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Adolescent Psychiatry

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ISSN (Print): 2210-6766
ISSN (Online): 2210-6774

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Review Article

Body Dysmorphic Disorder in Adolescents

Author(s): Himanshu Sharma*, Bharti Sharma and Nisheet Patel

Volume 9, Issue 1, 2019

Page: [44 - 57] Pages: 14

DOI: 10.2174/2210676608666181031105706

Abstract

Background and Objectives: Body Dysmorphic Disorder (BDD) is characterized by an abnormal preoccupation with alleged misshapen body parts. There is often poor insight and effort is made to hide the imagined defects, and consultation may be sought seeking unnecessary cosmetic surgery or procedures. It is underdiagnosed and established treatment protocols are lacking. The disease has a chronic and undulating course and is seriously compromises quality of life. Despite the fact that the prime age of onset of BDD is during adolescence relatively little has been written about it during this phase of life. This review aims to comprehensively cover the present understanding of BDD, including clinical features, epidemiology, psychopathology, nomenclature, comorbidity and management.

Methods: A literature search was undertaken using suitable key words on Google Scholar, MEDLINE & PsychoINFO up to June 2018 limited to articles in English.

Results: The prevalence of BDD is variable in the general and psychiatric population with equal gender distribution. Both sexes are equally affected. It is associated with poor functioning and a chronic course. There is considerable comorbidity and diagnostic overlap between BDD and obsessive-compulsive disorder, major depressive disorder, social anxiety disorder, anorexia nervosa, schizophrenia spectrum disorders and personality disorders. Psychiatric consultation is often late. Selective Serotonin Reuptake Inhibitors (SSRIs) and Cognitive Behavior Therapy (CBT) are currently the first line modalities for treatment. Internet based CBT, Acceptance and commitment therapy, and repetitive Transcranial Magnetic Stimulation (rTMS) are emerging treatment options.

Conclusions: BDD is a complex disorder with still lot of uncertainty about its diagnostic placement, treatment approaches, especially for refractory patients, and prognosis. Further study is needed to clarify its prevalence, especially in adolescents; to fully understand its neurobiological aspects, to determine its exact relation to obsessive compulsive related disorders, and to develop better treatment approaches.

Keywords: Body dysmorphic disorder, history, nomenclature, epidemiology, clinical features, comorbidity, management.

« Previous Next »
Ahluwalia, R., Bhatia, N.K., Kumar, P.S., Kaur, P. (2017). Body dysmorphic disorder: Diagnosis, clinical aspects and treatment strategies. Indian J. Dent. Res., 28, 193-197.
American Psychiatric Association (1980). Diagnostic and statistical manual of mental disorders. (3rd Ed.). American Psychiatric Association. Washington DC: American Psychiatric Publishing, Inc.
American Psychiatric Association (1987).. Diagnostic and statistical manual of mental disorders. (3rd Ed. Revised), Washington, DC: American Psychiatric Publishing, Inc.
American Psychiatric Association (1994). Diagnostic and statistical manual of mental disorders. (4th Ed.). Arlington, VA: American Psychiatric Publishing, Inc.
American Psychiatric Association (2000). Diagnostic and statistical manual of mental disorders. (4th Ed. Text- Revision). Arlington, VA: American Psychiatric Publishing, Inc.
American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders, (5th Ed., pp. 242-247) Arlington, VA, US: American Psychiatric Publishing, Inc.
Atmaca, M., Bingol, I., Aydin, A., Yildirim, H., Okur, I., Yildirim, M.A., Gurok, M.G. (2010). Brain morphology of patients with body dysmorphic disorder. J. Affect. Disord., 123(1-3), 258-263.
Bjornsson, A.S., Didie, E.R., Phillips, K.A. (2010). Body dysmorphic disorder. Dialogues Clin. Neurosci., 12(2), 221-232.
Bjornsson, A.S., Didie, E.R., Grant, J.E., Menard, W., Stalker, E., Philips, K.A. (2013). Age at onset and clinical correlates in body dysmorphic disorder. Compr. Psychiatry, 54, 893-903.
Bowyer, L., Krebs, G., Mataix-Cols, D., Veale, D., Monzani, B. (2016). A critical review of cosmetic treatment outcomes in body dysmorphic disorder. Body Image, 19, 1-8.
Buhlmann, U., Etcoff, N.L., Wilhelm, S. (2006). Emotion recognition bias for contempt and anger in body dysmorphic disorder. J. Psychiatr. Res., 40(2), 105-111.
Campbell, R.J. (2009). Campbell’s psychiatric dictionary. (9th ed., p. 137). New York, NY, US: Oxford University Press.
Carroll, B.J., Yendrek, R., Degroot, C., Fanin, H. (1994). Response of major depression with psychosis and body dysmorphic disorder to ECT. Am. J. Psychiatry, 151, 288-289.
Coles, M.E., Phillips, K.A., Menard, W., Maria, E., Fay, C., Weisberg, R.B., Stout, R.L. (2006). Body dysmorphic disorder and social phobia: Cross sectional and prospective data. Depress. Anxiety, 23(1), 26-33.
Connolly, F.H., Gipson, M. (1978). Dysmorphophobia - a long term study. Br. J. Psychiatry, 132, 568-570.
Dlagnikova, A., Van Niekerk, R.L. (2015). The prevalence of body dysmorphic disorder among South African university students. S. Afr. J. Psychiatry, 21(3), 104-106.
Enander, J., Andersson, E., Mataix-Cols, D., Lichtenstein, L., Alström, K., Andersson, G. (2016). Therapist guided internet based cognitive behavioural therapy for body dysmorphic disorder. Single blind randomised controlled trial. BMJ, 352, i241.
Fang, A., Hofmann, S.G. (2010). Relationship between social anxiety disorder and body dysmorphic disorder. Clin. Psychol. Rev., 30(8), 1040-1048.
Feusner, J.D., Bystritsky, A., Hellemann, G., Bookheimer, S. (2010). Impaired identity recognition of faces with emotional expressions in body dysmorphic disorder. Psychiatry Res., 179(3), 318-323.
Freud, S. (1918). From the history of an infantile neurosis. Standard.
Frías, Á., Palma, C., Farriols, N., González, L. (2015). Co-morbidity between obsessive –compulsive disorder and body dysmorphic disorder: Prevalence, explanatory theories, and clinical characterization. Neuropsychiatr. Dis. Treat., 11, 2233-2244.
Grant, J.E., Phillips, K.A. (2004). Is anorexia nervosa a subtype of body dysmorphic disorder? Probably not, but read on …. Harv. Rev. Psychiatry, 12(2), 123-126.
Grant, J.E., Phillips, K.A. (2005). Recognizing and treating body dysmorphic disorder. Ann. Clin. Psychiatry, 17(4), 205-210.
Greenberg, J.L., Mothi, S.S., Wilhelm, S. (2016). Cognitive-behavioral therapy for adolescent body dysmorphic disorder: A pilot study. Behav. Ther., 47, 213-224.
Grocholewski, A., Kliem, S.A., Heinrichs, N. (2012). Selective attention to imagined facial ugliness is specific to body dysmorphic disorder. Body Image, 9, 261-269.
Hadley, S.J., Kim, S., Priday, L., Hollander, E. (2006). Pharmacological treatment of body dysmorphic disorder. Prim. Psychiatry, 13(7), 61-69.
Harikrsihna, G.L., Kumar, M. (2015). Occurrence of body dysmorphic disorder among undergraduate nursing students and their socio- demographic correlates: A cross-sectional survey. Int. J. Sci. Res. (Ahmedabad), 4(8), 1392-1395.
Harrison, A., Fernandez de la Cruz, L., Enander, J., Radua, J., Mataix-Cols, D. (2016). Cognitive-behavioral therapy for body dysmorphic disorder: A systematic review and meta-analysis of randomized controlled trials. Clin. Psychol. Rev., 48, 43-51.
Hartmann, A.S., Greenberg, J.L., Wilhelm, S. (2013). The relationship between anorexia nervosa and body dysmorphic disorder. Clin. Psychol. Rev., 33, 675-685.
Hay, G.G. (1970). Dysmorphophobia. Br. J. Psychiatry, 116, 399-406.
Hong, K., Nezgovorova, V., Hollander, E. (2018). New perspectives in the treatment of bodydysmorphic disorder. F1000 Res., 7, 361.
[http://dx.doi.org/10.12688/f1000research.13700.1]
Hunt, T.J., Thienhaus, O., Ellwood, A. (2008). The mirror lies: Body dysmorphic disorder. Am. Fam. Physician, 78(2), 217-224.
Janet, P. (1903). Les obsessions et la psychasthenie.. Paris: Felix Alcan.
Jeremy Goh, C.G., Stephen, L. (2015). Prevalence of body dysmorphic disorder and impact on subjective outcome amongst Singaporean rhinoplasty patients. Anaplastology, 4, 140.
Jolanta, J.R., Tomasz, M.S. (2000). The links between body dysmorphic disorder and eating disorders. Eur. Psychiatry, 15, 302-305.
Kelly, M.M., Walters, C., Phillips, K.A. (2010). Social anxiety and its relationship to functional impairment in body dysmorphic disorder. Behav. Ther., 41, 143-153.
Kraepelin, E. (1909). Psychiatrie. (8th ed.). Leipzig: JA Barth.
Krebs, G., de laCruz, L.F., Monzani, B., Bowyer, L., Anson, M., Cadman, J. . . Mataix-Cols, D. (2017). Long term outcomes of cognitive-behavioural therapy for adolescent body dysmorphic disorder. Behav. Ther., 48(4), 462-473.
Kumar, V., Sattar, Y., Bseiso, A., Khan, S., Rutkofsky, I.H. (2017). The effectiveness of internet-based cognitive behavioral therapy in treatment of psychiatric disorders. Cureus, 9(8), e1626.
[http://dx.doi.org/10.7759/ cureus.1626]
Lai, C.S., Lee, S.S., Yeh, Y.C., Chen, C.S. (2010). Body dysmorphic disorder in patients with cosmetic surgery. Kaohsiung J. Med. Sci., 26, 478-482.
Lavell, C.S., Zimmer-Gembeck, M.J., Farrell, L.J., Webb, H. (2014). Victimization, social anxiety, and body dysmorphic concerns: Appearance-based rejection sensitivity as a mediator. Body Image, 11, 391-395.
Mataix-Cols, D., de laCruz, L.F., Isomura, K., Anson, M., Turner, C., Monzani, B., Krebs, G. (2015). A pilot randomized controlled trial of cognitive-behavioural therapy for adolescents with body dysmorphic disorder. J. Am. Acad. Child Adolesc. Psychiatry, 54(11), 895-904.
Morselli, E. (1891). Sulla Dismorfofobia e sullatafefobia. [On Dysmorphophobia and tafephobia]. Bolletin nodella Reale Accademia Medicina Genova, 6 , 110-119.
Munro, A., Chmara, J. (1982). Monosymptomatic hypochondriacal psychosis, a diagnostic checklist based on 50 cases of the disorder. Can. J. Psychiatry, 27(5), 374-376.
National Institute for Health and Care Excellence (2005) Obsessive-compulsive disorder and body dysmorphic disorder: Treatment clinical guideline [CG31] Retrieved from https://www.nice.org.uk/guidance/cg31/
Patel, A., Sharma, H., Thakker, Y. (2004). Body dysmorphic disorder: An unusual presentation of schizophrenia. Indian J. Psychiatry, 42(2), 180-181.
Phillips, K.A. (1991). Body dysmorphic disorder-the distress of imagined ugliness. Am. J. Psychiatry, 148, 1138-1149.
Philips, K.A. (1996). The broken mirror: Understanding and Treating BDD.. New York, NY: Oxford University Press. a
Phillips, K.A. (1996). An open study of buspirone augmentation of serotonin-reuptake inhibitors in body dysmorphic disorder. Psychopharmacol. Bull., 32(1), 175-180. b
Phillips, K.A. (2002). Pharmacological treatment of body dysmorphic disorder: Review of evidence and recommended treatment approach. CNS Spectr., 7(6), 453-463.
Phillips, K.A., Diaz, S. (1997). Gender differences in body dysmorphic disorder. J. Nerv. Ment. Dis., 185, 570-577.
Phillips, K.A., Menard, W., Fay, C., Weisberg, R. (2005). Demographic characteristics phenomenology, co-morbidity, and family history in 200 individuals with body dysmorphic disorder. Psychosomatics, 46(4), 317-325.
Phillips, K.A., Menard, W. (2006). Suicidality in body dysmorphic disorder. A prospective study. Am. J. Psychiatry, 163, 1280-1282.
Phillips, K.A., Pinto, A., Menard, W., Eisen, J.L., Mancebo, M., Rasmussen, S.A. (2007). Obsessive-compulsive disorder versus body dysmorphic disorder: A comparision study of two possibily related disorders. Depress. Anxiety, 24(6), 399-409.
Phillips, K.A., Quinn, G., Stout, R.L. (2008). Impairment in body dysmorphic disorder: A prospective, follow-up study. J. Psychiatr. Res., 42, 701-707.
Phillips, K.A., Hollander, E. (2008). Treating body dysmorphic disorder with medication: Evidence, misconceptions, and a suggested approach. Body Image, 5(1), 13-27.
Phillips, K.A., Stein, D.J., Rauch, S.L., Hollander, E., Fallon, B.A., Barsky, A., Leckman, J. (2010). Should an obsessive-compulsive spectrum grouping of disorders be included in DSM -V? Depress. Anxiety, 27, 528-555.
Phillips, K.A., Stein, D.J. Obsessive compulsive and related disorders- body dysmorphic disorder, trichotillomania (hair-pulling disorder) and excoriation (skin-picking disorder). in A. Tasman, J. Kay, J.A. Lieberman,. M.B. First, & M. B. Riba, (Eds.). Psychiatry.(4th Ed., pp. 1129-1134). Hoboken, NJ: Wiley and Blackwell. (2015).
Prazeres, A.M., Nascimento, A.L., Fontenelle, L.F. (2013). Cognitive-behavioral therapy for body dysmorphic disorder: A review of its efficacy. Neuropsychiatr. Dis. Treat., 9, 307-316.
Rief, W., Buhlmann, U., Wilhelm, S.M., Borkenhagen, A., Brahler, E. (2006). The prevalence of body dysmorphic disorder: A population-based survey. Psychol. Med., 36(6), 877-885.
Rosen, J.C., Ramirez, E.J. (1998). A comparison of eating disorders and body dysmorphic disorder on body image and psychological adjustment. Psychosomatic Research, 44(3-4), 441-449.
Schieber, K., Kollei, I., de Zwaan, M., Martin, A. (2015). Classification of body dysmorphic disorder –What is the advantage of the new DSM-5 criteria? J. Psychosom. Res., 78(3), 223-227.
Schneider, S.C., Mond, J., Turner, C.M., Hudson, J.L. (2017). Sub- threshold body dysmorphic disorder in adolescents: Prevalence and impact. Psychiatry Res., 251, 125-130.
Schneider, S.C., Turner, C.M., Mond, J., Hudson, J.L. (2017). Prevalence and correlates of body dysmorphic disorder in a community sample of adolescents. Aust. N. Z. J. Psychiatry, 51, 595-603.
Shaw, A.M., Arditte Hall, K.A., Rosenfield, E., Timpano, K.R. (2016). Body dysmorphic disorder symptoms and risk for suicide: The role of depression. Body Image, 19, 169-174.
Sims, A. (2003). Disorder of awareness of the body.Symptoms in the mind: An introduction to descriptive psychopathology. (3rd ed., pp. 241-271). London, UK: Elsevier Science Limited.
Stein, D.J.E., Lochner, C. Obsessive compulsive and related disorders. In B. J. Sadock, V.A. Sadock, & P. Ruiz (Eds.). Kaplan and Sadock’s Comprehensive Textbook of Psychiatry.(10th Ed. Vol. 1, pp. 1787-1789). Philadelphia, PA: Lippincott, Williams & Wilkins. (2017).
Thomas, C.S. (1990). Body dysmorphic disorder. Am. J. Psychiatry, 147(6), 816-817.
Veale, D., Boocock, A., Gournay, W., Dryden, W., Shah, F., Willson, R., Walburn, J. (1996). Body dysmorphic disorder. A survey of fifty cases. Br. J. Psychiatry, 169, 196-201.
Veale, D. (2004). Body dysmorphic disorder. Postgrad. Med. J., 80, 67-71.
Veale, D., Gledhill, L.J., Christodoulou, P., Hodsoll, J. (2016). Body dysmorphic disorder in different settings: A systematic review and estimated weighted prevalence. Body Image, 18, 168-186.
Wilhelm, S., Otto, M.W., Zucker, B.G., Pollack, M.H. (1997). Prevalence of body dysmorphic disorder in patients with anxiety disorders. J. Anxiety Disord., 11(5), 499-502.
Wilhelm, S., Phillips, K.A., Steketee, G. (2013). Cognitive-behavioral therapy for body dysmorphic disorder: A treatment manual.. New York: Guilford Press.
Wilson, A.C., Wilhelm, S., Hartmann, A.S. (2014). Experiential avoidance in body dysmorphic disorder. Body Image, 11, 380-383.
Windheim, K., Veale, D., Anson, M. (2011). Mirror gazing in body dysmorphic disorder and healthy controls: Effects of duration of gazing. Behav. Res. Ther., 49(9), 555-564.
World Health Organization. (1992). The ICD-10 Classification of Mental and Behavioural Disorders: Clinical descriptions and diagnostic guidelines.. Geneva: Author.
Zaidens, S.H. (1950). Dermatologic hypochondriasis: A form of schizophrenia. Psychosom. Med., 12(4), 250-253.
Zimmerman, M., Mattia, J.I. (1998). Body dysmorphic disorder in psychiatric outpatients: Recognition, prevalence, co-morbidity, demographic, and clinical correlates. Compr. Psychiatry, 39, 265-270.

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