Epidemiology of Body Dysmorphic Disorder Among Adolescents In Imphal West District, Manipur

Background: Body Dysmorphic Disorder (BDD) is a psychiatric disorder characterized by preoccupa-tion with a perceived flaw(s) in one’s appearance, leads sufferers to engage in repetitive behaviours to try to hide or fix the flaw(s) causing significant distress and interference. BDD is an unrecognized and undiagnosed problem among adolescents. Therefore, conducting a study in the Imphal West will identify the adolescents at risk. The objective of the study is to determine the prevalence of BDD among higher secondary students in Imphal West, Manipur. Methodology: This study was conducted among higher secondary students during Aug 2019 -Feb 2020. Sampling was done by stratified two stage cluster design and self-administered validated Body Image Disturbance Questionnaire was used. Data were summarized using descriptive statistics. Chi-square test was used for comparing proportions. Results: Out of the total 1207 students, 52% were female. Almost 92.2% of the students were concerned about some aspect of their appearance. About 2.6% met the DSM-V criteria for BDD. Females were sig-nificantly dissatisfied with their skin (71.3%), nose (59.3%), hair (34.7%), whereas men with their mus-cle build (54.8%) and eyes (40.3%). Conclusions: The study revealed BDD was prevalent but many individuals were unaware about the condition and its treatment.

Interview and treatment of a case with body dysmorphic disorder / 四川精神卫生

This paper reported a case of patient with body dysmorphic disorder in order to improve the clinical interview skills， diagnosis and treatment of clinicians in psychiatric department. The client was a 17-year-old unmarried male， came for psychological consultation because he was not satisfied with his appearance and had low self-esteem. After the changing of learning environment， the client showed excessive attention to his appearance along with low mood. The client was diagnosed with body dysmorphic disorder， and a biological-psychosocial comprehensive intervention was recommended. Sertraline combined with quetiapine was given as biotherapy to improve his mood and cognition. The psychotherapy included mindfulness-based stress reduction and cognitive behavioral therapy. These therapies helped the client learn to relax and correct cognitive biases. In terms of social resources， family members were encouraged to pay more attention to the client’s advantages， and schoolwork management on campus was strengthen. These methods promoted the development of client’s self-confidence.

El papel de las relaciones y la satisfacción vital en la percepción de la auto-imagen en una muestra de adolescentes mexicanos / The role of relationships and life satisfaction on body image perceptual disturbance in a sample of Mexican students

Objetivo: el Trastorno Dismórfico Corporal es una preocupación excesiva por un defecto corporal inexistente o de escasa importancia. El propósito de esta investigación consiste en evaluar el efecto de diferentes tipos de relaciones con el grupo de pares y de la satisfacción con la vida en el desarrollo del Trastorno Dismórfico Corporal en población adolescente. Materiales y métodos: se emplearon técnicas de análisis estructural para evaluar las relaciones entre estudiantes en clase. Los indicadores de centralidad se calcularon analizando diferentes relaciones entre alumnos (n=139) y alumnas (n=274) en 11 salones de clase. Se llevó a cabo una regresión jerárquica, análisis de conglomerados, análisis multivariado y visualización de grafos. Resultados: una baja satisfacción con el cuerpo y con la familia son las principales variables que predicen el desarrollo de este tipo de trastornos somatoformes. Mediante análisis de clúster se identifican dos grupos. El primero presenta niveles medio-altos de satisfacción y un contexto relacional potencialmente conflictivo. El segundo muestra elevada satisfacción y un contexto de relaciones predominantemente positivo. El primer grupo exhibe mayores niveles de Trastorno Dismórfico Corporal en comparación con el segundo. Conclusiones: disponer de una red social positiva actúa como factor de protección ante la aparición de este tipo de trastornos. Otorgar alta importancia al físico y criticar a los demás por su apariencia se relaciona con niveles elevados de Trastorno Dismórfico Corporal..(AU)

Objective: body Dysmorphic Disorder is defined as an excessive concern for a nonexistent or minor body defect. It is estimated that the incidence of this disorder is around 2% of the population worldwide. The main purpose of this work is to assess the effects of multiples kinds of relationships with the peer group and life satisfaction for developing Body Dysmorphic Disorder in adolescent population. Materials and methods: social Network Analysis techniques are applied to systematically assess the relationships among students within the class. Network centrality measures were calculated analyzing different kinds of relationships among boys (n= 139) and girls (n=274) at eleven classrooms. Multiple regressions, cluster analysis, multivariate analysis and graph visualization were developed. Results: the results indicates that a low satisfaction with the own body and with the family relationships are the main predictors of this kind of somatoform disorders. Two subgroups were identified through cluster analysis. The first one shows a high-medium level of satisfaction and a relational context potentially conflictive. The second one presents high level of satisfaction, and a context of predominantly positive relationships. The first group displayed higher levels of Body Dysmorphic Disorder compared with the second. Conclusions: the conclusions of this work point to having a broad positive network acts as a protective factor against this type of disorders. Giving high importance to body image and criticize others for their physical appearance it is related to high levels of Body Dysmorphic Disorder..(AU)

Prevalence and influence factors of subthreshold body dysmorphic disorder in undergraduates / 中华行为医学与脑科学杂志

Objective To explore the prevalence of subthreshold body dysmorphic disorder in an undergraduates sample and investigate the mediating role of self-esteem on big five personality and body image disturbance.Methods A sample of 1 166 undergraduates coming from four different colleges were recruited to complete questionnaire survey.Results The prevalence of subthreshold body dysmorphic disorder in undergraduates was 6.2％.Body image disturbance(35.2± 18.4) was negatively correlated with self-esteem ((29.0±4.3),r=-0.41,P＜0.01),positively correlated with neuroticism ((32.9±8.1),r=0.52,P＜0.01) while negatively correlated with extraversion (39.6 ± 6.8),openness (39.8 ± 6.4),agreeableness (41.7±4.7) and conscientiousness ((40.1±6.4),r=-0.18,-0.14,-0.14,-0.25;all P＜0.01).The mediating role of self-esteem was 19.7％.Conclusion The prevalence of subthreshold body dysmorphic disorder in undergraduates is rather high.Big five personality can directly predict body image disturbance and indirectly predict body image disturbance through the mediating role of self-esteem.

Dismorfofobia: un motivo de consulta oculto en dermatología / Dysmorphophobia: a hidden concern in dermatology

La dismorfofobia o trastorno dismórfico corporal, es una enfermedad que produce preocupación exagerada por un defecto poco visible o inexistente, provocando un malestar significativo en el paciente. Fue descrito por primera vez por el psiquiatra italiano Enrico Morselli en el siglo XIX, como la insatisfacción persistente y extendida respecto del propio cuerpo, sintiendo al mismo como anómalo o deforme en alguno de sus rasgos, generando malestar en el paciente, aún cuando no existan motivos objetivos y observables. En la quinta edición del manual estadístico de enfermedades mentales (DSM-V), se elimina de los trastornos somatomorfos, ubicándose dentro de los obsesivo-compulsivos. Las principales obsesiones se centran en: rostro, arrugas, dientes, cicatrices, asimetría facial, vello facial, labios, labios, nariz, genitales, glúteos, pecho. Se calcula que del 11 al 20% de los pacientes que consultan a dermatólogos presentan este trastorno, el que genera aislamiento social en casos extremos, suicidios, así como repercusiones médico - legales, amenazas e incluso homicidios a médicos tratantes, por lo que la sensibilización y formación del dermatólogo debe ir encaminada a ayudar al paciente a definir su problema, evitando procedimientos cosméticos. Se realizó una revisión exhaustiva en los motores de búsqueda como: Latindex y Scielo de los estudios más representativos hasta la actualidad, en el período comprendido entre 1970 y 2017 y las palabras clave a través de la web de Medical Subject Headings.

Concerns about body image are influenced by sociocultural, biological and environmental aspects; mass media and scientific advance has changed the conditions in which human existence has being marked by the last canons of beauty. Dysmorphophobia or body dysmorphic disorder is a disease that causes exaggerated concerns for a poorly visible or non-existent defect causing significant discomfort in the patient. Was described by the italian psychiatrist Enrico Morselli in the 19th century, as the persistent and widespread dissatisfaction with the body itself, feeling it as anomalous or deformed in some of its features causing discomfort in the patient, even when there are no objective and observable defects. In 2013 in the fifth edition of DSM-V was removed from somatomorphic disorders and located into obsessive-compulsive. The main obsessions focus on: face, wrinkles, teeth, scars, facial asymmetry, facial hair, lips, nose, genitals, glutes and chest. 11% to 20% of patients who consult dermatologists have this disorder which generates social isolation in extreme cases, suicides, as well as medico - legal repercussions, threats and even homicides to treating doctors. Therefore, the sensitization and training of the dermatologist should be aimed at helping the patient to define his problem, avoiding cosmetic procedures. An exhaustive review in search engines as Scholar google, Latindex and Scielo was made in the period between 1970 to 2017 and key words in Medical Subject Headings.

Prevalência do transtorno dismórfico corporal em pacientes candidatos e/ou submetidos a procedimentos estéticos na especialidade da cirurgia plástica: uma revisão sistemática com meta-análise / Prevalence of body dysmorphic disorder in patients who are candidates and/or are submitted to aesthetic procedures in the specialty of plastic surgery: a systematic review with meta-analysis

Este estudo objetivou verificar, por meio de uma revisão sistemática da literatura e da realização de uma meta-análise, a prevalência do transtorno dismórfico corporal em pacientes candidatos e/ou submetidos a procedimentos estéticos na especialidade da Cirurgia Plástica. Para cumprir com o objetivo proposto, foram analisados os mais relevantes estudos publicados originalmente em qualquer idioma, porém, que estivessem indexados às bases de dados National Library of Medicine (MEDLINE), Cochrane e Scielo, nas quais as buscas foram realizadas, por meio do uso de descritores associados ao tema e de critérios de inclusão e exclusão. Sendo assim, a amostra final deste estudo foi composta por 15 publicações, as quais foram submetidas a uma meta-análise, podendo-se verificar que 12,5% dos pacientes que são candidatos/submetidos a procedimentos estéticos na especialidade da Cirurgia Plástica possuem transtorno dismórfico corporal. Destes, a maioria é do gênero feminino (75,7%) e possui média de idade de 30 (± 10,5) anos. Devido ao alto índice de pacientes com transtorno dismórfico corporal atendidos na especialidade, ressalta-se a importância de os cirurgiões plásticos atentarem-se para o adequado atendimento dos pacientes, com vistas à identificação dos indivíduos potencialmente portadores desse transtorno e, consequentemente, à solicitação de um acompanhamento interdisciplinar com a participação de psicólogos e psiquiatras.

This study aimed at showing the prevalence of body dysmorphic disorder (BDD) in patients who are candidates and/or are submitted to aesthetic procedures in the specialty of plastic surgery via a systematic review of the literature and a meta-analysis. To comply with the proposed objective, we analyzed the most relevant studies originally published in any language that were available in the National Library of Medicine (MEDLINE), Cochrane, and SciELO databases. Searches were performed using keywords associated with the theme and inclusion and exclusion criteria. Thus, the final sample of this study was composed of 15 publications, which were submitted to a meta-analysis. It can be confirmed that 12.5% of the patients who were candidates/submitted to aesthetic procedures in the specialty of plastic surgery had BDD. Of these, the majority were women (75.7%) with a mean age of 30 (± 10.5) years. Given the high number of patients with BDD attended to in the specialty, it is important that plastic surgeons focus on providing patients with adequate care to identify individuals who potentially have BDD and consequently conduct an interdisciplinary follow-up with the participation of psychologists and psychiatrists.

Cirurgia plástica estética e (in) satisfação corporal: uma visão atual / Esthetic plastic surgery and (in) satisfaction index: a current view

O objetivo da pesquisa foi realizar uma revisão de literatura de estudos relacionados à Cirurgia Plástica Estética. Dessa forma, foram analisadas as pesquisas desenvolvidas com a amostra em questão. As buscas foram feitas nas bases de dados Scopus, PubMed e Medline. Foram utilizados os seguintes descritores: "cosmetic surgery", "body dysmorphic disorder" e "eating disorders". Os dados foram sintetizados em três tópicos: "Perfil do paciente e aspectos motivacionais", "Transtorno Dismórfico Corporal e Cirurgia Plástica" e "Transtornos Alimentares e Cirurgia Plástica". Conclui-se que o motivo principal para realização da cirurgia plástica estética é a insatisfação com o corpo. Além disso, o Transtorno Dismórfico Corporal possui alta prevalência nesses indivíduos. Ademais, mesmo após a realização do procedimento, esses sujeitos encontram-se insatisfeitos com seus corpos. As cirurgias plásticas mais comuns entre os pacientes com Transtornos Alimentares são o implante de silicone nas mamas e lipoaspiração de abdômen. Pela revisão de literatura pode-se perceber a necessidade dos profissionais da área de saúde terem acesso às informações referentes a esse grupo de indivíduos.

The aim of this study was to conduct a literature review of studies related to esthetic plastic surgery. Thus, studies conducted on this topic were searched. The searches were performed on the Scopus, PubMed, and Medline databases. The following keywords were used: "cosmetic surgery," "body dysmorphic disorder," and "eating disorders." The data were summarized in three topics: "profile of patients and motivational aspects," "plastic surgery and body dysmorphic disorder," and "plastic surgery and eating disorders." We conclude that the main reason for undergoing esthetic plastic surgery is dissatisfaction with the body . In addition, body dysmorphic disorder has a high prevalence in these individuals. Moreover, even after the completion of the surgery, these individuals are still dissatisfied with their bodies . The most common plastic surgeries among patients with eating disorders are silicone breast implantation and liposuction of the abdomen. From the literature review, we can perceive the need for health care professionals to have access to information regarding this group of individuals.

Trastorno dismórfico corporal: aspectos clínicos, dimensiones nosológicas y controversias con la anorexia nerviosa / Body dysmorphic disorder: clinical aspects, nosological dimensions and controversies with anorexia nervosa

There is strong evidence about the co-existence of body dysmorphic disorder (BDD) and eating disorders (ED), particularly with anorexia nervosa (AN). An exhaustive review of the specialised literature regarding these disorders was carried out. The results show that their co-occurrence implies a more complex diagnosis and treatment, a more severe clinical symptomatology and a worse prognosis and outcome. Both disorders display common similarities, differences and comorbidities, which allow authors to classify them in different nosological spectra (somatomorphic, anxious, obsessive-compulsive, affective and psychotic). Their crossover involves higher levels of body dissatisfaction and body image distortion, depression, suicidal tendency, personality disorders, substance use/abuse, obsessive-compulsive disorder, social phobia, alexithymia and childhood abuse or neglect background. Treatment including cognitive-behavioral psychotherapy and selective reuptake serotonin inhibitors are effective for both, BDD and ED; nevertheless, plastic surgery could exacerbate BDD. Clinical traits of BDD must be systematically detected in patients suffering from ED and vice versa.

A descriptive study of the prevalence of depression, anxiety, body dysmorphic disorder among cosmetic surgery patients in a private tertiary hospital in Metro Manila from February to September 2011

OBJECTIVES: This study was conducted to determine the prevalence of anxiety, depression, and BDD among patients about to undergo cosmetic surgery in the Center for Wellness and Aesthetics from February to September 2011.METHODOLOGY: This descriptive study included 50 patients who were scheduled to undergo cosmetic surgery in the Aesthetic and Wellness Center. Patients who consented to participate, complete the Hospital Anxiety and Depression scale (HADS) and Body Image Disturbance Questionnaire (BIDQ). Those who scored >8 for HADS-A and HADS-D and 3 and above for BIDQ had a follow up diagnostic clinical interview based on the Diagnostic and Statistics Manual of Mental Disorders (DSM-IV) for diagnosis.RESULTS: Out of the 50% patients, 76% were female, majority were married (54%) and College graduate (68%). The most common surgical procedure is EVLT (Endovenous Laser Treatment), followed by rhinoplasty and blepharoplasty (16%). 18% of the patients had probable anxiety, 6% depression and 6% BDD. Upon further clinical interview, 2 (4%) were diagnosed with mild BDD, 2 (4%) had panic disorder without agoraphobia and 1 (2%) had generalized anxiety disorder. No patient was clinically depressed. The 3 patients who were positive in BIDQ were likewise positive in HADS-A.CONCLUSION: The prevalence of anxiety was high (18%) in the subject population. However, BDD was lower (4%) than expected in the cosmetic surgery subjects. A high proportion of the participants had significant body image concerns.

Trastornos de la imagen corporal: anorexia nerviosa versus anorexia inversa (trastorno dismórfico muscular) / Body image disorders: anorexia nervosa versus reverse anorexia (muscle dysmorphia)

Resumen Introducción Entre los trastornos relacionados con la imagen corporal, la anorexia nerviosa (AN) en el sexo femenino y el trastorno dismórfico muscular (TDM) en el masculino surgen como los más representativos. Objetivo Analizar descriptivamente la relación entre las características clínicas de la AN y el TDM. Método Se realizó una búsqueda bibliográfica sobre la relación entre AN y TDM mediante las bases de datos Medline/PubMed, SciELO y textos especializados. Resultados Existen similitudes y diferencias entre ambos trastornos. Se inician en la adolescencia, muestran gran traslape diagnóstico, uso/abuso de fármacos, similares comorbilidades, mejoría con inhibidores selectivos de la recaptura de serotonina, psicoterapia cognitivo-conductual y se focalizan en la imagen corporal, pero en la AN se persigue la delgadez, mientras que en el TDM, el desarrollo muscular. Desde la perspectiva psicosocial, estos trastornos de la imagen corporal surgen debido a las presiones socioculturales occidentales relacionadas con los estereotipos de rol de género, que enfatizan una silueta esbelta femenina versus una masculina vigorosa. La clasificación nosológica del TDM ha sido controvertida, siendo actualmente incluida en el DSM-5 en el espectro obsesivo-compulsivo. Conclusiones Ambos trastornos implican una insatisfacción corporal con diversos grados de distorsión de la imagen corporal, alcanzando aun dimensiones delirantes. Se requieren futuras investigaciones que puedan fundamentar nuevas categorizaciones de estos desórdenes, clarificadoras de su esencia.

Abstract Background Among body image disorders, anorexia nervosa (AN) in females and muscle dysmorphia (MD) in males, emerge as the more representative. Objective To describe the relationship of clinical characteristics between AN and MD. Method A review of specialised textbooks and the available literature in Medline/PubMed and SciELO was made. Results There are similarities and differences between both disorders. They begin in adolescence, show a great diagnostic crossover, use/abuse of pharmacological drugs, similar co-morbidities, improvement with selective serotonin reuptake inhibitors and behavioural-cognitive psychotherapy, they are focused in body image, but AN pursuits thinness while MD muscle development. From a psychosocial perspective, body image disorders come out due to western socio-cultural pressures related to gender role stereotypes, which emphasise a slim feminine figure versus a vigorous masculine one. The nosological classification of MD is controversial and it has been including within the obsessive-compulsive spectrum of the DSM-5. Conclusions Both disorders imply body dissatisfaction with different degrees of body image distortion, even reaching delusional dimensions. Future studies are required which can lay the foundations of new categorisations of these disorders that better clarify their essence.

Evaluation of Body Dysmorphic Disorder in Hair Loss Patients and Benefit After Hair Transplant.

Introduction: Body dysmorphic disorder (BDD) is excessive concern about physical appearance leading to mental, social & functional distress. Patients seek cosmetic surgery not psychiatry & may remain dissatisfi ed after surgery. Study includes 100 hair transplant patients. Materials and Methods: From 1st Jan to 31st July 2013. Patient’s Personal Evaluation, Yale Brown Obsessive Scale, Sheehan Lifestyle Disability Scale & Derriford Appearance Scale were used for evaluation. Patients deformities were corrected with hair transplant and these patients were reassessed. Results: 10 months later to judge the benefi t. BDD prevalence in hair loss is 28%, which is higher than rhinoplasty 20.7%. Preoccupation of hair loss on the minds of the patients is much higher than perceived by their doctors. After hair transplant 52% patients considered their baldness has been corrected, 32% patients, had milder perception of their defect but 16% continue to feel that they have less hair than others. Conclusion: Th e study shows that hair loss patients who display BDD like concerns, can have signifi cant benefi t in personal life, social life and work performance after hair transplant. Study also shows that four diff erent psychiatry scales can be used for evaluation and follow up of BDD in hair loss patients.

Dismorfofobia: o olhar do outro / Dysmorphophobia: to be seen through someone else's eyes

O modus vivendi moderno tem produzido cada vez mais um crescente descontentamento em relação à anatomia corporal e a imaginação a respeito do corpo perfeito desperta um desejo no indivíduo nem sempre condizente com sua realidade. Sem limitação para as transfigurações, o corpo é modelado com base no sonho de uma estrutura corporal perfeita, na maioria das vezes, inalcançável, com os inúmeros procedimentos cirúrgicos propostos. Assim, é fundamental que os cirurgiões plásticos conheçam o Transtorno Dismórfico Corporal (TDC) ou dismorfofobia, desordem esta prevalente em ambos os sexos, em que a visão da aparência é deturpada, caracterizada pela inquietação excessiva de uma imperfeição física minúscula ou por imperfeições corporais ilusórias. O diagnóstico pode passar despercebido pelo não conhecimento, pelo subdiagnóstico ou pela preocupação apenas com a alteração corporal, o que pode trazer prejuízos pessoais, demandas jurídicas e até ajudar a manter o distúrbio.

The modern modus vivendi has promoted a growing discontentment in regard to self body image, and imagining a perfect body leads to a desire in an individual that is not always compatible with reality. With no limits in transfiguration, the body is modeled based on the dream of a perfect body structure, which is most times unattainable and requires numerous proposed surgical procedures. Therefore, it is of utmost importance for plastic surgeons to become aware of Body Dysmorphic Disorder (BDD), or dysmorphophobia. This is a disorder that is prevalent in both sexes, in which self visual appearance is distorted. It is also characterized by an excessive concern over a tiny physical imperfection or delusive physical imperfections. The diagnosis can remain unnoticed due to lack of knowledge, misdiagnosis, or concern only over body alterations, which may lead to personal damage, legal claims, and also risk of prolonging the disorder.

Body dysmorphic disorder and olfactory reference disorder: proposals for ICD-11

The article reviews the historical background and symptoms of body dysmorphic disorder (BDD) and olfactory reference disorder, and describes the proposals of the WHO ICD-11 Working Group on the Classification of Obsessive-Compulsive and Related Disorders related to these categories. This paper examines the possible classification of BDD symptoms in ICD-10. Four different possible diagnoses are found (hypochondriacal disorder, schizotypal disorder, delusional disorder, or other persistent delusional disorder). This has led to significant confusion and lack of clear identification in ICD-10. Olfactory reference disorder can also be classified as a delusional disorder in ICD-10, but there is no diagnosis for non-delusional cases. The Working Group reviewed the classification and diagnostic criteria of BDD in DSM-5, as well as cultural variations of BDD and olfactory reference disorder that include Taijin Kyofusho. The Working Group has proposed the inclusion of both BDD and olfactory reference disorder in ICD-11, and has provided diagnostic guidelines and guidance on differential diagnosis. The Working Group's proposals for ICD-11 related to BDD and olfactory reference disorder are consistent with available global evidence and current understanding of common mechanisms in obsessive-compulsive and related disorders, and resolve considerable confusion inherent in ICD-10. The proposals explicitly recognize cultural factors. They are intended to improve clinical utility related to appropriate identification, treatment, and resource allocation related to these disorders.

Psychopathology and psychiatric co-morbidities in patients seeking rhinoplasty for cosmetic reasons / Psicopatología y comorbilidad psiquiátrica en pacientes que buscan rinoplastia por razones cosméticas

AIM: The purpose of the study was to examine psychopathological traits and psychiatric co-morbidities in seekers of cosmetic rhinoplasty. SUBJECTS AND METHOD: Fifty persons seeking cosmetic rhinoplasty and 50 control subjects were admitted to the study. Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI) and Symptom Checklist - 90 [Revised] (SCL-90-R) were administered to people who requested cosmetic rhinoplasty and control subjects. All participants were also screened by the Structured Clinical Interview for DSM-IV-(SCIDI/ CV, SCID-II). RESULTS: Thirteen cosmetic rhinoplasty seekers [CRS] (26%) and three control subjects (6%) had at least one psychiatric diagnosis. There was a significant difference between the two groups (p = 0.006). Beck depression inventory (p = 0.002) and BAI (p = 0.046) levels above the cut-off point were significantly higher in the CRS group than in the normal control. Somatoform disorders were statistically higher in the CRS than control group (p = 0.007). Nine CRS (18%) and two control subjects (4%) had at least one personality disorder. There were differences between the two groups (p = 0.025). The average of SCL-90-R was significantly higher in the CRS than in the control subjects (p < 0.001). The most prevalent somatoform disorders of the CRS were six with body dysmorphic disorder [BDD] (12%). The most prevalent personality disorders of the CRS were three with avoidant (6%) and three with narcissistic (6%) personality. CONCLUSION: Assessment of detailed psychopathological aspects and psychiatric co-morbidities could help to define the clinical profile of people requesting cosmetic rhinoplasty in cosmetic surgery settings. Research into these factors may be important as it is essential to detect crucial problems such as personality disorders and BDD before surgery.

OBJETIVO: El propósito del estudio fue examinar los rasgos psicopatológicos y las comorbilidades psiquiátricas en los solicitantes de rinoplastia cosmética. SUJETOS Y MÉTODO: Cincuenta personas que buscaban rinoplastia cosmética, y 50 sujetos de control fueron registrados en el estudio. El Inventario de Depresión de Beck (BDI), el Inventario de Ansiedad de Beck (BAI), y el Listado de Síntomas 90 (Revisado) (SCL 90), fueron aplicados a las personas que solicitaron rinoplastia cosmética y a los sujetos del control. Todos los participantes fueron también sometidos a tamizaje mediante la Entrevista Clínica Estructurada para DSM - IV-(SCID-/ CV, SCIDII). RESULTADOS: Trece solicitantes de rinoplastia cosmética solicitantes (SRC) (26%) y tres sujetos de control (6%) tuvieron al menos un diagnóstico psiquiátrico. Hubo una diferencia significativa entre los dos grupos (p = 0.006). Los niveles de BDI (p = 0,002) y BAI (p = 0.046) por encima del valor límite, fueron significativamente más altos en el grupo de SRC que en el grupo control normal. Los trastornos somatoformes fueron estadísticamente más altos en el grupo SRC que en el grupo control (p = 0.007). Nueve SRC (18%) y dos sujetos de control (4%) tenían al menos un trastorno de personalidad. Hubo diferencias entre los dos grupos (p = 0. 025). El promedio de SCL-90-R fue significativamente más alto en el grupo de SRC que en los sujetos del grupo control (p < 0.001). Los trastornos somatoformes más prevalentes de SRC fueron seis con trastorno dismórfico corporal (TDC) (12%). Los trastornos de personalidad más prevalentes de SRC fueron: tres con trastorno de la personalidad por evitación (6%) y tres con personalidad narcisista (6%). CONCLUSIÓN: La evaluación de los aspectos psicopatológicos detallados y las comorbilidades psiquiátricas podrían ayudar a definir el perfil clínico de las personas que solicitan rinoplastia cosmética en los escenarios de cirugía cosmética. La investigación en estos factores puede ser importante, ya que es esencial para detectar problemas cruciales tales como los trastornos de personalidad y TDC antes de la cirugía.

General self-efficacy and body dysmorphic disorder of patients with deformities of the maxillofacial region / 中华行为医学与脑科学杂志

Objective To observe the self-efficacy and body image changes of the patients with oral and maxillofacial deformity in pre-and post-operative.Methods 183 patients with oral and maxillofacial deformity and 200 relatives as control group were measured by applying General Self-Efficacy Scale (GSES) of Chinese version and Self-rating Scale of Body Image(SSBI).Postoperative satisfaction degree was scored by applying attitude measurement method of interval scale.Perioperative GSES,SSBI score,and postoperative satisfaction degree were statistically analyzed.Results GSES score (26.79 ± 5.26) was lower than that in control group in preoperative (29.69 ± 5.37),and the difference was statistically significant (P ＜ 0.05).While SSBI score (24.35 ± 8.59) was higher than that in control group(11.04 ± 6.67),and the difference was also statistically significant (P ＜ 0.05).GSES score in postoperative(29.52 ± 3.80) was significantly higher than that in preoperative (P ＜ 0.05).SSBI score in postoperative(18.88 ± 8.19) was significantly higher than that in preoperative (P ＜ 0.05).Postoperative satisfaction was comparatively lower for the patients whose GSES score was higher than 32 and 36 for SSBI in preoperative.Conclusion Oporation can enhance the self-efficacy of patients with oral and maxillofacial deformity and reduce the incidence of patients with body dysmorphic disorder tendency.

Amending and evaluation of body dysmorphic disorder questionnaire / 中华行为医学与脑科学杂志

Objective To evaluate the reliability and validity of body dysmorphic disorder questionnaire (BDDQ) Chinese version. Methods A total of 222 participants from a plastic surgery department were enrolled in the study by systematic sampling. They were measured with BDDQ Chinese version and interviewed with Structured Clinical Interview for DSM-]V-TR-Patients( SCID/P) to evaluate the validity. Fifty participants were assessed again after two weeks to evaluate the test-retest reliability. Results The sensitivity of BDDQ Chinese version was 100% and the specificity was 93%. The correlation coefficient of each item was between 0. 808 and 1.000(P＜ 0.001). Conclusion BDDQ Chinese version has fairly high reliability and validity. Thus, it can be used as a screening diagnosis tool for BDD.

Cuerpo vivido e identidad narrativa en mujeres diagnosticadas con trastornos de la conducta alimentaria1 / Lived Body and Narrative Identity in Women with Eating Disorders Abstract

Introducción: Este trabajo presenta los resultados de la investigación titulada Narrativas identitarias sobre la vivencia corporal en mujeres diagnosticadas con trastorno de la alimentación, hecha en Medellín (Colombia) durante el 2008. Objetivo: Reconocer cómo el significado atribuido a la vivencia corporal devela la construcción de la identidad en mujeres con trastornos de la alimentación. Método: Estudio cualitativo con diseño de casos múltiples en el que se siguieron los procedimientos del método fenomenológico-hermenéutico. Como técnicas se utilizó entrevista en profundidad y grupos focales. El estudio se ajustó a los principios éticos vigentes para la investigación con seres humanos. Para ello se firmó el consentimiento informado por parte de cada una de las participantes. Resultados y conclusiones: Las mujeres diagnosticadas con anorexia-bulimia adoptan el modelo social de belleza y atractivo, anhelan un cuerpo competente como forma de ser exitosas y lo asocian al cuerpo delgado; el cuerpo y el "otro" son los dos horizontes privilegiados en la configuración de la identidad en estas mujeres; el hilo conductor de la identidad es vivir para lograr un cuerpo y exhibirlo, y las posibilidades de recuperación no consisten solamente en que la joven coma y acepte su cuerpo, sino en que pueda interrogar el modelo de cuerpo competente mediante un ejercicio narrativo que la lleva a una nueva configuración identitaria.

Introduction: This paper shows the results obtained in the research about narrative identity and lived body in women diagnosed with eating disorders, which was conducted in Medellin during 2008. Objective: To recognize how the meaning given to the lived body reveals the construction of the identity of women with eating disorders. Methodology: Qualitative study with a multiplecase design that follows the procedures of the phenomenological hermeneutic method. This study complied with current ethical principles for research with human beings. For this purpose, each participant willingly signed the informed consent form. Techniques used were in-depth interview and focus groups. Results and Conclusions: Women diagnosed with anorexia bulimia adopt the social model of beauty and attractiveness. They desire a competent body as a means of being successful, and therefore associate it with a thin body; the body and the "other" are the two main horizons in the identity construction of these women, the common thread is to live in order to accomplish a body and to show it. The possibilities of recovery do not simply involve the young woman eating and accepting her body, but rather prompting her to question the model of competent body by means of a narrative exercise that leads her to a new identity construction.

Mutilación genital en paciente transexual: ¿manifestación de un espectro patológico imprecisamente definido? / Genital Mutilation in a Transsexual Patient: Is it an Indication of an Imprecisely Defined Pathological Spectrum?

Introducción: Tradicionalmente, la automutilación genital se ha considerado un evento psicótico dentro del contexto religioso o fuera de éste. Aunque catalogado como un hecho muy infrecuente antes del advenimiento de internet, existen elementos para pensar que la incidencia es cada vez mayor y que la psicosis como factor psicopatológico no siempre estaría presente. Objetivos: Revisar la literatura sobre la automutilación genital y formular un replanteamiento teórico sobre su concepción psicopatológica. Método: Reporte de caso. Resultados: A continuación se presenta el caso de un paciente con un trastorno de identidad de género que intentó fallidamente realizarse la autocastración. El hecho, motivado por una profunda distorsión de la imagen corporal, ocurrió sin evidencia de psicosis, según la evaluación clínica y de pruebas psicológicas. Hasta donde se tiene conocimiento, este es el primer caso que se reporta en la literatura latinoamericana. Conclusiones: Estos actos podrían ser uno de varios puntos de confluencia clínica de un continuo de trastornos cuyo principal elemento psicopatológico sería la distorsión de la imagen corporal y no necesariamente la psicosis. Estas entidades eventualmente podrían ser incluidas dentro de una nueva sección categorial en las futuras clasificaciones diagnósticas en psiquiatría.

Introduction: Traditionally, genital self-mutilation has been considered a psychotic reaction in or outside the religious context. There are good data supporting the fact that it is not as infrequent as once thought and that psychosis might not always be present as a psycho-pathological determinant. Objectives: To review the literature concerning genital self-mutilation and to redefine its psychopathological conception. Method: Case report. Results: The presentation of a patient with gender identity disorder who failed in the attempt to perform an orchidectomy on himself. The act, motivated by a deep body image distortion, happened without evident psychosis as assessed clinically and by psychological batteries. As far as we know, this is the first case reported in the Latin-American scientific community. Conclusions: This kind of acts could be one of several points of clinical confluence in a continuum of disorders whose most important psychopathologic element would be self body image distortion and not necessarily psychosis. This group of entities eventually could be grouped into a new categorical section of future diagnostic classifications in psychiatry.

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.

Complicación psiquiátrica de una rinoplastia / A psychiatric complication of a rhinoplasty

Introducción: La prevalencia del trastorno dismórfi co corporal (TDC) se presenta, aproximadamente, entre el 1% y 2% de la población general, y en los pacientes que solicitan cirugía estética o tratamientos dermatológicos la tasa asciende hasta el 15%. Objetivo: Discutir el curso clínico de un paciente con TDC a quien se le realizó una rinoplastia. Método: Reporte de caso. Resultados: Se reporta el caso de un adolescente de 18 años, con preocupación constante por el tamaño de sus fosas nasales, con aislamiento social y familiar por temor a la evaluación negativa; es llevado a cirugía y en el posoperatorio presenta un episodio psicótico acompañado de síntomas de despersonalización. Durante la exploración psicopatológica en la hospitalización se encuentran elementos obsesivos y compulsivos. Discusión y conclusión: Es importante, por una parte, conocer el motivo que subyace en la decisión de buscar la cirugía estética y, por otra, realizar un diagnóstico oportuno de TDC no sólo para evitar problemas médicos legales o de decepción del paciente y del equipo médico después del procedimiento quirúrgico, sino también para iniciar una adecuada intervención en salud mental...

Introduction: The prevalence of body dysmorphic disorder (BDD) is estimated to be approximately between 1% and 2% of the general population and in patients seeking cosmetic surgery or dermatological treatments the rate rises to 15%. Objective: To discuss the clinical course of a patient with TDC who had a rhinoplasty. Method: Case Report. Results: We report the case of an 18-year-old adolescent, with concern about the size of his nasal passages associated with social and family isolation for fear of negative evaluation, whom is taken to surgery, presenting in the postoperative with a psychotic episode with symptoms of depersonalization. While exploring for psychopathology, obsessive and compulsive elements are found. Discussion and conclusion: It is important to know the reason behind the decision to seek cosmetic surgery and to diagnose TDC, not only to avoid legal problems for physicians or disappointment of the patient and the medical team after the surgical procedure, but to initiate an appropriate mental health intervention...