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
ABSTRACT
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.

Full-text

Available from: Richard T Serpe
The Prevalence of Body
Dysmorphic Disorder in the
United States Adult Population
By Lorrin M. Koran, MD, Elias Abujaoude, MD,
Michael D. Large, PhD, and Richard T. Serpe, PhD
316
CNS Spectr 13:4 © MBL Communications April 2008
Original Research
Dr. Koran is emeritus professor of psychiatry and Dr. Aboujaoude is clinical assistant professor in the Department of Psychiatry and Behavioral Sciences, both at
Stanford University School of Medicine in California. Dr. Large is research analyst at Palomar College in San Marcos, California. Dr. Serpe is professor in the
Department of Sociology at Kent State University in Ohio.
Faculty Disclosures: Dr. Koran is a member of the speaker’s bureau of Forest and receives grant/research support from Eli Lilly, Forest, Jazz, Ortho-McNeil,
and Somaxon. Dr. Aboujaoude is a member of the speaker’s bureau of Forest. Drs. Large and Serpe do not have an affiliation with or financial interest in an
organization that might pose a conflict of interest.
Funding/Support: This work was supported in part by an unrestricted educational grant from Forest.
Submitted for publication: November 19, 2007; Accepted for publication: March 6, 2008.
Please direct all correspondence to: Lorrin M. Koran, MD, Stanford University School of Medicine, OCD Clinic, Room 2363, 401 Quarry Road, Stanford, CA
94305; Email: lkoran@stanford.edu.
ABSTRACT
Objective: In clinical samples, body dysmorphic
disorder (BDD) is associated with substantial suf-
fering and reduced quality of life. Limited surveys
report widely varying prevalence estimates. To bet-
ter establish the prevalence of BDD, we conducted
a United States nationwide prevalence survey.
Method: 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.
Results: 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-
Needs Assessment
Body dysmorphic disorder (BDD), a distressing or impairing preoccupa-
tion with an imagined or slight defect in appearance, is associated with
substantial suffering, suicide attempts and reduced quality of life. Limited
surveys report widely varying prevalence estimates. To better establish
the public health importance of BDD in the United States, we conducted a
nationwide prevalence survey of BDD, the first of its kind in this country.
Learning Objectives
At the end of this activity, the participant should be able to:
Describe the range of estimates of the prevalence of body dysmor-
phic disorder.
Discuss the limitations in the available data, including those embed-
ded in the current study.
Discuss the data that future epidemiological studies should gather to
inform treatment efforts.
Target Audience: Neurologists and psychiatrists
CME Accreditation Statement
This activity has been planned and implemented in accordance with the
Essentials and Standards of the Accreditation Council for Continuing
Medical Education (ACCME) through the joint sponsorship of the Mount
Sinai School of Medicine and MBL Communications, Inc. The Mount
Sinai School of Medicine is accredited by the ACCME to provide con-
tinuing medical education for physicians.
Credit Designation
The Mount Sinai School of Medicine designates this educational activ-
ity for a maximum of 3 AMA PRA Category 1 Credit(s)
TM
. Physicians
should only claim credit commensurate with the extent of their partici-
pation in the activity.
This activity has been peer-reviewed and approved by Eric Hollander, MD,
chair at the Mount Sinai School of Medicine. Review date: March 17,
2008. Dr. Hollander does not have an affiliation with or financial interest
in any organization that might pose a conflict of interest.
To Receive Credit for This Activity
Read this article and the two CME-designated accompanying articles,
reflect on the information presented, and then complete the CME posttest
and evaluation found on page 333. To obtain credits, you should score
70% or better. Early submission of this posttest is encouraged: please
submit this posttest by April 1, 2010, to be eligible for credit. Release
date: April 1, 2008. Termination date: April 30, 2010. The estimated time
to complete all three articles and the posttest is 3 hours.
3
CME
Page 1
317
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 general-
ized 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.
Conclusion: A study using clinically valid
interviews is needed to evaluate these results.
Such studies could inform treatment by docu-
menting rates of seeking treatment from various
sources, suicide attempt rates, and the preva-
lence of comorbid conditions.
CNS Spectr. 2008;13(4):316-322
INTRODUCTION
Body dysmorphic disorder (BDD), a distress-
ing or impairing preoccupation with an imag-
ined or slight defect in appearance, causes great
suffering
1-4
and is associated with a poor quality
of life
5
and suicide attempts.
2,6
This disorder has
received relatively little study, perhaps because
it is believed to be rare. A recent nationwide
prevalence study in Germany,
7
which utilized
a self-report questionnaire, reported a point
prevalence of 1.7% for Diagnostic and Statistical
Manual of Mental Disorders, Fourth Edition-cri-
teria BDD, but no nationwide prevalence study
has been conducted in the United States.
The most careful US study
8
of BDD preva-
lence in adults focused on women 36–44 years
of age (318 depressed, 658 non-depressed) from
seven Boston metropolitan-area communities;
it produced a point prevalence of 0.7% for DSM-
IV BDD. This study utilized structured clinical
interviews. Since it focused only on women
within an 8-year age range and a restricted geo-
graphic area, the results cannot be generalized
to the US population. A survey conducted in
Florence, Italy,
9
utilizing DSM-III-R criteria and
interviews by general practitioners trained in
psychiatry nonetheless lends some credibility
to this prevalence figure, although DSM-III-R
did not require clinically significant interference
with functioning or clinically significant distress
and the questions asked are not reported. The
Florence study produced a 1-year prevalence
estimate of 0.7% (among 673 individuals).
A study conducted in the Baltimore-Washington
area
10
examined the prevalence of DSM-IV BDD
in 373 individuals (73 randomly selected com-
munity subjects and their first-degree relatives)
and reported a lifetime prevalence of probable
or definite BDD of 1.1%. The study, however, was
relatively small and the diagnostic questions
were not reported. Other studies focused on
German
11
or American
12-14
college students have
produced higher prevalence estimates (2.5% to
13%). Because they are derived from self-report
questionnaires without clinical verification, these
estimates may be less accurate. An older study
15
that utilized the less stringent DSM-III-R criteria,
also produced a higher estimate.
To establish a firmer estimate in US adults and
thereby further examine the importance of BDD
to public mental health, we conducted a large,
random sample, nationwide telephone survey.
METHODS
Data and Sampling
The data were generated in the spring and
summer of 2004 from a national household tele-
phone survey that we designed, which included
2,513 adults
>
18 of age. The survey addressed
BDD criteria along with financial and demo-
graphic information and questions about three
impulse-control disorders: compulsive buy-
ing, Internet “addiction,and skin picking. The
interviews were conducted from the Social
and Behavioral Research Institute (SBRI) at the
California State University-San Marcos by inter-
viewers with an average of 14 months experience
in health-related telephone surveys and specific
training for this project. The SBRI conducts health
surveys for the US Health and Human Services
Agency and the Centers for Disease Control and
Prevention (CDC), for numerous health agencies,
and academic researchers. Interviewers used a
computer-assisted telephone interviewing sys-
tem that guarded against errors of omission and
presentation. For additional quality control, the
first author monitored pilot interviews and pro-
vided feedback. During data collection, super-
visors (one for eight interviewers) monitored
Original Research
CNS Spectr 13:4 © MBL Communications April 2008
Page 2
318
performance of randomly selected interviews.
To obtain informed consent, interviewers identi-
fied themselves, the survey organization, study
sponsor and survey topics, and stated that the
interview was voluntary, anonymous, termina-
ble by the respondent at any time, included no
incentive, and might be monitored by a supervi-
sor. The interviews, averaging 11.3 minutes, were
conducted with the first person >18 years of age
answering the telephone.
The sample was obtained via random-digit-
dial telephone calls within the continental US,
stratified by state. All listed and unlisted residen-
tial telephone numbers had an equal chance of
inclusion. Cell phone numbers were not included.
This household sampling method over-samples
women and under-samples younger individuals
and some minorities. In order to ensure that busy
individuals were represented, telephone num-
bers were called until finalized or 15 call attempts
had been made. A respondent was defined as a
person who completed a full or partial interview.
A status of “unknown study eligibility” could be
assigned to a telephone number after, for exam-
ple, persistent busy signals or repeated answers
by a telephone-answering device. The proportion
of those with unknown eligibility status who were
then assumed to be eligible was set as equal to
the proportion of eligible persons among people
who were actually reached.
The response rate was 56.3% according
to formula RR4 of the American Association of
Public Opinion Researchers (AAPOR),
16
which is
approved by both the AAPOR and the Council of
American Survey Research Organizations. Formula
Response Rate 4 defines the response rate as the
ratio of respondents (n=2,513) divided by the sum
of: respondents (n=2,513), refusals and break-
offs (n=61), those unable to be contacted (n=0),
those unable to respond (eg, because of illness
or language barriers) (n=6), and the proportion of
those with unknown eligibility who are assumed
to be eligible (n=1,881). The study’s response rate
is comparable with those obtained in national
health surveys by the CDC.
17
The CDCs Behavioral
Risk Factors Surveillance System surveys have a
median response rate of 53.2% (range: 34.4% to
67.3%, excluding one outlier).
The cooperation rate in the present study was
established using AAPOR cooperation-rate for-
mula COOP4, which is the number of respondents
divided by the sum of respondents plus refusals
and break-offs. The cooperation rate was 97.63%,
demonstrating a low rate of refusal.
The presence/absence of the DSM-IV diagnos-
tic criteria for BDD was evaluated with a series
of questions slightly modified from those of
Phillips,
18
which have excellent reliability (κ=.96).
Preoccupation with appearance (DSM-IV criterion
A) was evaluated by asking, “Have you ever been
worried about your appearance in any way?
Those answering “Yes” were asked to choose
from a list: “Which part or parts of your body do
you think or worry about the most (currently)?”
They were next asked, “Have you thought your
(body part) was especially unattractive? A
respondent answering “Yeswas considered to
suffer from excessive preoccupation if he or she
answeredYes” to either of two further ques-
tions: “Have you thought about this concern a lot
and wish you could worry about it less?” “Have
others said that you were more concerned about
your (body part) than you should have been?
In order to conform to DSM-IV criterion C, which
states that the appearance preoccupations must
not be better accounted for by another mental
disorder, such as anorexia nervosa, respondents
preoccupied with a body part regarded as espe-
cially unattractive were asked,Is your main
concern with how you look that you aren’t thin
enough or that you may be overweight?” Those
answering “Yes” were excluded from further BDD
consideration. Clinically significant distress (DSM-
IV criterion B1) was evaluated by asking: “Would
you say that thinking or worrying about your
appearance has caused you a lot of distress?”
Significant impairment of functioning (DSM-IV
criterion B2) was evaluated by means of two
questions: “How often would you say thinking
or worrying about your appearance gets in the
way of doing things with friends or dating?” and
“How often would you say thinking or worrying
about you appearance has caused any problems
at work or school or in other activities?” Answers
of “Almost always” or Often” to either question
met our interference criterion. Interviewers did
not ask for examples to ascertain whether the
interference was clinically significant.
A diagnosis of BDD required excessive preoc-
cupation about a body part (other than weight)
regarded as especially unattractive, and either
excessive distress or interference.
Original Research
CNS Spectr 13:4 © MBL Communications April 2008
Page 3
319
Data Analysis
The analyses included descriptive and com-
parison statistics for the samples demographics;
the demographic characteristics of those meet-
ing BDD criteria; the prevalence of BDD; and the
distribution of body parts that were the focus of
concern. Significance level was set at P<.05, two-
tailed, for comparisons of demographic variables.
Although missing data were minimal, missing
cases result in some variation in the number of
cases used in different analyses.
RESULTS
Participants’ Demographics
Compared with the US adult population, the
respondents include a substantially higher per-
centage of women, and to a lesser extent, a
higher percentage of people
>
55 years of age
(Table 1). A little over half (56.7%) of the respon-
dents were married compared with 52.5% in
the US population (χ
2
=17.33, df=1, P<.001). The
respondents and the subset of respondents
administered the BDD module have racial dis-
tributions that closely resemble that of the US
population, but include a smaller proportion of
Hispanic individuals. Because the study sam-
pling method stratified on state, the respon-
dents are representative of the US population
with regard to distribution by state.
Of the 2,513 respondents, 2,048 provided suf-
ficient data to evaluate possible BDD. The BDD
module respondents did not differ substantially
from all respondents in terms of gender, age
distribution, ethnicity, marital status, or mean
household size (Table 1). Of the 2,048 BDD
respondents, 1,356 (66.2%) were concerned
about a body part, including weight, if at least
one other body part was of concern.
The point prevalence of DSM-IV BDD as eval-
uated by our question set was 2.4% (49/2,048).
The point prevalence for women was 2.5%
(33/1,309), and for men was 2.2% (16/739)
(Fishers exact test P=.65).
Given the small number of cases, we exam-
ined the relationship to age by dividing the
sample into age groups centered on mid-
decades of age. BDD prevalence decreased
after 44 years of age: prevalence at 18–24 years
of age, 4.4% (6/136); 25–34 years of age, 4.2%
(13/310); 35–44 years of age, 3.7% (14/380); 45–
54 years of age, 1.4% (6/414);
>
55 years of age,
1.3% (9/708). The marital status distribution of
individuals with BDD differed from that of all
other BDD module respondents (χ
2
=33.55, df=5,
P<.001). Smaller proportions of the group with
BDD were married (36.2% vs 55.5%) or wid-
owed (4.3% vs 9.8%) and larger proportions
were separated (10.6% vs 1.5%) or never mar-
ried (34.0% vs 17.5%). The proportions living
unmarried with partners (4.3% and 5.1%) and
divorced (10.6% vs 10.6%) were about equal
within the BDD and non-BDD groups.
Of the 2,048 BDD module respondents, 1,790
(87.4%) were worried about their appearance.
Among respondents who worried about a body
part they regarded as especially unattractive
(other than weight) (n=798), and wished they
could worry less about it (n=392), the propor-
tion answering in a positive diagnostic direc-
tion for each additional BDD diagnostic criterion
was as follows: told by others that concern
was excessive, 49.0% (192/392); appearance
has caused “a lot of distress,42.3% (166/392);
worrying or thinking about appearance inter-
fered almost always oroftenwith doing
things with friends or dating 20.7% (81/391);
and, interfered “almost always” or often” with
school or work or other activities 9.4% (37/392).
Among the respondents who met criteria for
DSM-IV BDD, 90% (45/49) qualified on the basis of
the distress criterion, and 51% (25/49) on the basis
of the interference-with-functioning criterion. Only
8% (4/49) of those meeting BDD diagnostic crite-
ria qualified on the interference criterion without
qualifying on the distress criterion.
The body parts causing distress differed by
gender (Table 2). Respondents of both genders
meeting DSM-IV criteria for BDD were most often
distressed by a body part they chose not to name.
The specific body part most often mentioned by
men was “hair,” and by women, “stomach.
DISCUSSION
This first nationwide survey of the prevalence
of BDD found a point prevalence of 2.4%, which,
if valid, would make it more common than schizo-
phrenia or bipolar I disorder and about as com-
mon as the mid-range estimate for generalized
anxiety disorder.
19
Although the study over-sam-
pled women, gender-specific prevalence rates
did not differ substantially. The DSM-IV distress
criterion identified more respondents as having
BDD than did the interference-with-functioning
CNS Spectr 13:4 © MBL Communications April 2008
Original Research
Page 4
320
criterion. Respondents meeting DSM-IV BDD cri-
teria reported lower rates of ever having been
married, which is consistent with the findings of
earlier studies of more restricted samples.
2,20
The studys strengths included drawing a large,
random, nationwide sample; utilizing a structured
interview incorporating DSM-IV diagnostic criteria;
and applying stringent quality-control measures.
The study also has a number of limitations. First,
the interviews were telephonic and the interview-
ers were not mental health professionals. Second,
the sample size, though large and representative
of the US adult population by state, over-sampled
women, and under-sampled individuals without
telephones and younger individuals who rely
solely on cell phones. Moreover, the sample size
is modest for accurately estimating a prevalence
of the magnitude we found. Third, our prevalence
estimate is constrained by our response rate:
56.3%. While substantial, it does not guarantee
that our sample is representative of the US adult
population with regard to concerns about appear-
ance. This response rate compares favorably, how-
ever, with those obtained in nationwide health
surveys. Fourth, as in any telephone survey, some
respondents may have exaggerated responses
(eg, the degree of distress) or, conversely, may
have been reluctant to admit unpleasant truths
(eg, how much their preoccupation interfered with
functioning), or may have lacked insight into the
CNS Spectr 13:4 © MBL Communications April 2008
Original Research
TABLE 1.
Demographic Comparison of Study Sample to the US Population
*
Demographics US Population Study Sample (N=2,513) BDD Respondents (n=2,048)
Gender (%)
N=209,128,094
Male 48.3 34.5 36.1
Female 51.7 65.5 63.9
Average household size 2.59 2.82 2.82
Age of those
>
20 years (%) N=200,948,641
20–24 9.4 6.6 7.0
25–34 19.9 15.1 15.9
35–44 22.5 19.9 19.3
45–54 18.8 22.0 21.3
55–59
6.7 9.2 8.8
60–64 5.4 7.6 7.2
65–74 9.2 11.4 11.7
75–84 6.2 6.5 6.9
>
85 2.1 1.6 1.7
Race (%)
§
N=281,421,906
White 75.1 79.7 78.2
Black 12.3 10.3 11.4
American Indian/Alaskan Native 0.9 5.2 5.0
Asian 3.6 2.5 2.5
Hispanic (%)
//
12.5 7.1 7.7
* US population demographics are derived from sampling individuals, whereas study sample demographics are derived using a household-sampling method. The
US population figures are for all states and territories, whereas the study sample reflects only the Continental US.
χ
2
=210.67, df=1, P<.001.
χ
2
=51.60, df=1, P<.001.
§ For race, US population percentages indicate percentages of all people, and study sample percentages are for adults only.
// χ
2
=111.64, df=1, P<.001.
US=United States.
Koran LM, Abujaoude E, Large MD, Serpe RT. CNS Spectr. Vol 13, No 4. 2008.
Page 5
321
excessiveness or irrationality of their preoccu-
pation with appearance. For example, a recent
study reported that 27% of BDD subjects were
delusional (ie, did not recognize that they suffered
from a disorder.)
21
Moreover, like previous stud-
ies that relied on self-reports,
7,11-14
our telephone
survey could not distinguish between “imagined
or slight” defects and more readily seen “defects.
Thus, although we did ask whether others had
said the individual was more concerned with the
troubling body part than he or she should be, we
cannot be certain that clinicians would diagnose
BDD in all of those whom our survey identified as
having the disorder. Nor can we be certain as to
the disorder’s degree of severity in our diagnosed
respondents. Finally, the large percentage of sub-
jects who declined to name the body part that con-
cerned them is another significant limitation.
Over-diagnosis of BDD may have occurred
because our telephonic interviews could not
determine whether the individuals perceived
defects” in appearance were, as required by
DSM-IV, nonexistent or slight. However, 49% of
individuals diagnosed with BDD reported that
others said they were overly concerned about the
named body part. Since shame prevents many
people with BDD from revealing their appear-
ance concerns, this high percentage suggests that
the perceived defect was frequently nonexistent
or slight. That many BDD subjects declined to
name a specific body part also suggests shame.
Nevertheless, individuals with BDD may be more
willing to report their BDD symptoms over the
phone than in person, and we may have over-
diagnosed BDD. BDD may have been under-diag-
nosed because we did not count weight concerns
toward a BDD diagnosis even though weight con-
cerns are a relatively common symptom of BDD.
Because BDD and eating disorders may be comor-
bid
23
BDD may have been missed in subjects with
both disorders (if the subjects’ main concern was
weight [ie, their eating disorder]). In this regard,
we cannot be certain how to interpret the finding
that among the female BDD subjects, “stomach”
was chosen as the most concerning body part
(that they would admit to). Studies using in-per-
son interviews by mental health professionals
are needed to address the differential diagnosis
between BDD and eating disorders. Similarly, by
excluding individuals whose main concern was
being too thin, we may have missed BDD in the
form of muscle dysmorphia.
24
CONCLUSION
Although the gender ratio has varied in some
clinical samples, our results are consistent with
findings from the largest clinical samples, in
which males and females were approximately
equal
25
or BDD was somewhat more common
in women.
23
This suggests that in contrast to
major depression and anxiety disorders,
26
where
women predominate in clinical but not commu-
nity samples, men and women with BDD are
nearly equally likely to seek treatment. The fall-off
of prevalence with age may reflect a number of
influences (eg, a greater chance of receiving suc-
cessful treatment as one ages, differential mortal-
ity, or differences in response biases in different
age groups). The fall-off seems unlikely to stem
from a natural history of recovery, since a con-
tinuous course characterizes most sufferers.
Our data suggest that excessive worry about
appearance is more often associated in the com-
munity with self-reported distress than with self-
reported interference with functioning. The data
also suggest that interference, when present, is
CNS Spectr 13:4 © MBL Communications April 2008
Original Research
TABLE 2.
Which Part or Parts of Your Body do
You Think or Worry About the Most?
Body Part Men, n (%) Women, n (%) Total, n (%)
Other (and
decline to
state)
7 (35) 19 (42) 26 (40)
Hair 4 (20) 4 (9) 8 (12)
Skin 3 (15) 5(11) 8 (12)
Stomach 2 (10) 9 (20) 11 (17)
Mouth 2 (10) 0 (0) 2 (3)
Hands 2 (10) 0 (0) 2 (3)
Weight 0 (0) 3 (7) 3 (5)
Breasts 0 (0) 2 (4) 2 (3)
Nose 0 (0) 2 (4) 2 (3)
Lips 0 (0) 1 (2) 1 (2)
Jaw 0 (0) 0 (0) 0 (0)
Hips 0 (0) 0 (0) 0 (0)
Genitals 0 (0) 0 (0) 0 (0)
Total 20 (100) 45 (100) (65) 100
Koran LM, Abujaoude E, Large MD, Serpe RT. CNS Spectr. Vol 13, No 4. 2008.
Page 6
322
more likely to affect friendships and dating than
work, school, or other activities. However, other
studies
5,28,29
have reported that impaired social,
familial and occupational functioning is nearly uni-
versal in patients with BDD. As noted, we cannot be
certain how truthful or accurate our respondents
were in acknowledging dysfunction. The high fre-
quency of preoccupation with and worry about
appearance reported by our respondents with BDD
confirms the importance of the DSM-IV decision to
add criteria of distress and/or dysfunction in defin-
ing BDD as a disorder requiring treatment.
If, as our results suggest, BDD has a nation-
wide prevalence of one (interference with func-
tioning) or two (substantial distress) in 10 0
adults, then, given the associated suffering,
impaired functioning and high rate of attempted
suicide, increased efforts to educate the public
and professionals about the disorder, identify
cases early, facilitate access to care and develop
more effective treatments would be desirable.
Future studies to define nationwide prevalence
should utilize a clinically validated, structured
interview instrument, preferably administered
in person by mental health professionals. Such
studies could inform future treatment studies by
carefully documenting BDD onset and course,
the degree to which and ways in which function-
ing has been impaired, rates of seeking treat-
ment from various sources, suicide attempt
rates, and the lifetime and point prevalence of
comorbid conditions. CNS
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CNS Spectr 13:4 © MBL Communications April 2008
Original Research
Page 7
  • Source
    • "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
  • Source
    • "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
  • Source
    • "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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