14.3±18.0 0.479
Instagram 12.9±17.5 10.2±14.8 10.3±15.0 0.193
Twitter 9.7±11.2 8.9±16.2 8.9±16.0 0.283
Facebook 1.0±4.0 0.9±4.6 0.9±4.6 0.576
YouTube 12.4±20.2 7.7±13.4 7.9±13.8 0.408
Topic of interest
Following celebrities 32 (76.2) 630 (65.1) 662 (65.5) 0.138
Fashion related 19 (45.2) 428 (44.2) 447 (44.3) 0.896
Music, songs, movies 36 (85.7) 737 (76.1) 773 (76.5) 0.152
Nutrition, food, cooking 24 (57.1) 475 (49.1) 499 (49.4) 0.306
Video games 18 (42.9) 459 (47.4) 477 (47.2) 0.562
Body health and beauty 18 (42.9) 501 (51.8) 519 (51.4) 0.259
Sports news and competitions 16 (38.1) 420 (43.4) 436 (43.2) 0.498
Shopping 25 (59.5) 536 (55.4) 561 (55.5) 0.596
Religion related 10 (23.8) 466 (48.1) 476 (47.1) 0.002
Medical related topics 15 (35.7) 430 (44.4) 445 (44.1) 0.266
Technology and smartphones 22 (52.4) 439 (45.4) 461 (45.6) 0.371
Travel and tourism 18 (42.9) 424 (43.8) 442 (43.8) 0.904
Business and economy 6 (14.3) 236 (24.4) 242 (24.0) 0.134
Politics 10 (23.8) 270 (27.9) 280 (27.7) 0.563
Sex and sex education 13 (31.0) 237 (24.5) 250 (24.8) 0.342
Test used was chi square test except marked: *Fisher exact.
[page 73] [Dermatology Reports 2020; 12:87774]
(35.0%), and shape or size of hips (24.9%).
Participants with BDD had a higher number
of defects that they were very concerned
about (p<0.001), especially face disfigure-
ments (78.6% versus 63.1%, p=0.044) but
not the shape or size of the belly (7.1% ver-
sus 42.0%, p<0.001). The majority (70.5%)
of participants reported that their primary
concern about appearance was what they
think, not what others think. Approximately
23.4% of the participants were comparing
their appearance with famous people in
social media, with more comparisons in the
BDD group (47.6% versus 22.3%, p<0.001).
Approximately 13.9% of the participants
believed that others see their appearance as
severely abnormal, with higher belief in the
BDD group (35.7% versus 12.9%, p<0.001).
The majority (71.2%) of participants
believed that people around them were judg-
ing others based on many factors, not just
appearance, with less belief in the BDD
group (54.8% versus 71.9%, p=0.016).
Approximately 18.9% of the participants
Article
Table 4. Concerns, harassment, and psychiatric problems by Body Dysmorphic Disorder (BDD) status among included participants
(N=1010).
BDD, N=42 (%) No BDD, N=968 (%) Total, N=1010 (%) p-value
Number of defects you are very concerned about
None 0 (0.0) 396 (40.9) 396 (39.2) <0.001
One or two 28 (66.7) 329 (34.0) 357 (35.3)
Three or more 14 (33.3) 243 (25.1) 257 (25.4)
If very concerned, what are these defects?
Skin (acne, scars, wrinkles, paleness, redness) 33 (78.6) 361 (63.1) 394 (64.2) 0.044
Hair 15 (35.7) 245 (42.8) 260 (42.3) 0.368
The shape or size of nose, mouth, jaws or lips 20 (47.6) 195 (34.1) 215 (35.0) 0.076
The shape or size of belly 3 (7.1) 240 (42.0) 243 (39.6) <0.001
The shape or size of hips 7 (16.7) 146 (25.5) 153 (24.9) 0.200
The shape or size of breasts 3 (7.1) 101 (17.7) 104 (16.9) 0.080
The shape or size of genitals 1 (2.4) 51 (8.9) 52 (8.5) 0.244*
Skin color 4 (9.5) 78 (13.6) 82 (13.4) 0.450
Congenital defects in the hands or anywhere else 3 (7.1) 19 (3.3) 22 (3.6) 0.185*
Others 1 (2.4) 10 (1.7) 11 (1.8) 0.544*
Type of primary concern about your appearance
What others think 15 (35.7) 166 (29.0) 181 (29.5) 0.358
What I think 27 (64.3) 406 (71.0) 433 (70.5)
Comparing your appearance with famous people in social media
No 22 (52.4) 752 (77.7) 774 (76.6) <0.001
Yes 20 (47.6) 216 (22.3) 236 (23.4)
Beliefs of others on your appearance
Normal 27 (64.3) 843 (87.1) 870 (86.1) <0.001
Severely abnormal 15 (35.7) 125 (12.9) 140 (13.9)
Standards by which you judge others
Mainly by appearance 10 (23.8) 90 (9.3) 100 (9.9) 0.006*
By many factors more important than appearance 32 (76.2) 878 (90.7) 910 (90.1)
Standards by which people around you judge others
Mainly by appearance 19 (45.2) 272 (28.1) 291 (28.8) 0.016
By many factors more important than appearance 23 (54.8) 696 (71.9) 719 (71.2)
Did you have appearance-related harassment while using social media?
No 25 (59.5) 794 (82.0) 819 (81.1) <0.001
Yes 17 (40.5) 174 (18.0) 191 (18.9)
If yes, what types of harassment?
Mockery 8 (47.1) 97 (55.7) 105 (55.0) 0.072*
Insult or abuse 0 (0.0) 18 (10.3) 18 (9.4)
Bullying 8 (47.1) 39 (22.4) 47 (24.6)
Threatening or defamation 0 (0.0) 8 (4.6) 8 (4.2)
Incitement to do immoral acts 0 (0.0) 11 (6.3) 11 (5.8)
Others 1 (5.9) 1 (0.6) 2 (1.0)
Were you previously diagnosed with psychiatric problems?
No 28 (66.7) 833 (86.1) 861 (85.2) 0.001
Yes 14 (33.3) 135 (13.9) 149 (14.8)
If yes, what psychiatric problems?
Depression 7 (50.0) 68 (50.4) 75 (50.3) 0.732*
Anxiety 4 (28.6) 32 (23.7) 36 (24.2)
Social phobia 1 (7.1) 21 (15.6) 22 (14.8)
Obsessive compulsive disorder 1 (7.1) 10 (7.4) 11 (7.4)
Schizophrenia 1 (7.1) 4 (3.0) 5 (3.4)
Are you consulting a psychiatrist?
No 34 (81.0) 899 (92.9) 933 (92.4) 0.011*
Yes 8 (19.0) 69 (7.1) 77 (7.6)
Test used was chi square test except marked: *Fisher exact.
[Dermatology Reports 2020; 12:8774] [page 74]
[page 75] [Dermatology Reports 2020; 12:8774]
reported appearance-related harassment,
mainly in the form of mockery (55.0%) and
bullying (24.6%). Approximately 14.8% of
the participants were previously diagnosed
with psychiatric problems, mainly depres-
sion (50.3%), anxiety (24.2%), and social
phobia (14.8%). Only 7.6% of the partici-
pants are currently consulting a psychiatrist.
BDD group reported more harassment
(40.5% versus 18.0%, p<0.001) and more
history of psychiatric problems (33.3% ver-
sus 13.9%, p=0.001).
Discussion
We are reporting the burden, determi-
nants, and impacts of BDD among a com-
munity sample of social media users in
Saudi Arabia. The current rate of BDD
(4.2%) is considered higher than the aver-
age rates of BDD reported in the general
population worldwide, which was estimated
at 2.2% in adolescents, 1.9% in adults, and
3.3% in students.5However, the current
rates were generally similar to previous
studies done in Saudi Arabia. For example,
BDD was reported among 4.4% of female
medical students in Riyadh and 12.3% of
female secondary school students in
Jeddah.14,15 The reported high prevalence of
BDD in female secondary school students
in Jeddah may be due to the non-exclusion
of those with eating disorders who account-
ed for 8.7% of the total number of stu-
dents.14
As expected, skin and hair were the
areas of highest concern in the current
study. The same was generally reported by
studies done internationally,21 and among
students in Saudi Arabia.14,15 For example,
75% and 44% of female medical students in
Riyadh had concerns about the appearance
of their skin and hair compared with 64%
and 42% in the current study.15 This may
explain the much higher prevalence of BDD
among dermatology patients in Saudi
Arabia (14.1%-18.6%).16,17 They usually
have more concerns about skin color, acne,
and hair loss than the general population.17
In our study, those with no BDD are more
likely to be bothered by the shape or size of
the belly than those with BDD. This is
explained by the Body Dysmorphic
Disorder Questionnaire (BDDQ) used in
this study, which excludes those who have
their main concern of appearance as not
being thin enough or might become fat from
the BDD group.
The prevalence of BDD in the current
study was not associated with socio-demo-
graphic characteristics, with the exception
of age, where BDD was significantly higher
among younger participants. The majority
of the studies done internationally showed
that BDD is more frequent in adolescents
and young adults and in females.5In Saudi
Arabia, the association between BDD and
socio-demographic characteristics was not
the focus of the few community studies
done, which examined only females with a
very narrow age range.14,15 Nevertheless,
similar to the current findings, BDD in der-
matology patients in Saudi Arabia was asso-
ciated with younger age but not female gen-
der.16 Adolescents and young adults are usu-
ally more worried and self-conscious about
their appearance and are subjected to a
higher degree of peer pressure.5
Snapchat and Instagram were the most
heavily used social media applications in
the current study, as evidenced by the dura-
tion spent and the number of daily visits.
Interestingly, BDD was significantly associ-
ated with a longer duration spent on both
applications and less interest in religious
content. This may indicate a higher interest
in sharing and following personal photos
and videos among those with BDD.
Snapchat specifically is specialized in edit-
ing and customizing personal photos and
videos, a common behavior in individuals
with BDD.2The fact that the study partici-
pants were heavily using multiple social
media applications may point to the fear of
missing out on rewarding experiences that
others are having.22
It has been suggested that social media
can enhance the negative belief in body
image by promoting universal features of
beauty.11-13 Propagating photos, videos, and
comments about the ideal face, nose, hair,
and skin color can easily trigger the belief
that an individual’s own body parts are
deviated from normal. Consistent with this
proposed link, those with BDD in the cur-
rent study were more likely to compare
their own appearance with famous people in
social media, emphasize appearance as an
important judgment factor, and underscore
the abnormalities of their own body. The
heavy use of social media, together with its
negative impact on body image, may
explain the higher rates of BDD in the cur-
rent study compared with the general popu-
lation worldwide.5
Participants with BDD in the current
study reported more harassment and a more
frequent history of psychiatric problems
than those without BDD. Social media has
been associated with harassment, cyberbul-
lying, and other behaviors of antisocial per-
sonality disorder.23,24 Additionally, it has
been suggested that critical events or trau-
matic incidents such as harassment and
repeated criticism about appearance may
activate the dysfunctional assumptions seen
in individuals with BDD.25 Therefore, the
more frequent harassment observed in the
current study is probably a cause, not an
outcome of the disease. Similar to the cur-
rent findings, those with BDD are at higher
risk of psychiatric problems,26 and even sui-
cidal attempts.27 This may explain the high-
er prevalence of those with BDD who are
seeking psychiatric help in the current and
previous studies.7,28
The current study is considered the first
local study to examine the association
between BDD and social media.
Additionally, it examined the socio-demo-
graphic determinants as well as the impacts
of BDD among a relatively large sample
size. Nevertheless, the cross-sectional
design used does not prove causality and
cannot preclude the possibility of response
bias. Further, the majority of responses
were from young participants (84% of par-
ticipants aged ≤25 years), therefore, these
results may not be generalized for other age
groups. Additionally, the electronic recruit-
ment limits the generalizability of the find-
ings to social media users in Saudi Arabia.
This study used the Body Dysmorphic
Disorder Questionnaire (BDDQ), and using
a different questionnaire or criteria for BDD
would have different results accordingly.
These limitations, however, are very com-
mon in similar studies and probably had a
limited impact on the study findings, if any.
Conclusions
We are reporting a 4.2% prevalence of
BDD among a community sample of social
media users in Saudi Arabia, with higher
prevalence among those with young age.
Skin disfigurements and hair issues were
the defects of the highest concern. BDD
was significantly associated with a longer
duration spent on Snapchat and Instagram.
Participants with BDD were more likely to
compare their own appearance with famous
people in social media and were at higher
risk of harassment and psychiatric prob-
lems. The findings call for the need to edu-
cate the public about the risk of BDD and its
consequences and to promote safe social
networking, especially among adolescents.
Additionally, they may underscore the role
of physicians, especially psychiatrists, plas-
tic surgeons, and dermatologists, in identi-
fying BDD among young patients seeking
medical care. However, more studies, with
larger sample size, are needed to assess the
relationship between prolonged social net-
working, mainly on Snapchat and
Instagram, and BDD as well as eating dis-
orders.
Article
[Dermatology Reports 2020; 12:8774] [page 76]
References
1. Harris D, Carr A. Prevalence of concern
about physical appearance in the gener-
al population. Br J Plast Surg 2001;54:
223-6.
2. American Psychiatric Association
(APA). Diagnostic and statistical manu-
al of mental disorders. (5th Edition).
Washington, DC; 2013.
3. Johnson S, Williamson P, Wade TD. A
systematic review and meta-analysis of
cognitive processing deficits associated
with body dysmorphic disorder. Behav
Res Ther 2018;107:83-94.
4. Pavan C, Simonato P, Marini M, et al.
Psychopathologic aspects of body dys-
morphic disorder: a literature review.
Aesthetic Plast Surg 2008;32:473-84.
5. Veale D, Gledhill LJ, Christodoulou P,
Hodsoll J. Body dysmorphic disorder in
different settings: a systematic review
and estimated weighted prevalence.
Body Image 2016;18:168-86.
6. Ribeiro RVE. Prevalence of body dys-
morphic disorder in plastic surgery and
dermatology patients: a systematic
review with meta-analysis. Aesthetic
Plast Surg 2017;41:964-70.
7. Hundscheid T, Van Der Hulst RR,
Rutten BP, Leue C. Body dysmorphic
disorder in cosmetic surgery - preva-
lence, psychiatric comorbidity and out-
come. Tijdschr Psychiatr 2014;56:514-
22.
8. IsHak WW, Bolton MA, Bensoussan
JC, et al. Quality of life in body dysmor-
phic disorder. CNS Spectr 2012;17:167-
75.
9. Phillips KA, Menard W, Fay C, Pagano
ME. Psychosocial functioning and qual-
ity of life in body dysmorphic disorder.
Compr Psychiatry 2005;46:254-60.
10. TNS: Arab Social Media Report.
Available from:https://www.extradigi-
tal.co.uk/marketing-assets/arabsocial-
mediareport2015.pdf
11. Holland G, Tiggemann M. A systematic
review of the impact of the use of social
networking sites on body image and
disordered eating outcomes. Body
Image 2016;17:100-10.
12. De Vries DA, Vossen HGM, van der
Kolk-van der Boom P. Social media and
body dissatisfaction: investigating the
attenuating role of positive parent-ado-
lescent relationships. J Youth Adolesc
2019;48:527-36.
13. Zeeni N, Doumit R, Abi Kharma J,
Sanchez-Ruiz MJ. Media, technology
use, and attitudes: associations with
physical and mental well-being in youth
with implications for evidence-based
practice. Worldviews Evid Based Nurs
2018;15:304-12.
14. Alomari AA, Makhdoom YM.
Magnitude and determinants of body
dysmorphic disorder among female stu-
dents in Saudi public secondary
schools. J Taibah Univ Med Sci 2019;
14:439-47.
15. Shaffi Ahamed S, Enani J, Alfaraidi L,
et al. Prevalence of body dysmorphic
disorder and its association with body
features in female medical students.
Iran J Psychiatry Behav Sci 2016;10:
e3868.
16. Alonazi H. Prevalence of body dysmor-
phic disorder in patients attending der-
matology clinic in saudi arabia/qassim
region. J Med Sci Clin Res
2017;5:30471-9.
17. AlShahwan MA. Prevalence and char-
acteristics of body dysmorphic disorder
in Arab dermatology patients. Saudi
Med J 2020;41:73-8.
18. Phillips KA. The broken mirror: under-
standing and treating body dysmorphic
disorder. Oxford: Oxford University
Press; 2005.
19. Dey JK, Ishii M, Phillis M, et al. Body
dysmorphic disorder in a facial plastic
and reconstructive surgery clinic: mea-
suring prevalence, assessing comorbidi-
ties, and validating a feasible screening
instrument. JAMA Facial Plast Surg
2015;17:137-43.
20. Brohede S, Wingren G, Wijma B,
Wijma K. Prevalence of body dysmor-
phic disorder among Swedish women: a
population-based study. Compr
Psychiatry 2015;58:108-15.
21. Siegfried E, Ayrolles A, Rahioui H.
Body dysmorphic disorder: Future
prospects of medical care. Encephale
2018;44:288-90.
22. Franchina V, Vanden Abeele M, van
Rooij AJ, et al. Fear of missing out as a
predictor of problematic social media
use and phubbing behavior among
flemish adolescents. Int J Environ Res
Public Health 2018;15:2319.
23. Galica VL, Vannucci A, Flannery KM,
Ohannessian CM. Social media use and
conduct problems in emerging adults.
Cyberpsychol Behav Soc Netw
2017;20:448-52.
24. Golder S, Norman G, Loke YK.
Systematic review on the prevalence,
frequency and comparative value of
adverse events data in social media. Br
J Clin Pharmacol 2015;80:878-88.
25. Cororve MB, Gleaves DH. Body dys-
morphic disorder: a review of conceptu-
alizations, assessment, and treatment
strategies. Clin Psychol Rev 2001;21:
949-70.
26. Van der Meer J, van Rood YR, van der
Wee NJ, et al. Prevalence, demographic
and clinical characteristics of body dys-
morphic disorder among psychiatric
outpatients with mood, anxiety or
somatoform disorders. Nord J Psychiatr
2012;66:232-8.
27. Snorrason I, Beard C, Christensen K, et
al. Body dysmorphic disorder and
major depressive episode have comor-
bidity-independent associations with
suicidality in an acute psychiatric set-
ting. J Affect Disord 2019;259:266-70.
28. Dyl J, Kittler J, Phillips KA, Hunt JI.
Body dysmorphic disorder and other
clinically significant body image con-
cerns in adolescent psychiatric inpa-
tients: prevalence and clinical charac-
teristics. Child Psychiatry Hum Dev
2006;36:369-82.
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... BDD in adults usually leads to high rates of social and occupational dysfunction whereas BDD in youth is associated with a poorer academic performance, social withdrawal and higher school dropping out rates (2). Despite the increasing prevalence of BDD among young people worldwide (4)(5)(6)(7)(8)(9)(10)(11) and the serious implications toward their quality of life and social functioning, there is still a lack of data on BDD in the general population of Malaysia, especially among young male adults. ...
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This systematic review and meta-analysis examined the evidence supporting the association between body dysmorphic disorder (BDD) symptomology and four types of cognitive processing abnormalities: local processing, selective attention, interpretive biases, and memory deficits. Twenty-three studies met inclusion requirements that examined differences in performance on cognitive tasks between BDD and control groups across the four categories. Multilevel modelling was used to calculate an overall effect size for each cognitive category. BDD and control groups differed significantly on measures of selective attention (g = 0.60, 95% CI = 0.26: 0.93), interpretive biases (g = 0.30, 95% CI = . 07: 0.54), and memory deficits (g=.56, 95% CI = 0.26: 0.87). Differences between the BDD and control groups on measures of local processing did not reach significance. These findings support the hypothesis that people with BDD may selectively attend to perceived threats or to disorder-related stimuli, misinterpret ambiguous stimuli as threatening, overvalue the importance of attractiveness, and have inaccurate coding and recall for facial or bodily stimuli. Recommendations for future research of these specific cognitive deficits in BDD include introducing the use of Modified Dot Probe Paradigms and new treatment targets that can be used as adjuncts to current treatment modalities.
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Background: Previous research has shown that the use of technology and media, in their different available forms, may have detrimental effects on the physical and mental well-being of adolescents and young adults. Aims: The present study aimed to investigate the use of different types of technology and media, attitudes toward them, and how they relate to physical and mental well-being in Lebanese university students. Methods: A descriptive, correlational, cross-sectional design was used. A sample of 244 undergraduates completed a self-report measuring media and technology use and attitudes, eating-related variables (e.g., healthy eating, body image dissatisfaction [BID], and eating disorders [EDs] risk), trait emotional intelligence (TEI), and psychopathology indicators (stress, anxiety, and depression). Results: The use of mobile phone multimedia (music, pictures, and videos) correlated with unhealthy eating and stress. Social media use was associated with BID, EDs risk, and the self-control construct of TEI. Anxiety of separation from technological devices and dependence on them was associated with increased BID, EDs risk, depression, and anxiety. Linking evidence to action: Practical implications are discussed in terms of setting limits and boundaries on technology use during childhood and adolescence, and encouraging healthy eating and physical activity at home and on college campuses. Moreover, social media could be used as a platform for intervention and prevention programs to decrease BID, EDs, depression, and anxiety.
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Clinical characteristics: BDD appears to be relatively common with a prevalence rate between 1 and 2% in general population with a chronic course evolution without treatment, it is also associated with a high rate of depression and suicide. The current prevalence in adult psychiatric population is estimated over 10%; prevalence is also elevated in dermatology and cosmetic surgery patients. Therapeutic: Adequate treatments may improve symptoms and quality of life. International guidelines recommend cognitive behavior therapy (CBT) as first line of treatment. Several studies have shown evidence of CBT benefit. High dose selective serotonin reuptake inhibitors (SRI) for at least 12weeks are recommended in more severe cases. SRI augmentation strategies with antipsychotic adjunction do not report benefit in small-size sample. Antipsychotic medication for BDD even with delusional beliefs is not indicated. Attachment based interpersonal psychotherapy, analyzing and correcting interpersonal relationship from individuals with BDD may represent an alternative therapy improving self-esteem. Cosmetic treatments: Insight is generally poor and patients often require cosmetic and surgical treatments to "correct" their imagined defect with sometimes a transitional initial benefit but without positive impact on long-term remission and can exacerbate preoccupation. Screening and awareness: Healthcare professionals need to be aware of an early detection of this trouble, clinical tools validated in cosmetic population can help them to identify BDD in order to provide education about diagnosis and refer patients to a psychiatrist. More collaboration between psychiatrists and cosmetic practitioners is necessary.