Koran LM, Abujaoude E, Large MD, Serpe RT. The prevalence of body dysmorphic disorder in the United States adult population. CNS Spectr 13: 316-322

Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California 94305, USA.
CNS spectrums (Impact Factor: 2.71). 05/2008; 13(4):316-22.
Source: PubMed


In clinical samples, body dysmorphic disorder (BDD) is associated with substantial suffering and reduced quality of life. Limited surveys report widely varying prevalence estimates. To better establish the prevalence of BDD, we conducted a United States nationwide prevalence survey.
We conducted a random sample national household telephone survey in the spring and summer of 2004 and interviewed 2,513 adults, of whom 2,048 qualified for the BDD-module administration. The computer-assisted, structured interviews, conducted by trained lay interviewers, addressed Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria for BDD, along with information regarding several impulse-control disorders and the respondents' financial and demographic data.
The rate of response was 56.3%, which compared favorably with rates in federal national health surveys. The cooperation rate was 97.6%. Respondents included a higher percentage of women and people >55 years of age than in the US adult population, and a lower percentage of Hispanics. The estimated point prevalence of DSM-IV BDD among respondents was 2.4% (49/2,048) (by gender: 2.5% for women, 2.2% for men), exceeding the prevalence of schizophrenia and bipolar disorder type I and about that of generalized anxiety disorder. BDD prevalence decreased after 44 years of age, and a larger proportion of BDD respondents were never married. Of those meeting DSM-IV criteria for BDD, 90% (45/49) met the DSM-IV distress criterion, and 51% (25/49) met the interference-with-functioning criterion.
A study using clinically valid interviews is needed to evaluate these results. Such studies could inform treatment by documenting rates of seeking treatment from various sources, suicide attempt rates, and the prevalence of comorbid conditions.


Available from: Richard T Serpe
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    • "BDD is now classified within the obsessive compulsive and related disorders (OCRD) section of the Diagnostic and Statistical Manual of mental disorders 5th Edition (DSM5) (American Psychiatric Association , 2013) and it is proposed to include the diagnosis in the same section of the revised version of International Classification of Diseases (ICD-11) (Veale and Matsunaga, 2014). BDD is more common than previously recognised with a prevalence of about 2% in the general population (Koran et al., 2008; Rief et al., 2006). It may be a chronic disorder, which persists for many years if left untreated (Phillips et al., 2005b). "
    [Show abstract] [Hide abstract] ABSTRACT: The aim of this study was to estimate the prevalence of body dysmorphic disorder (BDD) on an inpatient ward in the UK with a larger sample than previously studied and to investigate the value of a simple screening question during an assessment interview. Four hundred and thirty two consecutive admissions were screened for BDD on an adult psychiatric ward over a period of 13 months. Those who screened positive had a structured diagnostic interview for BDD. The prevalence of BDD was estimated to be 5.8% (C.I. 3.6–8.1%). Our screening question had a slightly low specificity (76.6%) for detecting BDD. The strength of this study was a larger sample size and narrower confidence interval than previous studies. The study adds to previous observations that BDD is poorly identified in psychiatric inpatients. BDD was identified predominantly in those presenting with depression, substance misuse or an anxiety disorder. The screening question could be improved by excluding those with weight or shape concerns. Missing the diagnosis is likely to lead to inappropriate treatment.
    Full-text · Article · Sep 2015 · Psychiatry Research
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    • "The Beck Depression Inventory was used to assess depressive symptoms [12]. Body dysmorphic disorder symptoms were assessed used the questionnaire described by Koran et al. [13]. The first two questions deal with the preoccupation of the participant with perceived defects in physical appearance not observable to others. "
    [Show abstract] [Hide abstract] ABSTRACT: Objective The purpose of the study was to examine the prevalence of excoriation (skin picking) disorder (SPD) and associated physical and mental health correlates in a sample of Israeli university students. Methods Five thousand Israeli students were given questionnaires screening for SPD, depression, obsessive-compulsive disorder, body dysmorphic disorder and disruptive, impulse control and conduct disorders. A total of 2176 participants (43.6%) responded and were included in the analysis. Mean age was 25.1±4.8 (range 17-60) years and 64.3% were female. Results 3.03% of students screened positive for SPD with a nearly equal gender distribution (3.0% in females and 3.1% in males). There was a trend towards significantly higher rates of psychiatric problems such as generalized anxiety, compulsive sexual behavior and eating disorders in these students. Within the group of students screening positive for SPD, alcohol intake was higher in male students, while female students perceived themselves as less attractive. No association was found between depression and SPD. A high prevalence rate of skin picking was found within first-degree family members of the participants screening positive for SPD. Conclusions Clinicians and public health officials within university settings should screen for SPD as it is common and associated with psychosocial dysfunction.
    Full-text · Article · Nov 2014 · General Hospital Psychiatry
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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. "
    [Show abstract] [Hide abstract] 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.
    Full-text · Article · Oct 2014 · Journal of Psychiatric Research
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