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PubMed2000

Nonweight-related body image concerns among female eating-disordered patients and nonclinical controls: some preliminary observations.

OBJECTIVE: Eating disorders(ED) have been classically associated with a concern about body shape and size that manifests mainly as an intense fear of weight gain (DSM-IV criteria). To further examine the nature of the body image disturbance in ED, we surveyed the prevalence of nonweight-related body image concerns among ED patients and nonclinical controls. METHOD: We examined 53 women (M +/- SD age: 28.1 +/- 6.8 years) with anorexia nervosa and/or bulimia nervosa (DSM-III-R criteria) and 73 randomly selected nonclinical women (M +/- SD age: 30.2 +/- 6.6 years) from the community. The participants rated (by checking a "Yes" or "No") whether they were satisfied with the appearance of the following body regions: their skin, teeth, jaw, nose, eyes, ears, hair, and height and completed the Drive for Thinness (DT) and Body Dissatisfaction (BD) subscales of the Eating Disorders Inventory (EDI). RESULTS: The frequencies of dissatisfaction with the appearance of various physical attributes among the ED patients versus the nonclinical controls were as follows: skin: 79.2% vs. 52.1%, p =.002; teeth: 62.3% vs. 39.7%, p =. 012; jaw: 24.5% vs. 9.7%, p =.026; nose: 45.3% vs. 24.7%, p =.015; eyes: 22.6% vs. 12.3%, p =.12; ears: 20.8% vs. 2.7%, p =.001; hair: 52.8% vs. 39.7%, p =.14; and height: 28.3% vs. 13.7%, p =.04. As expected, the M +/- SD DT (EDI): 14.0 +/- 6.1 vs.3.5 +/- 4.6, p <. 0001 and the M +/- SD BD (EDI): 19.7 +/- 5.8 vs. 10.1 +/- 7.3, p <. 0001, were both higher in the ED group. Furthermore, greater dissatisfaction with nonweight-related body image was associated with higher DT and BD scores. CONCLUSION: The higher prevalence of dissatisfaction with appearance of most of the nonweight-related physical attributes is probably an indication of the core ego deficits that are often present in ED and an index of the severity of the overall body image disturbance in these patients, and not indicative of another condition (e.g., body dysmorphic disorder) as the current nosology (DSM-IV) suggests.

Adult↗
PubMed2005

The demystification of autoscopic phenomena: experimental propositions.

Autoscopic phenomena (AP) are rare, illusory visual experiences during which the subject has the impression of seeing a second own body in extrapersonal space. AP consist of out-of-body experience, autoscopic hallucination, and heautoscopy. Recent neurologic reports support the role of multisensory integration deficits of body-related information and vestibular dysfunctions in AP at the temporo-parietal junction. A caveat to test the underlying neurologic and cognitive mechanisms of AP has been their rare and spontaneous occurrence. Recent evidence linked AP to mental own-body imagery engaging brain mechanisms at the temporo-parietal junction. These recent observations open a new avenue for testing AP-related cognitive mechanisms in selected clinical and normal populations. We review evidence on several clinical syndromes (psychosis, depression, anxiety, depersonalization, body dysmorphic disorder), suggesting that some of these syndromes may relate to AP-proneness, thereby leading to testable propositions for future research on body and self processing in addition to AP.

Awareness↗
PubMed2001

Muscle dysmorphia: a critical review of the proposed criteria.

While body-image related disorders such as anorexia nervosa have focused on thinness, only recently have clinical criteria for a disorder that centers around muscularity--muscle dysmorphia--been proposed. An individual affected by muscle dysmorphia is overly concerned with his or her degree of muscularity. This preoccupation is manifested in the individual's behavior (excessive weight lifting, excessive attention to diet, social impairment). This article examines the historical aspects and proposed criteria for muscle dysmorphia and contrasts them with those of anorexia nervosa. While the authors of the proposed criteria have suggested that muscle dysmorphia be classified as a subcategory of body dysmorphic disorder, both the historical and clinical aspects of this syndrome are more consistent with its classification as an obsessive-compulsive disorder.

Anorexia Nervosa↗
PubMed1999

Platelet [3H]paroxetine binding in patients with OCD-related disorders.

The recently introduced notion of clinical conditions being related one to another, the spectrum concept, permits the testing of the involvement of serotonergic systems in a broad range of disorders tentatively linked to obsessive-compulsive disorder (OCD) for which no pathophysiological hypotheses yet exist. We therefore compared the binding of [3H]paroxetine ([3H]Par), a ligand that specifically labels the serotonin (5-HT) transporter, in platelets of drug-free outpatients suffering from various OCD-related disorders with binding in platelets of OCD patients and healthy subjects. Diagnoses were made according to DSM-IV criteria. The most frequent diagnosis was that of body dysmorphic disorder, followed by impulse control disorder, kleptomania, Tourette's syndrome and trichotillomania. Platelet membranes and [3H]Par binding were studied according to standardized protocols. The results, showing a similarly decreased density of [3H]Par binding sites in both patient groups as compared with healthy subjects, suggest the presence of a shared abnormality at the level of the presynaptic 5-HT transporter, probably linked to a common dimension yet to be identified.

Adolescent↗
PubMed2000

Muscle dysmorphia in a young Chinese male.

INTRODUCTION: To describe a young Chinese male with muscle dysmorphia, a recently proposed variant of body dysmorphic disorder. CLINICAL PICTURE: A 24-year-old Chinese male with a morbid fear of weight and muscle loss with associated compulsive weight training, avoidance behaviour, forced eating, depressed mood and disturbed body image. TREATMENT: Antidepressants and cognitive-behavioural psychotherapy. OUTCOME: Preoccupation with muscularity was reduced. CONCLUSIONS: Muscle dysmorphia has been reported in Western populations, mostly among body builders and anabolic steroid abusers. To our knowledge, this is the first case report originating from a non-Western population. The patient illustrates the nosological difficulty of this recent entity. It is likely to be a culture-bound phenomena associated with a Western concept of an ideal body shape for males.

Adult↗
PubMed2001

Ethical issues in limb transplants.

On one view, limb transplants cross technological frontiers but not ethical ones; the only issues to be resolved concern professional competence, under the assumption of patient autonomy. Given that the benefits of limb transplant do not outweigh the risks, however, the autonomy and rationality of the patient are not necessarily self-evident. In addition to questions of resource allocation and informed consent, limb, and particularly hand, allograft also raises important issues of personal identity and bodily integrity. We present two linked schemas for exploring ethical issues in limb transplants. The first, relying on conventional concepts in biomedical ethics, asks whether the procedure is research or therapy, whether the costs outweigh the benefits, and whether it should be up to the patient to decide. The second introduces more speculative and theoretically challenging questions, including bodily integrity, the argument from unnaturalness, and the function of the hand in expressing personal identity and intimacy. We conclude that limb transplants are not ruled out a priori, unlike some procedures that are prima facie wrong to perform, such as amputation of healthy limbs to relieve body dysmorphic disorders. However, their legitimacy is not proven by appeals to the interests of scientific research, cost-benefit, or patient autonomy.

Body Image↗
PubMed2005

Male body image in Taiwan versus the West: Yanggang Zhiqi meets the Adonis complex.

OBJECTIVE: Body image disorders appear to be more prevalent in Western than non-Western men. Previous studies by the authors have shown that young Western men display unrealistic body ideals and that Western advertising seems to place an increasing value on the male body. The authors hypothesized that Taiwanese men would exhibit less dissatisfaction with their bodies than Western men and that Taiwanese advertising would place less value on the male body than Western media. METHOD: The authors administered a computerized test of body image to 55 heterosexual men in Taiwan and compared the results to those previously obtained in an identical study in the United States and Europe. Second, they counted the number of undressed male and female models in American versus Taiwanese women's magazine advertisements. RESULTS: In the body image study, the Taiwanese men exhibited significantly less body dissatisfaction than their Western counterparts. In the magazine study, American magazine advertisements portrayed undressed Western men frequently, but Taiwanese magazines portrayed undressed Asian men rarely. CONCLUSIONS: Taiwan appears less preoccupied with male body image than Western societies. This difference may reflect 1) Western traditions emphasizing muscularity and fitness as a measure of masculinity, 2) increasing exposure of Western men to muscular male bodies in media images, and 3) greater decline in traditional male roles in the West, leading to greater emphasis on the body as a measure of masculinity. These factors may explain why body dysmorphic disorder and anabolic steroid abuse are more serious problems in the West than in Taiwan.

Adult↗
PubMedDate not supplied

A conceptual model of factors contributing to the development of muscle dysmorphia.

Muscle dysmorphia is a recently described subcategory of Body Dysmorphic Disorder. It is most prevalent in males and has a number of cognitive, behavioral, socioenviornmental, emotional, and psychological factors that influence its expression. An etiological model describing these influences is presented for evaluation. Nine variables (body mass, media influences, ideal body internalization, low self-esteem, body dissatisfaction, health locus of control, negative affect, perfectionism, and body distortion) were identified through the use of extant literature on muscle dysmorphia and through extrapolation from literature involving women and eating disorders. The functional relationships among these variables are described and implications of the model are discussed.

Body Image↗
PubMed2006

Psychotherapy of obsessive-compulsive disorder and spectrum: established facts and advances, 1995-2005.

Dropout rates and refractory cases persist, for reasons that remain unexplained. There are few predictor variables and few innovative approaches to deal with them. New treatment approaches must be developed to improve treatment response even for the responders. Studies show that symptoms are reduced minimally (30% 50%). No new ways of dealing with treatment-refractory cases have been developed. Studies now include more co-morbid cases, however, and their inclusion may account for some of the lack of progress in improvement rates. It needs to be seen whether patients who have one or more comorbid conditions do as well as patients who do not have comorbidity and whether the number or type of comorbid disorders accounts for treatment response. Perhaps better results would be seen with pure OCD cases. Certainly results now are more generalizable to clinical practice. Now it is important to look for alternative treatment approaches and to apply cognitive therapy to more specific problems. Cognitive therapy seems to be helpful with the disorders of the obsessive-compulsive spectrum. The attrition rate is lower when cognitive therapy is used in the treatment of hypochondriasis, and cognitive therapy also is helpful in reducing OVI , which is more severe in body dysmorphic disorder and hypochondriasis. The role of cognitive therapy in OVI needs further exploration.

Cognitive Behavioral Therapy↗
PubMed1997

[I see, I see what you don't see (body dysmorphic syndrome)].

In three men, aged 20, 42 and 32 years who suffered from excessive concern with an imaginary physical deviation, body dysmorphic disorder was diagnosed. By co-operation between treating psychiatrist and plastic surgeon the obsession, shame and avoidance behaviour could be alleviated.

Adult↗
PubMed2004

Psychoemotional assessment changes in patients treated with orthognathic surgery: pre- and postsurgery report.

AIM: To evaluate a sample of patients treated with orthognathic surgery, establishing the emotional and self-perception differences between the pre- and postsurgical assessment. MATERIAL AND METHODS: Several questionnaires (Body Dysmorphic Disorder Examination, State Trait Anxiety Inventory, Self-Rating Depression Scale, Oral Health Status Questionnaire, Post-Surgical Satisfaction Questionnaire) were administered to the sample of 30 patients; these were used to study the data related to body image, level of anxiety, eventual depressive status, quality of life, and postsurgical satisfaction. RESULTS: The longitudinal study results outline the impact of orthognathic surgery on the psychological and emotional well-being of the patient and the need for the specialist to understand the emotional status and expectations of the patient.

Adult↗
PubMed1996

A conceptual and quantitative analysis of 178 historical cases of dysmorphophobia.

The construction of the clinical category dysmorphophobia (now known as body dysmorphic disorder) resulted from the historical convergence of a neologism (coined by Enrico Morselli), a family of clinical concepts (already available during the late 19th century), and a specifiable behaviour (an 'attitude' towards part of the self and/or the body). The stability of such convergence has so far depended upon the epistemological capacity of the concepts involved and the social duration of the said attitude. This paper analyses the historical framework within which such convergence took place, and traces the history of dysmorphophobia in qualitative and quantitative terms. With regard to the latter, it compares cases reported before (139 subjects) and after (39 subjects) the publication of the DSM III criteria map. Patients in the former group were found to constitute a more heterogeneous group, and in the latter to have a better outcome. In the pre-DSM III group, differences were also found between delusional and non-delusional patients. The implications of these differences are discussed.

Adult↗
PubMed1997

Epidemiology of somatoform disorders: a community survey in Florence.

Since the exclusion of somatic causes is necessary for somatoform disorders (SMD) to be diagnosed, there is little information on the prevalence of such disorders in the community. As the method we have previously developed [general practitioners (GPs) with psychiatric training who interview samples representative of the general population] seemed to be appropriate to deal with the problem, we carried out a community survey focused on somatoform disorders. The prevalence rates of DSM-III-R somatoform disorders were studied in two wards of the city of Florence. In order to be representative of the general population, 673 subjects randomly selected were interviewed by their own GP. Four GPs, all with specific training in psychiatry, participated in the interviewing process. The 1-year prevalence figures were as follows: 0.7% body dysmorphic disorder; 4.5% hypochondriasis; 0.6% somatoform pain disorder; 0.3% conversion disorder; 0.7% somatization disorder; 13.8% undifferentiated somatoform disorder. No specific comorbidity was found between somatoform disorders and mood or anxiety disorders. Although the sample investigated was small, this study may be seen as one of the first in an area where knowledge is still scant. The prevalence rates of somatoform disorders were generally found to be slightly lower than expected.

Adolescent↗
PubMed2004

Correlates of dysmorphic concern in people seeking cosmetic enhancement.

OBJECTIVE: To determine the clinical correlates of dysmorphic concern in persons seeking cosmetic enhancement from cosmetic physicians. METHOD: A questionnaire survey of 137 patients attending the practices of two cosmetic physicians. RESULTS: Four subjects (2.9%; 95% CI = 0.8%-7.3%) had a diagnosis of body dysmorphic disorder (BDD), but many more expressed overconcern with physical appearance ('dysmorphic concern'). Dysmorphic concern accounted for a substantial amount of the variance for mood, social anxiety, and impairment in work and social functioning, while concerns related to how self or others perceive the putative flaw in appearance, impacted significantly on work and leisure activities, but did not apparently influence mood and social anxiety to any significant degree. CONCLUSIONS: Dysmorphic concern is a broad dimensional construct that is related to both inter- and intrapsychic distress and disablement associated with people seeking cosmetic enhancement

Adolescent↗
PubMed2000

Muscle dysmorphia in male weightlifters: a case-control study.

OBJECTIVE: Muscle dysmorphia is a form of body dysmorphic disorder in which individuals develop a pathological preoccupation with their muscularity. METHOD: The authors interviewed 24 men with muscle dysmorphia and 30 normal comparison weightlifters, recruited from gymnasiums in the Boston area, using a battery of demographic, psychiatric, and physical measures. RESULTS: The men with muscle dysmorphia differed significantly from the normal comparison weightlifters on numerous measures, including body dissatisfaction, eating attitudes, prevalence of anabolic steroid use, and lifetime prevalence of DSM-IV mood, anxiety, and eating disorders. The men with muscle dysmorphia frequently described shame, embarrassment, and impairment of social and occupational functioning in association with their condition. By contrast, normal weightlifters displayed little pathology. Indeed, in an a posteriori analysis, the normal weightlifters proved closely comparable to a group of male college students recruited as a normal comparison group in an earlier study. CONCLUSIONS: Muscle dysmorphia appears to be a valid diagnostic entity, possibly related to a larger group of disorders, and is associated with striking and stereotypical features. Men with muscle dysmorphia differ sharply from normal weightlifters, most of whom display little psychopathology. Further research is necessary to characterize the nosology and potential treatment of this syndrome.

Adipose Tissue↗
PubMedDate not supplied

Psychopathology and body image in cosmetic surgery patients.

The purpose of this study was to investigate the presence of psychiatric symptoms and evaluate the perceptive, cognitive, and behavioral aspects of body image in cosmetic surgery patients. These parameters of 20 cosmetic patients and of 20 control patients matched for age, gender, education, and marital status who attended the general surgery department for minor surgery were compared in a cross-sectional design. Symptom Check List-90 (SCL-90), Beck Depression Inventory (BDI), and The Multi-Dimensional Body Self Relations Questionnaire were administered to both groups. No significant difference was determined in the rates of psychopathology of the patient and control groups. Scales assessing self-image did not indicate any significant difference between the groups. Four (20%) of the cosmetic patients, however, were diagnosed with body dysmorphic disorder according to DSM-IV. Cosmetic patients were usually defensive towards psychological evaluations. A wide range of diversity was determined in the psychiatric evaluation of the cosmetic patient group. While some patients exhibited healthy psychological traits, some had severe depressive disorder or nearly psychotic somatic preoccupations.

Adolescent↗
PubMedDate not supplied

The high prevalence of "soft" bipolar (II) features in atypical depression.

Seventy-two percent of 86 major depressive patients with atypical features as defined by the DSM-IV and evaluated systematically were found to meet our criteria for bipolar II and related "soft" bipolar disorders; nearly 60% had antecedent cyclothymic or hyperthymic temperaments. The family history for bipolar disorder validated these clinical findings. Even if we limit the diagnosis of bipolar II to the official DSM-IV threshold of 4 days of hypomania, 32.6% of atypical depressives in our sample would meet this conservative threshold, a rate that is three times higher than the estimates of bipolarity among atypical depressives in the literature. By definition, mood reactivity was present in all patients, while interpersonal sensitivity occurred in 94%. Lifetime comorbidity rates were as follows: social phobia 30%, body dysmorphic disorder 42%, obsessive-compulsive disorder 20%, and panic disorder (agoraphobia) 64%. Both cluster A (anxious personality) and cluster B (e.g., borderline and histrionic) personality disorders were highly prevalent. These data suggest that the "atypicality" of depression is favored by affective temperamental dysregulation and anxiety comorbidity, clinically manifesting in a mood disorder subtype that is preponderantly in the realm of bipolar II. In the present sample, only 28% were strictly unipolar and characterized by avoidant and social phobic features, without histrionic traits.

Adolescent↗