Prevalence and clinical characteristics of body dysmorphic disorder in an adult inpatient setting

Department of Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University, Providence, RI 02906, USA.
General Hospital Psychiatry (Impact Factor: 2.61). 02/2008; 30(1):67-72. DOI: 10.1016/j.genhosppsych.2007.09.004
Source: PubMed


Body dysmorphic disorder (BDD), a distressing or impairing preoccupation with an imagined or slight defect in appearance, is an often-severe, understudied disorder. We determined BDD's prevalence and clinical features on a general adult psychiatric inpatient unit. To our knowledge, only one previous prevalence study has been done in this setting.
One hundred patients completed 3 self-report measures: the Body Dysmorphic Disorder Questionnaire (BDD-Q), Beck Anxiety Inventory (BAI) and Center for Epidemiologic Studies Depression Scale (CES-D). Those who screened positive for BDD were interviewed to confirm DSM-IV BDD and its clinical features. Charts were reviewed for demographic and clinical information.
BDD was diagnosed in 16.0% (95% CI=8.7-23.3%) (n=16) of patients. A high proportion of those with BDD reported that BDD symptoms contributed to suicidality. Patients revealed BDD symptoms to a mean of only 15.1%+/-33.7% lifetime mental health clinicians; only one (6.3%) reported symptoms to his current inpatient psychiatrist. Most did not disclose their symptoms due to embarrassment. Those with BDD were younger (P=.008) and had higher CES-D scores (P=.008). The two groups did not significantly differ on BAI score, demographic characteristics or discharge diagnoses.
BDD is relatively common but underdiagnosed in psychiatric inpatients and is associated with more severe depressive symptoms.

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    • "What was striking in all these studies is that virtually all the patients identified as having BDD had not disclosed their symptoms to the treating psychiatrist. A self-report BDD screening questionnaire was used in Conroy et al. (2008) and Grant et al. (2001) but screening questionnaires are rarely adopted in routine clinical practise. We therefore decided to evaluate the usefulness of a single screening question that could be incorporated into a standard history taking by a psychiatrist. "
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    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 largest epidemiological study to date (Rief, Buhlmann, Wilhelm, Borkenhagen, & Brähler, 2006) reported a BDD prevalence rate of 1.7% (95% CI ¼ 1.2%e2.1%) in the community. Prevalence rates are significantly higher when examined in psychiatric populations (e.g., 13%e16%; Conroy et al., 2008; Grant, Kim, & Crow, 2001). A recent Dutch study found 3e8% of the patients in dermatology and plastic surgery clinics of an academic hospital to be suffering from BDD (Vulink et al., 2006). "
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    ABSTRACT: The purpose of the present study was to determine the effect of metacognitive therapy (MCT) on symptoms of body dysmorphic disorder (BDD) and on symptoms of thought-fusion, by means of a wait-list controlled clinical trial. Participants were referred from dermatology and cosmetic surgery clinics in the city of Isfahan, Iran, and 20 patients were selected on the basis of DSM-IV-TR diagnostic criteria for BDD. They were randomly assigned to either the experimental or the wait-list control group. The Yale-Brown Obsessive Compulsive Scale Modified for Body Dysmorphic Disorder (BDD-YBOCS) and the Thought-Fusion Inventory (TFI) were used as the outcome measures. The experimental group received 8 weekly metacognitive intervention sessions. The control group was in the waiting-list until the end of the follow-up. Measures were taken at pre-test, post-test (after 2 months) and follow-up (after 6-months). The results of analysis of variance showed that MCT significantly reduced the symptoms of BDD and of thought-fusion, compared to the wait-list. Effects on both outcome measures were maintained at 6-months follow-up.
    Full-text · Article · Oct 2011 · Journal of Behavior Therapy and Experimental Psychiatry
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    • "BDD has distinct features that go beyond perhaps even severe cases of body image disturbance (Cash et al. 2004). Though the prevalence of BDD has recently been elucidated in clinical populations (e.g., Conroy et al. 2008; Phillips et al. 2004), estimates of the disorder in non-clinical populations have been limited. In this respect, this study has contributed to the literature in many ways. "
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    ABSTRACT: Body Dysmorphic Disorder (BDD) is a psychological disorder characterized by excessive appearance concerns. This cross-sectional study assessed an undergraduate sample of 1,041 participants from a southeastern American university to estimate an overall prevalence of BDD; investigate differences by gender, race/ethnicity, and sexual orientation; and also examine the contributions of other related constructs including appearance comparison, obligatory exercise, body image disturbance, and self-esteem. Results indicated an overall prevalence of 4.9%. Women endorsed more symptoms of BDD than men, among women Caucasians and Latinas endorsed more symptoms than African Americans, and sexual minorities endorsed more symptoms than heterosexuals. Overall, BDD symptomatology was negatively correlated with body satisfaction and self-esteem and positively correlated with appearance comparison and obligatory exercise. KeywordsBody dysmorphic disorder-Body image-Gender-Race/ethnicity-LGBT
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