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At least 19 recordsLinked to original sources
PubMed1999

In pursuit of perfection: a primary care physician's guide to body dysmorphic disorder.

Body dysmorphic disorder is an under-recognized chronic problem that is defined as an excessive preoccupation with an imagined or a minor defect of a localized facial feature or body part, resulting in decreased social, academic and occupational functioning. Patients who have body dysmorphic disorder are preoccupied with an ideal body image and view themselves as ugly or misshapen. Comorbid psychiatric disorders may also be present in these patients. Body dysmorphic disorder is distinguished from eating disorders such as anorexia nervosa that encompass a preoccupation with overall body shape and weight. Psychosocial and neurochemical factors, specifically serotonin dysfunction, are postulated etiologies. Treatment approaches include cognitive-behavioral psychotherapy and psychotropic medication. To relieve the symptoms of body dysmorphic disorder, selective serotonin reuptake inhibitors, in higher dosages than those typically recommended for other psychiatric disorders, may be necessary. A trusting relationship between the patient and the family physician may encourage compliance with medical treatment and bridge the transition to psychiatric intervention.

Adolescent↗
PubMed1995

Cognitive-behavioral body image therapy for body dysmorphic disorder.

Body dysmorphic disorder (BDD) is a distressing body image disorder that involves excessive preoccupation with physical appearance in a normal appearing person. Prior case reports of behavior therapy were encouraging, but no controlled evaluation of behavior therapy or any other type of treatment had been conducted. In the present study, 54 BDD subjects were randomly assigned to cognitive behavior therapy or no treatment. Patients were treated in small groups for eight 2-hour sessions. Therapy involved modification of intrusive thoughts of body dissatisfaction and overvalued beliefs about physical appearance, exposure to avoided body image situations, and elimination of body checking. Body dysmorphic disorder symptoms were significantly decreased in therapy subjects and the disorder was eliminated in 82% of cases at posttreatment and 77% at follow-up. Overall psychological symptoms and self-esteem also improved in therapy subjects.

Adult↗
PubMed2006

Body dysmorphic disorder.

Body dysmorphic disorder is a relatively common psychiatric disorder among the dermatology patient population. These individuals may present to dermatologists for treatment of normal or minimally abnormal skin findings. Recognizing that these patients have body dysmorphic disorder can avert unnecessary and potentially unsuccessful treatments. Understanding and directing patients toward appropriate treatment options can minimize the distress and morbidities associated with the disorder.

Body Image↗
PubMedDate not supplied

A comparison of eating disorders and body dysmorphic disorder on body image and psychological adjustment.

Eating and body dysmorphic disorders are two diagnoses with body image disturbance as a central feature. No empirical study of the similarity of these disorders or any controlled study of body dysmorphic disorder were available. The present study compared 45 women with anorexia or bulimia nervosa to 51 men and women with body dysmorphic disorder (BDD) and 50 nonclinical controls. The eating disorder patients were mainly preoccupied with weight and body shape. BDD subjects had more diverse physical complaints and reported more negative self-evaluation and avoidance due to appearance. However, the two groups showed equally severe body image symptoms overall, and were clearly abnormal compared with controls. Both types of patients had negative self-esteem, but eating disorder patients had more widespread psychological symptoms. In conclusion, the disorders are comparable on psychological measures. Explanations of the minor differences and questions for future research on the relation between eating and body dysmorphic disorders are presented.

Adaptation, Psychological↗
PubMed1996

Body dysmorphic disorder.

Body dysmorphic disorder is one of the most difficult conditions to manage but a significant proportion of patients do respond to selective serotonin reuptake inhibitors. This group of drugs has helped to revolutionize the treatment of this common but disabling disorder of perceived body ugliness. The condition may affect up to 1% of the population in the United States. Patients often show obsessional features, and depression is common. Ever present is a risk of suicide in these patients.

Body Image↗
PubMed1997

A review of cognitive behavioral and pharmacological treatment of body dysmorphic disorder.

Body dysmorphic disorder (BDD) first appeared in the diagnostic nomenclature in 1987 with the Diagnostic and Statistical Manual of Mental Disorders, 3rd Edition Revised (DSM-III-R) (APA, 1987). Currently in DSM-IV (APA, 1994), the criterion of impairment in functioning was added to the already existing criteria of preoccupation with an imagined defect in appearance not accounted for by another mental disorder. The body parts most often perceived as defective are the nose, hair, and complexion. Behavioral and pharmacological studies consist primarily of case reports. Systematic desensitization, exposure and response prevention, and cognitive therapy are promising approaches that need further investigation. Pharmacological agents noted to be beneficial are the selective serotonin reuptake inhibitors. Controlled studies in this area are also needed.

Body Image↗
PubMed2002

Selective processing of emotional information in body dysmorphic disorder.

Body dysmorphic disorder (BDD) is a syndrome characterized by distress about imagined defects in one's appearance. Though categorized as a somatoform disorder, BDD is marked by many characteristics associated with social phobia (e.g., fear of negative evaluation) and obsessive-compulsive disorder (e.g., intrusive thoughts about one's ugliness, checking). In the present experiment, we tested whether BDD patients exhibit selective processing of threat in the emotional Stroop paradigm as do anxiety-disordered patients. Relative to healthy control participants, BDD patients exhibited greater Stroop interference for positive and negative words, regardless of disorder-relevance, than for neutral words. Further analyses suggested that interference tended to be greatest for positive words related to BDD. These data suggest that BDD patients are vulnerable to distraction by emotional cues in general, and by words related to their current concerns in particular. Results suggest that BDD may indeed be related to anxiety disorders such as social phobia.

Adult↗
PubMed2006

Beauty and the beast: Psychobiologic and evolutionary perspectives on body dysmorphic disorder.

Body dysmorphic disorder (BDD) is characterized by preoccupation with a defect in appearance. Concepts of beauty play a particularly crucial role in humans' mental and social life, and may have specific psychobiologic and evolutionary underpinnings. In particular, there is a growing literature on the neurocircuitry underpinning the body schema, body image and facial expression processing, and aesthetic and symmetry judgments. Speculatively, disruptions in cognitive-affective processes relevant to judgements about physical beauty lead to BDD.

Adult↗
PubMed2004

Body dysmorphic disorder.

Body dysmorphic disorder (BDD) is defined as a preoccupation with an "imagined" defect in one's appearance. Alternatively, where there is a slight physical anomaly, then the person's concern is markedly excessive. The preoccupation is associated with many time consuming rituals such as mirror gazing or constant comparing. BDD patients have a distorted body image, which may be associated with bullying or abuse during childhood or adolescence. Such patients have a poor quality of life, are socially isolated, depressed, and at high risk of committing suicide. They often have needless dermatological treatment and cosmetic surgery. The condition is easily trivialised and stigmatised. There is evidence for the benefit of cognitive behaviour therapy and selective serotonin reuptake inhibitors in high doses for at least 12 weeks, as in the treatment of obsessive-compulsive disorder. There is no evidence of any benefit of antipsychotic drugs or other forms of psychotherapy.

Body Image↗
PubMed2003

Cosmetic rhinoplasty in body dysmorphic disorder.

Body dysmorphic disorder (BDD) occurs in about 5% of patients seeking cosmetic surgery. Such patients are often dissatisfied with surgery or their symptoms of BDD are the same or worse after surgery. We report on a study that was designed to determine the frequency of BDD in patients requesting cosmetic rhinoplasty in the UK and to compare them with BDD patients in a psychiatric clinic. In the first stage of the study, we used a screening questionnaire for BDD and found that 20.7% of patients requesting rhinoplasty had a possible diagnosis of BDD. However, we believe that we identified a group of patients with sub-clinical or very mild BDD who are satisfied by cosmetic rhinoplasty. In the second stage of the study, we compared (a) patients without BDD who had a good outcome after cosmetic rhinoplasty with (b) BDD patients seen in a psychiatric clinic (who crave cosmetic rhinoplasty but for a variety of reasons do not obtain it). We found that BDD patients seen in a psychiatric clinic who desire cosmetic rhinoplasty are a quite distinct population from those obtaining routine rhinoplasty without symptoms of BDD. BDD patients are significantly younger, more depressed and anxious than this group, and are more preoccupied by their nose and check their nose more frequently. They are more likely to conduct "D.I.Y" surgery and have multiple concerns about their body. They are more likely to be significantly handicapped in their occupation, social life, and in intimate relationships and to avoid social situations because of their nose. They are therefore more likely to believe that dramatic changes would occur in their life after a rhinoplasty. This study provides some clues for surgeons who wish to identify patients with BDD who might have a poor prognosis in cosmetic rhinoplasty. Further research is required in the development of a screening questionnaire or interview for identifying patients with BDD seeking cosmetic surgery.

Adult↗
PubMed2006

Emotion recognition bias for contempt and anger in body dysmorphic disorder.

Body dysmorphic disorder (BDD) patients are preoccupied with imagined defects or flaws in appearance (e.g., size or shape of nose). They are afraid of negative evaluations by others and often suffer significant morbidity including hospitalization and suicide attempts. Many patients experience ideas of reference, e.g., they often believe others take special notice of their "flaw". Facial expressions play an important role in conveying negative or positive feelings, and sympathy or rejection. In this study, we investigated emotion recognition deficits in 18 BDD patients and 18 healthy controls. Participants were presented with two questionnaires accompanying facial photographs. One questionnaire included self-referent scenarios ("Imagine that the bank teller is looking at you. What is his facial expression like?"), whereas the other one included other-referent scenarios ("Imagine that the bank teller is looking at a friend of yours," etc.), and participants were asked to identify the corresponding emotion (e.g., anger, contempt, neutral, or surprise). Overall, BDD patients, relative to controls, had difficulty identifying emotional expressions in self-referent scenarios. They misinterpreted more expressions as contemptuous and angry in self-referent scenarios than did controls. However, they did not have significantly more difficulties identifying emotional expressions in other-referent scenarios than controls. Thus, poor insight and ideas of reference, common in BDD, might be related to a bias for misinterpreting other people's emotional expressions as negative. Perceiving others as rejecting might reinforce concerns about one's personal perceived ugliness and social desirability.

Adult↗
PubMed2004

Psychosis in body dysmorphic disorder.

Body dysmorphic disorder (BDD) has both psychotic and nonpsychotic variants, which are classified as separate disorders in DSM-IV (delusional disorder and a somatoform disorder). Despite their separate classification, available evidence indicates that BDD's delusional and nondelusional forms have many similarities (although the delusional variant appears more severe), suggesting that they may actually be the same disorder, characterized by a spectrum of insight. And contrary to what might be expected, BDD's delusional form, although classified as a psychotic disorder, appears to respond to serotonin-reuptake inhibitors alone. These and other data suggest that a dimensional view of psychosis (in particular, delusions) in these disorders may be more accurate than DSM's current categorical view. A dimensional model might also facilitate more consistent and accurate classification of other disorders that are likely characterized by a spectrum of insight, such as obsessive compulsive disorder, hypochondriasis, and anorexia nervosa. Further research is needed to better understand these classification issues, which likely have treatment implications.

Adult↗
PubMed2002

Neuroanatomical correlates and somatosensorial disturbances in body dysmorphic disorder.

Body dysmorphic disorder (BDD) is a condition characterized by an intense preoccupation with an imagined or slight defect in physical appearance. Although there is a general consensus that psychosocial factors play a major role in the development of BDD, there is some evidence suggesting that an organic somatosensorial disturbance may also exist in this condition. Several psychiatric and neurological disorders, including the interparietal syndrome, Gertsman's syndrome, inferoparietal syndrome, phantom limb syndrome, genital retraction syndrome, panencephalitis, cerebrovascular syndromes, and pharyngeal streptococcia affecting the basal ganglia, can present with somatosensorial disturbances similar to BDD. The cerebral pathology in all these disorders appears to be localized in the parietal-occipital region, indicating that cerebral involvement may also be associated with BDD. An interdependence exists between cerebral regions through integrated neural networks that enable efficient processing of information. Disturbances in these association pathways can lead to an imbalance in the extensive cerebral loops. Therefore, it is possible that a defect in information-processing may play a role in the pathogenesis of BDD.

Journal Article↗
PubMed2004

Depression, anxiety, anger, and somatic symptoms in patients with body dysmorphic disorder.

Body dysmorphic disorder (BDD) is a relatively common and impairing disorder. However, little is known about non-BDD symptoms and well-being in patients with this disorder. Seventy-five outpatients with DSM-IV BDD completed the Symptom Questionnaire, a validated self-report measure with four scales: depression, anxiety, somatic/somatization, and anger-hostility. Scores were compared to published norms for normal subjects and psychiatric outpatients. Participants in an open-label fluvoxamine trial completed the Symptom Questionnaire at baseline and endpoint. Compared to normal controls, BDD subjects had markedly elevated scores on all four scales, indicating severe distress and psychopathology. Compared to psychiatric patients, BDD subjects had higher scores on the depression, anxiety, and anger/hostility scales but not on the somatic/somatization scale. Scores on all scales significantly decreased with fluvoxamine. In conclusion, patients with BDD have markedly high levels of distress, are highly symptomatic, and have poor well-being in the domains of depression, anxiety, somatic symptoms, and anger-hostility. All of these symptoms significantly improved with fluvoxamine.

Adult↗
PubMed2002

Current concepts in body dysmorphic disorder.

Body dysmorphic disorder (BDD) is a potentially debilitating psychiatric illness characterized by intense preoccupation with an imagined or slight defect in physical appearance. Until recently, it has gone largely unrecognized and did not appear in the Diagnostic and Statistical Manual of Mental Disorders until 1987. Improved methods of assessment and treatment of BDD have increased interest in this disorder. This article reviews current literature on BDD, including the similarities between BDD and obsessive-compulsive disorder (OCD), current assessment and treatment strategies, and implications for clinical practice and future research.

Cognitive Behavioral Therapy↗
PubMed2000

Quality of life for patients with body dysmorphic disorder.

Body dysmorphic disorder (BDD) is a relatively common, distressing, and impairing disorder. Quality of life in BDD, however, has not been investigated. In this study, 62 consecutive outpatients with BDD were evaluated with the self-report Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) and other scales. SF-36 scores were descriptively compared to published norms for several populations. Physical health-related quality of life scores were generally worse than general U.S. population norms and better than norms for outpatients with a medical illness or depression. However, in all mental health domains, BDD subjects' scores were notably worse than norms for the general U.S. population and for patients with depression, diabetes, or a recent myocardial infarction. More severe BDD symptoms and greater delusionality were associated with poorer mental health-related quality of life. These results indicate that patients with BDD have notably poor mental health status and mental health-related quality of life.

Adolescent↗
PubMed2006

An open-label study of escitalopram in body dysmorphic disorder.

Body dysmorphic disorder (BDD) is a relatively common and impairing disorder. Selective serotonin reuptake inhibitors (SRIs) appear selectively efficacious for BDD, but pharmacotherapy research is limited, and escitalopram has not been studied. Fifteen subjects with BDD were treated with escitalopram and assessed with reliable and valid measures. BDD symptoms significantly improved (P<0.001), and 73.3% (n=11) of subjects were responders. Of the subjects, 46.7% were very much improved, and 33.3% were much improved. Depressive symptoms, delusionality, functioning and quality of life also significantly improved. Escitalopram was well tolerated. These preliminary data suggest that escitalopram is safe and efficacious for BDD.

Adolescent↗
PubMed1996

Pharmacologic treatment of body dysmorphic disorder.

Body dysmorphic disorder (BDD), a preoccupation with an imagined or slight defect in appearance, has been described for more than a century and reported around the world. However, investigation into the treatment of this distressing and impairing disorder is just beginning. Available data on the pharmacologic treatment of BDD suggest that it often responds to serotonin reuptake inhibitors (SRIs), which may be preferentially effective for this disorder. Augmentation of SRIs with buspirone and neuroleptics, as well as combinations of SRIs, also appear promising. Available data also suggest that serotonin reuptake inhibitors may be effective for delusional BDD (a type of delusional disorder, somatic type). Because controlled treatment studies are lacking, however, these findings are preliminary. Controlled pharmacotherapy studies, which are under way, are greatly needed.

Adult↗