Prevalence and factors associated with body dysmorphic disorder in women under dermatological care at a Brazilian public institution

Abstract Background: Body dysmorphic disorder consists of excessive concern with minimal appearance defects, which causes functional impairment. Its prevalence is estimated to range from 5% to 35% of dermatological patients, especially adult women with esthetic complaints. Objectives: To investigate the prevalence and factors associated with dysmorphic disorder in female dermatological patients, in a public institution in Brazil. Methods: This was a cross-sectional study involving adult women attended at a public dermatological service in Brazil. Participants underwent a demographic survey, in addition to a screening form for body dysmorphic disorder (Body Dysmorphic Disorder Examination [BDDE]). The presence of dysmorphic disorder (BDDE > 66 points) was assessed among the participants according to demographic covariates and psychological problems, through logistic regression. Results: A total of 223 women were evaluated. The BDDE showed high internal consistency (Cronbach's α = 0.90). It is noteworthy the high prevalence of psychological problems and the fact that over one-third (38%) of the sample presented a high degree of dissatisfaction with their image. The prevalence of dysmorphic disorder was 48% among women with esthetic complaints and 30% among the others (p < 0.01). Lower family income (OR = 2.97), history of domestic violence (OR = 3.23), search for dermatological care due to an esthetic complaint (OR = 2.05), and suicidal ideation (OR = 4.22) were independently associated with the occurrence of body dysmorphic disorder. Study limitations: This was a single-center study of a non-randomized sample from public service. Conclusions: Body dysmorphic disorder is prevalent among female dermatological patients; it is associated with traumatic psychological experiences, lower income, affective disorders, and demand for esthetic care. It is essential to recognize the diagnosis in order to treat such patients and refer them for appropriate psychiatric treatment instead of trying to satisfy their esthetic demands.

Body dysmorphic disorder in patients attending a dermatology clinic in Nigeria: sociodemographic and clinical correlates

Abstract: Background: Body dysmorphic disorder is a relatively common psychiatric disorder in the context of dermatology and cosmetic and plastic surgery but is underdiagnosed and underreported in Africa. Objective: To evaluate the prevalence of body dysmorphic disorder and symptoms of anxiety/depression and determine their sociodemographic and clinical correlates. Methods: A systematic random sampling design was made to recruit 114 patients with skin diseases. Sociodemographic and clinical data were obtained. The Body Dysmorphic Disorder Modification of the Yale-Brown Obsessive-Compulsive Scale, Hospital Anxiety and Depression Scale was administered, and data were analyzed using SPSS 20. Results: Mean age of participants was 37.70±17.47 years, and 67/114 (58.8%) were females. Prevalence of body dysmorphic disorder was 41/114 (36.0%), and prevalence of anxiety/depression symptoms was 35/114 (30.7%). Prevalence of body dysmorphic disorder in patients with anxiety/depression symptoms was 15/41 (36.6%), and patients with facial disorders expressed the highest burden of anxiety/depression symptoms, in 15/35 (42.9%). Factors associated with significantly higher mean body dysmorphic disorder include age<50years (p=0.039), and anxiety/depression (p<0.001), education below high school was associated with higher mean anxiety/depression score (P= 0.031). In a binary logistic regression model, presence of anxiety/depression symptoms was predictive of body dysmorphic disorder (OR=10.0, CI: 4.1-28.2, p<0.001). Study limitations: the study is uncontrolled, conducted in a single source of care, thus limiting generalization to nonrelated settings. Conclusion: Prevalence of body dysmorphic disorder is high among dermatology patients and most prevalent in facial disorders. Facial diseases are associated with the highest burden of anxiety/depression symptoms. This is a clarion call for dermatologists to routinely assess for body dysmorphic disorder and appropriately refer affected patients to mental health care.

The Association between Body Weight Misperception and Psychosocial Factors in Korean Adult Women Less than 65 Years Old with Normal Weight

With society's increasing interest in weight control and body weight, we investigated the association between psychological factors and body image misperception in different age groups of adult Korean women with a normal weight. On a total of 4,600 women from the Korea National Health and Nutrition Examination Survey 2007-2009, a self-report questionnaire was used to assess body weight perception and 3 psychological factors: self-rated health status, stress recognition, and depressed mood. Through logistic regression analysis, a poor self-rated health status (P = 0.001) and a higher recognition of stress (P = 0.001) were significantly associated with body image misperception and this significance remained after controlling for several sociodemographic (Model 1: adjusted odds ratio [aOR], 1.62; 95% confidence interval [CI], 1.31-2.00), health behavior and psychological factors (Model 2: aOR, 1.59; 95% CI, 1.29-1.96; Model 3: aOR, 1.36; 95% CI, 1.01-1.84). Especially, highly stressed middle-aged (50-64 yr) women were more likely to have body image misperception (Model 2: aOR, 2.85; 95% CI, 1.30-6.26). However, the correlation between depressed mood and self-reported body weight was inconsistent between different age groups. In conclusion, self-rated health status and a high recognition rate of severe stress were related to body weight misperception which could suggest tailored intervention to adult women especially women in younger age or low self-rated health status or a high recognition rate of severe stress.

Disordered eating behaviors and body image in male athletes

Objective: To identify disordered eating behaviors and body image dissatisfaction, as well as their relationship to body fat (BF), among male athletes in high risk sports for eating disorders. Methods: One hundred and fifty-six male athletes were divided into the following categories: weight-class sports, sports where leanness improves performance, and sports with aesthetic ideals. BF was assessed and three questionnaires were used: the Eating Attitudes Test; the Bulimic Investigatory Test, Edinburgh; the Body Shape Questionnaire. Results: Disordered eating behaviors and body image dissatisfaction were found in 43 (27.6%) and 23 athletes (14.7%), respectively, and an association was detected between the two variables (p < 0.001). Athletes with and without disordered eating behaviors did not differ in %BF (11.0±5.2% and 9.8±4.0%, respectively; p = 0.106). However, athletes with body image dissatisfaction had higher %BF than those who were satisfied (12.6±5.9% and 9.7±3.9%, respectively; p = 0.034). There were no differences in BF, frequency of disordered eating behaviors, and body image dissatisfaction between sports categories. Conclusion: Nearly one-quarter of athletes showed disordered eating behaviors, which was associated with body image dissatisfaction. Athletes with higher %BF were more likely to be dissatisfied with body image. There was no difference in eating behavior and body image between athletes from different sports categories. .

Motivos e prevalência de insatisfação com a imagem corporal em adolescentes / Reasons and prevalence of body image dissatisfaction in adolescents

OBJETIVO: Verificar os motivos e a prevalência de insatisfação com a imagem corporal (IC) em adolescentes. Métodos: Participaram do estudo 641 adolescentes de 11 a 17 anos. A imagem corporal foi autoavaliada através da escala de nove silhuetas corporais. Resultados: A prevalência de insatisfação com a IC foi de 60,4% (masculino = 54,5%, feminino = 65,7%; p < 0,05). Os rapazes (26,4%) apresentaram maior desejo em aumentar o tamanho da silhueta corporal, enquanto as moças (52,4%) desejavam diminuir. Prevalência mais elevada de insatisfação com a IC foi encontrada nos adolescentes urbanos. Os motivos indicados pelos adolescentes para a insatisfação foram similares entre os sexos (p = 0,156). Quando ao domicílio, a estética foi o motivo indicado pelos adolescentes urbanos e a autoestima pelos adolescentes rurais. Foi encontrada associação entre a percepção da imagem corporal e os motivos de insatisfação. Conclusões: A estética, a autoestima e a saúde são os motivos que mais influenciam a insatisfação com a IC. Mais da metade dos adolescentes está insatisfeita com sua silhueta corporal. Neste sentido, intervenções por profissionais e serviços de saúde são necessárias nessa fase da vida, para prevenir possíveis problemas futuros de distúrbios alimentares (anorexia, bulimia e vigorexia).

OBJECTIVE: To investigate the prevalence of body image (BI) dissatisfaction in adolescents. The study enrolled 641 adolescents aged 11 to 17 from the town of Saudades, Santa Catarina, Brazil. The prevalence of BI dissatisfaction was 60.4% (males = 54.5%, females = 65.7%; p < 0.05). Boys were more likely to wish to increase the size of their body silhouette (26.4%) while girls wished to reduce theirs (52.4%). Adolescents from urban areas manifested greater prevalence of BI dissatisfaction and were more likely to want to reduce their body silhouette. The reasons given by these adolescents for why they were dissatisfied with their body images were similar for both sexes (p = 0.156). When analyzed by neighborhood the urban adolescents said that their dissatisfaction was esthetic, whereas the rural adolescents said it was based on self-esteem. An association was detected between perceived BI and the reasons for dissatisfaction. Conclusions: Esthetics, self-esteem and health were the most common reasons for BI dissatisfaction among these adolescents. More than half of them were dissatisfied with their body silhouettes. Therefore, there is a need for interventions by health services and professionals in this age range in order to avoid possible future problems with eating disorders (anorexia, bulimia and vigorexia).

Dismorfia muscular, imagen corporal y conductas alimentarias en dos poblaciones masculinas / Muscle dysmorphia, body image and eating behaviors in two male populations

Background: Muscle dysmorphia or vigorexia is a disorder in which a person becomes obsessed with the idea that he or she is not muscular enough. Aim: To assess physical exercise, eating behaviors and the presence of muscle dysmorphia among weightlifters and medical students. Subjects and Methods: Cross sectional evaluation of 88 male weightlifters aged 27 ± 7 years and 84 male medical students aged 22 ± 1 year was made. Eating behaviors were evaluated using the Eating Attitudes Test (EAT-40) and the Eating Disorders Inventory (EDI). The perception of body image was assessed using the Graduate Hannover Scale (GHS). Results: Prevalence of muscle dysmorphia among weightlifters was 13.6 percent. Both groups did not differ in body dissatisfaction. Interest in appearance among weightlifters was significantly higher than in students and ranged significantly higher in EAT-40 and EDI (p < 0.001). Other sports were practiced with the same frequency by weightlifters and students. Weightlifters expended more time than students exercising to improve their appearance (p < 0.005). Forty two percent of weightlifters with muscle dysmorphia displayed abuse of anabolics and 67 percent used other substances to improve their performance (p < 0.005). Conclusions: The presence of muscle dysmorphia among weightlifters was confirmed. They were dissatisfied with their body image and more concerned with their physical appearance than those without muscle dysmorphia and/or students. Their anabolic abuse rate was high. Our findings were similar to those reported in the international literature.

Comorbidade entre transtorno dismórfico corporal e transtornos alimentares: uma revisão sistemática / Comorbidity between body dysmorphic disorder and eating disorders: a systematic review

INTRODUÇÃO: A insatisfação com a imagem corporal é uma das características mais proeminentes do transtorno dismórfico corporal (TDC) e dos transtornos alimentares (TA). Esses dois grupos de transtornos apresentam semelhanças em suas características psicopatológicas e epidemiológicas e na resposta ao tratamento. Apesar de ambos serem considerados transtornos do espectro obsessivo-compulsivo, pouco se sabe em relação à comorbidade entre esses dois grupos de transtornos. OBJETIVO: Avaliar a produção bibliográfica atual sobre a comorbidade entre TDC e TA. MÉTODO: Foi realizada uma revisão sistemática nos bancos de dados PubMed e ISI Web of Science dos artigos referentes à comorbidade entre TDC e TA. RESULTADOS: Oito artigos foram selecionados. As amostras de portadores de TA apresentavam comorbidade com TDC em 6 por cento a 39 por cento dos casos. Dos pacientes com TDC, 10 por cento a 32,5 por cento, por sua vez, podem apresentar comorbidade com TA. O TDC frequentemente precedia o TA, e os pacientes com comorbidade apresentavam quadro clínico mais grave que os com apenas um dos transtornos. CONCLUSÃO: Estudos recentes demonstram que as taxas de comorbidade entre esses dois transtornos são elevadas. Apesar disso, o TDC raramente é diagnosticado em portadores de TA, mesmo quando é o transtorno que causa mais incômodo.

BACKGROUND: Body image dissatisfaction is one of the most prominent psychopathological features of body dysmorphic disorder (BDD) and eating disorders (ED). These groups of disorders present similarities in psychopathological and epidemiological features and also in response to treatment. Although these disorders are included in the obsessive-compulsive spectrum, little is known about the comorbidity between the two groups of disorders. OBJECTIVE: To evaluate the current bibliographic production on the comorbidity of BDD and ED. METHOD: A systematic review has been conducted on the PubMed and ISI Web of Science databases. RESULTS: Eight articles have been selected. These articles report that patients with ED may present comorbidity with BDD in 6 percent to 39 percent of the cases. 10 percent to 32.5 percent of the patients with BDD might present comorbidity with a TA. BDD preceded ED in the majority of the patients with comorbidity and patients with both disorders had more severe presentations than patients with either disorder alone. CONCLUSION: Recent studies have shown that comorbidity ratios between these disorders are high. However, BDD is seldom diagnosed in patients with ED, even when it is the most severe disorder.

Transtorno dismórfico corporal em dermatologia: diagnóstico, epidemiologia e aspectos clínicos / Body dysmorphic disorder in dermatology: diagnosis, epidemiology and clinical aspects

São cada vez mais frequentes as queixas cosméticas, uma vez que objetivam a perfeição das formas do corpo e da pele. Os dermatologistas são consultados para avaliar e tratar essas queixas. Sendo assim, é importante conhecer o Transtorno Dismórfico Corporal, inicialmente chamado de "dismorfofobia", pouco estudado até recentemente. Esse transtorno é relativamente comum, por vezes, incapacitante, e envolve uma percepção distorcida da imagem corporal, caracterizada pela preocupação exagerada com um defeito imaginário na aparência ou com um mínimo defeito corporal presente. A maioria dos pacientes apresenta algum grau de prejuízo no funcionamento social e ocupacional, e como resultado de suas queixas obsessivas com a aparência, podem desenvolver comportamentos compulsivos, e, em casos mais graves, há risco de suicídio. O nível de crença é prejudicado, visto que não reconhecem o seu defeito como mínimo ou inexistente e, frequentemente, procuram tratamentos cosméticos para um transtorno psíquico. A prevalência do transtorno, na população geral, é de 1 a 2 por cento e, em pacientes dermatológicos e de cirurgia cosmética, de 2,9 a 16 por cento. Considerando a alta prevalência do Transtorno Dismórfico Corporal, em pacientes dermatológicos, e que os tratamentos cosméticos raramente melhoram seus sintomas, o treinamento dos profissionais para a investigação sistemática, diagnóstico e encaminhamento para tratamento psiquiátrico é fundamental.

Cosmetic concerns are becoming increasingly common in view of the obsession with the perfect body and skin. Dermatologists are often seen to evaluate and treat these conditions. Therefore, it is important to acknowledge the existence of Body Dysmorphic Disorder, also known as dysmorphophobia. Despite being relatively common, this disorder has not been well researched. Sometimes causing impairment, the disease involves a distorted body image perception characterized by excessive preoccupation with a perceived defect. Most of the patients experience some degree of impairment in social or occupational functioning and, as a result of their obsessive concerns, they may develop compulsive behaviors. In severe cases, there is a risk of suicide. Most individuals do not acknowledge that their defect is minimal or nonexistent and seek out cosmetic treatments for a psychiatric disorder. The prevalence of this disorder among the general population ranges from 1 to 2 percent and in dermatological and cosmetic surgery patients, from 2.9 to 16 percent. The training of professionals to systematically investigate, diagnose, and refer these patients to adequate psychiatric treatment is essential, considering the high prevalence of Body Dysmorphic Disorder in dermatological patients and the fact that cosmetic treatments rarely improve their condition.