Preditores de dismorfia muscular em homens brasileiros de minoria sexual e de gênero / Muscle dysmorphia predictors among sexual and gender minority Brazilian men

RESUMO Objetivos Avaliar preditores de dismorfia muscular em homens brasileiros de minoria sexual e de gênero e descrever normas comunitárias para o Muscle Dysmorphic Disorder Inventory (MDDI), instrumento de avaliação de sinais e sintomas de dismorfia muscular. Métodos Trata-se de estudo transversal realizado com 1.444 homens brasileiros de minoria sexual e de gênero, com idade entre 18 e 50 anos. Por meio de uma pesquisa on-line , os participantes responderam a um questionário sociodemográfico, assim como medidas para avaliação dos sintomas de dismorfia muscular, busca pela muscularidade, internalização da aparência ideal e auto-objetificação. Foram realizadas análises descritivas e de correlação ( rho de Spearman) entre as variáveis do estudo, bem como uma análise de regressão linear múltipla ( stepwise forward ) para avaliar preditores de dismorfia muscular. Resultados Associação positiva e significante, de grande magnitude, foi observada entre os sintomas de dismorfia muscular, busca pela muscularidade, internalização da aparência ideal e auto-objetificação. Regressão linear múltipla demonstrou que todas essas variáveis são preditoras dos sintomas de dismorfia muscular em homens brasileiros de minoria sexual e de gênero. Conclusões Homens brasileiros de minoria sexual e de gênero apresentaram elevado risco para dismorfia muscular. Sintomas de dismorfia muscular estiveram associados com a busca pela muscularidade, internalização da aparência ideal e auto-objetificação, demonstrando que elas são preditoras de dismorfia muscular. Intervenções devem ser direcionadas a essa população, considerando a necessidade de criar estratégias de redução de sintomas de dismorfia muscular, da busca pela muscularidade, da internalização da aparência ideal e da auto-objetificação.

ABSTRACT Objectives To evaluate predictors of muscle dysmorphia in sexual and gender minority Brazilian men and to describe community norms for the Muscle Dysmorphic Disorder Inventory (MDDI), an instrument for assessing muscle dysmorphia symptoms. Methods This cross-sectional study was carried out with 1.444 sexual and gender minority Brazilian men, with ages between 18 and 50 years. By means of an on-line survey the participants answered a sociodemographic questionnaire, as well as muscle dysmorphia symptoms, drive for muscularity, appearance-ideal internalization, and self-objectification measures. Descriptive and correlation (Spearman's rho ) analysis were performed among the study variables, in addition to a multiple linear regression analysis (stepwise forward) to evaluate predictors of muscle dysmorphia. Results A positive and significant association of large magnitude was observed among muscle dysmorphia symptoms, drive for muscularity, appearance-ideal internalization, and self-objectification. Multiple linear regression showed that all these variables are predictors of muscle dysmorphia symptoms in sexual and gender minority Brazilian men. Conclusions Sexual and gender minority Brazilian men present high risk for muscle dysmorphia. Muscle dysmorphia symptoms were associated with drive for muscularity, appearance-ideal internalization, and self-objectification, showing that they are predictors of muscle dysmorphia. Interventions should target this population, considering the need to create strategies to reduce muscle dysmorphia symptoms, the drive for muscularity, appearance-ideal internalization, and self-objectification.

Body Dysmorphic Disorder and the influence of the media in demand for plastic surgery: the importance of proper evaluation / O Transtorno Dismórfico Corporal e a influência da mídia na procura por cirurgia plástica: a importância da avaliação adequada

Introduction: Since the beginning, plastic surgery has improved self-esteem and acceptance in a society that idealizes the cult of the body. The pressure of consumption and the ease of undergoing plastic surgery becomes an obsession in these patients' lives. Method: Female patients who underwent psychological evaluation and follow-up throughout the surgical and plastic surgery procedure, aged between 19 and 57, answered the Sociocultural Attitudes Questionnaire concerning appearance and the Body Dysmorphophobia Symptom Scale. Results: Of the 38 patients evaluated, 17 have the media as an influence concerning their body image and have symptoms of Body Dysmorphic Disorder (BDD), 13 patients have the media as an influence on their body image, but they do not have BDD symptoms, and in eight patients the media does not influence their body image, and they do not have BDD symptoms. Conclusion: The importance of a multidisciplinary team, with a psychologist, is highlighted to evaluate and monitor the patient throughout the surgical process, as the early diagnosis of BDD will avoid dissatisfaction with the result of the plastic surgery and, mainly, future court lawsuits.

Introdução: Desde os primórdios, a cirurgia plástica melhora a autoestima e a aceitação em uma sociedade que idealiza o culto ao corpo. A pressão do consumo e a facilidade de se submeter a um procedimento de cirurgia plástica acabam tornando-se obsessão na vida desses pacientes. Método: Pacientes do sexo feminino que passaram por avaliação e acompanhamento psicológico em todo o processo cirúrgico, e procedimento de cirurgia plástica, com a idade entre 19 e 57 anos, responderam ao questionário de Atitudes Socioculturais em relação a aparência e a Escala de Sintomas de Dismorfobia Corporal - Body Dysmorphic Scale. Resultados: Dos 38 pacientes avaliados, 17 têm a mídia como influência em relação a sua imagem corporal e apresentam sintomas do Transtorno Dismórfico Corporal (TDC), 13 pacientes têm a mídia como influência em relação a sua imagem corporal, mas não apresentam sintomas do TDC, e em oito pacientes a mídia não influencia em relação a sua imagem corporal e não apresentam sintomas do TDC. Conclusão: Destaca-se a importância de uma equipe multidisciplinar, com a presença de um psicólogo, para avaliar e acompanhar o paciente em todo processo cirúrgico, pois o diagnóstico precoce do TDC evitará uma insatisfação com o resultado da cirurgia plástica e, principalmente, futuros processos judiciais.

Galloway-Mowat Syndrome in an infant caused by OSGEP gene mutation: a case report and literature review / 中国新生儿科杂志

Objective:To summarize the clinical features and pathogenic gene mutation of Galloway-Mowat syndrome (GAMOS).Methods:We retrospectively collected the medical history, physical signs, laboratory findings, imaging, and molecular data of GAMOS in an infant diagnosed at the department of Pediatrics of Women and Children's Hospital, School of Medicine, Xiamen university. Relevant literature up to December 2021, retrieved from PubMed, Embase, Web of Science, the Cochrane Library, China National Knowledge Infrastructure, VIP, Wanfang and the Chinese Medical Journal Full Text database with the terms of "Galloway-Mowat syndrome", "infant", "WDR73", "LAGE3", "OSGEP", "TP53RK" and "TPRKB".Results:The male infant with dysmorphic facial features and microcephaly at birth gradually displayed growth restriction and developmental delay. He was admitted to hospital at 3 months and 1 day due to "tachypnea for a half day", and suffered from severe pneumonia, urinary tract infection, nephrotic syndrome, repetitive convulsion, septic shock, disseminated intravascular coagulation, acute renal damage and multiple organ failure during hospitalization. He died when his family had given up treatment. Whole exome sequencing revealed a homozygous mutation c.740G>A (p.Arg247Gln) in the OSGEP gene and both of his parents were heterozygous variation carriers. In the total 14 publications (13 were in English and only 1 in Chinese) that were retrieved, with 78 patients from 58 pedigrees. Together with the index case, there were 79 patients in total. The main clinical manifestations were craniofacial and skeletal dysmorphism, as well as nervous system, renal and eye impairment. Obstetric problems were detected in 15 cases (19.0%), including intrauterine growth restriction, microcephaly, oligohydramnios and fetal distress in utero. 49 cases (62.0%) died when reported. The genetic cause of GAMOS had been reported in 79 patients: OSGEP in 36 (45.6%), WDR73 in 29 (36.7%), TP53RK in 7(8.9%), LAGE3 in 5 (6.3%), and TPRKB in 2(2.5%).Conclusions:The main clinical manifestations of GAMOS were craniofacial and skeletal dysmorphism, development delay, leukoencephalopathy, myelination defect, proteinuria and nephrotic syndrome, and associated with poor prognosis. Prenatal findings may be useful for an early diagnosis.

Evaluation of postoperative satisfaction with rhinoseptoplasty in patients with symptoms of body dysmorphic disorder / Avaliação da satisfação pós-operatória da rinosseptoplastia em pacientes com sintomas de transtorno dismórfico corporal

Abstract Introduction: The prevalence of body dysmorphic disorder among candidates for plastic surgery may vary from 6% to 54%. Some studies report discrete benefits with the surgical results, while others show symptomatic exacerbation. Some authors even affirm that body dysmorphic disorder would be a surgical contraindication, against others who suggest satisfactory results. Objective: To describe the prevalence of body dysmorphic disorder in rhinoseptoplasty candidates and to compare outcomes among patients with and without body dysmorphic disorder symptoms. Methods: Cohort study. Individuals ≥ 16 years, candidates for aesthetic and/or functional rhinoseptoplasty were recruited at a university hospital in Brazil. The prevalence of body dysmorphic disorder was assessed through the Body Dysmorphic Disorder Examination (BDDE) and the patients divided into groups: no symptoms of body dysmorphic disorder, mild-moderate and severe symptoms. The specific quality of life outcomes, Nasal Obstruction Symptom Evaluation (NOSE) and Rhinoplasty Outcome Evaluation (ROE) were evaluated before and after 90 and 180 days of the procedure. Results: 131 individuals were included, 59.5% female. The prevalence of preoperative symptoms of body dysmorphic disorder was 38%. There was a reduction in the symptoms of body dysmorphic disorder in the preoperative body dysmorphic disorder examination versus 3 and 6 months in all groups (78.94 ± 2.46 vs. 33.63 ± 6.41 and 35.51 ± 5.92, respectively, p < 0.002). Among patients with severe body dysmorphic disorder symptoms, rhinoplasty outcome evaluation ranged from 21.24 ± 3.88 to 58.59 ± 5.83 at 3 months and 52.02 ± 5.41 at 6 months postoperatively (p < 0.001); while NOSE from 71 ± 8.47 to 36.11 ± 12.10 at 6 months postoperatively (p <0.01). Conclusion: The prevalence of body dysmorphic disorder symptoms in our sample was high. Rhinoseptoplasty was associated with an improvement in quality of life outcomes related to nasal function and aesthetic outcome in all groups, irrespective of the presence and intensity of body dysmorphic disorder symptoms. Rhinoseptoplasty in body dysmorphic disorder symptomatic patients was also associated with a reduction in postoperative body dysmorphic disorder symptoms, even in severe cases.

Resumo Introdução: A prevalência do transtorno dismórfico corporal entre os candidatos à cirurgia plástica pode variar de 6% a 54%. Alguns estudos relatam benefícios discretos com os resultados cirúrgicos, enquanto outros mostram exacerbação dos sintomas. Alguns autores chegam a afirmar que o transtorno dismórfico corporal seria uma contraindicação cirúrgica, contra outros que sugerem resultados satisfatórios. Objetivo: Descrever a prevalência do transtorno dismórfico corporal em candidatos à rinosseptoplastia e comparar os desfechos entre pacientes com e sem sintomas de transtorno dismórfico corporal. Método: Estudo de coorte. Indivíduos ≥ 16 anos, candidatos à rinosseptoplastia estética e/ou funcional, foram recrutados em um hospital universitário no Brasil. A prevalência de transtorno dismórfico corporal foi avaliada por meio do questionário body dysmorphic disorder examination e os pacientes foram divididos nos grupos: sem sintomas de transtorno dismórfico corporal, sintomas leves-moderados e sintomas graves. Os resultados específicos da avaliação de qualidade de vida, com os instrumentos nasal obstruction symptom evaluation, NOSE, e rhinoplasty outcome evaluation, foram avaliados antes, após 90 e 180 dias do procedimento. Resultados: Foram incluídos 131 indivíduos, 59,5% do sexo feminino. A prevalência de sintomas pré-operatórios de transtorno dismórfico corporal foi de 38%. Houve redução dos sintomas de transtorno dismórfico corporal no body dysmorphic disorder examination pré-operatório vs. 3 e 6 meses em todos os grupos (78,94 ± 2,46 vs. 33,63 ± 6,41 e 35,51 ± 5,92, respectivamente, p < 0,002). Entre os pacientes com sintomas graves de transtorno dismórfico corporal, o escore do instrumento rhinoplasty outcome evaluation variou de 21,24 ± 3,88 a 58,59 ± 5,83 em 3 meses e 52,02 ± 5,41 em 6 meses de pós-operatório (p < 0,001); enquanto o escore do NOSE variou de 71 ± 8,47 a 36,11 ± 12,10 aos 6 meses de pós-operatório (p < 0,01). Conclusão: A prevalência de sintomas de transtorno dismórfico corporal em nossa amostra foi alta. A rinosseptoplastia foi associada a uma melhoria nos desfechos de qualidade de vida relacionados à função nasal e estética em todos os grupos, independentemente da presença e intensidade dos sintomas do transtorno dismórfico corporal. A rinosseptoplastia em pacientes com transtorno dismórfico corporal sintomático também foi associada à redução dos sintomas do transtorno dismórfico corporal no pós-operatório, mesmo em casos graves.

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.

Dimensión histórica, síntomas y neurobiología del trastorno dismórfico corporal / Historical dimension, symptoms and neurobiology of disorder body dysmorphic

Resumen El trastorno dismórfico corporal (TDC) se caracteriza por una preocupación excesiva por una parte del cuerpo que resulta defectuosa; así como por la presencia de pensamientos sobre el cuerpo que resultan desagradables, intrusivos y difíciles de controlar. Este artículo presenta la dimensión histórica y la evolución de la clasificación del TDC, así como su semiología en correlación con la neurobiología que se ha descrito hasta la fecha. Para ello, se realizó una revisión de estudios acerca de la dimensión histórica, los síntomas y las comorbilidades del trastorno dismórfico corporal, llevados a cabo entre los años 2000 y 2020. Se emplearon las bases de datos PubMed, MedLine, Embase, Science Direct y Bibliomed y los descriptores "trastorno dismórfico corporal", "evaluación de síntomas" y "comorbilidad" tanto en inglés como en español. Se encontró que el TDC está asociado a otros trastornos mentales y a síntomas como ideación e intentos de suicidio; en cuanto a la edad, se describe un inicio a los 16 años; y sobre la neurobiología del TDC, algunos estudios indican cambios en la corteza occipital y los circuitos frontoestriatales. Sin embargo, es necesario generar nuevo conocimiento sobre el TDC con el fin de precisar los diagnósticos diferenciales y las nuevas formas de tratamiento.

Abstract Body dysmorphic disorder (BDD) is characterized by an excessive preoccupation with a defective body part, as well as the presence of thoughts about the body that are unpleasant, intrusive and difficult to control. This article presents the historical dimension and the evolution of the classification of BDD, as well as its semiology in correlation with the neurobiology that has been described to date. For this purpose, a review of studies about the historical dimension, symptoms and comorbidities of body dysmorphic disorder, conducted between 2000 and 2020, was performed. The databases PubMed, MedLine, Embase, Science Direct and Bibliomed and the descriptors "body dysmorphic disorder", "symptom assessment" and "comorbidity" were used in both English and Spanish. It was found that BDD is associated with other mental disorders and symptoms such as suicidal ideation and attempts; as for age, an onset at 16 years is described; and on the neurobiology of BDD, some studies indicate changes in the occipital cortex and frontostriatal circuits. However, it is necessary to generate new knowledge on BDD in order to clarify differential diagnoses and new forms of treatment.

Case report of intellectual developmental disorder with dysmorphic facies and behavioral abnormalities due to FBXO11 gene mutation / 中华实用儿科临床杂志

A retrospective analysis was performed on the clinical data of a case of intellectual developmental disorders with dysmorphic facies and behavioral abnormalities admitted in the Department of Neurology and Endocrinology, Children′s Hospital Affiliated to Shandong University in February 2020.The proband was a 3 years and 6 months old boy, who was hospitalized because of " convulsions for more than 1 year" . Physical examination revealed facial deformities.Gesell developmental schedule showed that adaptive and gross motor behavior development was severely retarded, and fine motor, language and personal-social behavior development was moderately retarded.Brain magnetic resonance imaging suggested schizencephaly.Electroencephalogram results indicated extensive discharges mainly in bilateral anterior head areas, and one myoclonic seizure was detected.Gene detection results disclosed the pathogenic variation of the proband, which was a heterozygote mutation (c.2480_2484del) in FBXO11 gene.High-throughput sequencing technology increases the possibility of identifying potential genetic mutations as the cause of disease.Patients with recurrent seizures, multi-malformation and general developmental delays should undergo gene detection in time to clarify the etiology.This technique can guide prenatal diagnosis and genetic counseling.

Case report of intellectual developmental disorder with dysmorphic facies and behavioral abnormalities due to FBXO11 gene mutation / 中华实用儿科临床杂志

A retrospective analysis was performed on the clinical data of a case of intellectual developmental disorders with dysmorphic facies and behavioral abnormalities admitted in the Department of Neurology and Endocrinology, Children′s Hospital Affiliated to Shandong University in February 2020.The proband was a 3 years and 6 months old boy, who was hospitalized because of " convulsions for more than 1 year" . Physical examination revealed facial deformities.Gesell developmental schedule showed that adaptive and gross motor behavior development was severely retarded, and fine motor, language and personal-social behavior development was moderately retarded.Brain magnetic resonance imaging suggested schizencephaly.Electroencephalogram results indicated extensive discharges mainly in bilateral anterior head areas, and one myoclonic seizure was detected.Gene detection results disclosed the pathogenic variation of the proband, which was a heterozygote mutation (c.2480_2484del) in FBXO11 gene.High-throughput sequencing technology increases the possibility of identifying potential genetic mutations as the cause of disease.Patients with recurrent seizures, multi-malformation and general developmental delays should undergo gene detection in time to clarify the etiology.This technique can guide prenatal diagnosis and genetic counseling.

Considerações sobre a busca por muscularidade entre homens gays / Considerations about drive for muscularity among gay men

Apresenta-se um manuscrito no formato de "carta ao editor", em que é abordada a busca por muscularidade por homens gays e suas possíveis funções, como reparação da autoestima danificada por exposição crônica a experiências de homofobia, necessidade ou desejo de uma aparência mais masculina, sensação de força e capacidade de autoproteção e evitação da constatação da própria fragilidade psíquica. São apresentadas indicações a profissionais de saúde mental que cuidam dessa população. Alguns fragmentos da experiência clínica do primeiro autor são apresentados a título de ilustração. (AU)

A manuscript in the form of a "letter to the editor" is presented, in which the search for muscularity by gay men and its possible functions is addressed, such as repairing self-esteem damaged by chronic exposure to experiences of homophobia, need or desire for a more masculine appearance, feeling of self-confidence and capacity for self-protection and avoidance of the realization of one's own psychic fragility. Indications are presented to mental health professionals who care for this population. Some fragments of the first author's clinical experience are presented by way of illustration.(AU)

Se presenta un manuscrito en forma de "carta al editor", en el que se aborda la búsqueda de la musculatura por parte de los hombres homosexuales y sus posibles funciones, como reparar la autoestima dañada por la exposición crónica a experiencias de homofobia, necesidad o deseo de apariencia más masculina, sentimiento de fortaleza y capacidad de autoprotección y evitación de la realización de la propia fragilidad psíquica. Se presentan indicaciones a los profesionales de la salud mental que atienden a esta población. A modo de ilustración se presentan algunos fragmentos de la experiencia clínica del primer autor.(AU)

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.

Translation, cultural adaptation, and evidence of instrument validity for a morphological examination performed in children with autism spectrum disorder / Tradução, adaptação cultural e evidência de validade de instrumento para o exame morfológico aplicado a crianças com transtorno do espectro autista

ABSTRACT Objective: For every 100 random children diagnosed with autism, at least 20 have morphological abnormalities, often associated with syndromes. Brazil does not have a standardized and validated instrument for morphological physical examination. This study aimed to translate into Brazilian Portuguese and culturally adapt the clinical signs described in the Autism Dysmorphology Measure, as well as validate the instrument in a sample of children with autism. Methods: The original instrument was translated, culturally adapted, and published in full, following traditional procedures for translation, back-translation, and terminology adaptation according to the Nomina Anatomica. The sample included 62 children from a published multicenter study, with intelligence quotient between 50-69, of both genders, with chronological age between 3-6 years. Two clinical geneticists performed the morphological physical examination, which consisted of investigating 82 characteristics assessing 12 body areas. We used Cohen's Kappa coefficient to evaluate the agreement between the two observers. Results: The final version of the instrument - translated into Brazilian Portuguese and culturally adapted - showed high agreement between the two observers. Conclusions: The translated instrument meets all international criteria, and minor anomalies and their clinical descriptions were standardized and are recognizable for physicians not specialized in genetics.

RESUMO Objetivo: Entre 100 crianças, não selecionadas, com diagnóstico de autismo, pelo menos 20 apresentam anomalias morfológicas, quase sempre associadas a síndromes. Não há no Brasil instrumento de exame físico morfológico padronizado e validado. O objetivo foi traduzir para o português do Brasil e adaptar culturalmente os sinais clínicos descritos no Autism Dysmorphology Measure, assim como procurar evidências de validade quando aplicado a uma amostra de crianças com autismo. Métodos: Foram feitas a tradução e a adaptação cultural do instrumento original, publicado na íntegra. Foram adotados os procedimentos tradicionais de tradução, retrotradução e adaptação da terminologia segundo a Nomina Anatomica. Foram incluídas na amostra 62 crianças com quociente de inteligência entre 50 e 69, de ambos os sexos, com idade cronológica entre três e seis anos, provenientes de estudo multicêntrico com os procedimentos metodológicos já publicados. O exame físico morfológico foi realizado por dois médicos geneticistas e consistiu na pesquisa de 82 características que avaliam 12 áreas corporais. Para avaliar a concordância entre os dois observadores foi utilizado o coeficiente Kappa de Cohen. Resultados: A versão final do instrumento traduzido e adaptado culturalmente ao português do Brasil mostrou alta concordância entre os dois observadores. Conclusões: O instrumento traduzido preenche todos os critérios propostos internacionalmente e o reconhecimento das anomalias menores e sua descrição clínica estão padronizados e são de fácil reconhecimento aos médicos não especialistas em genética.

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.

Partial trisomy 15: a rare occurrence

Partial trisomy 15q is a very rare entity and most of them are characterized by duplication of regions 15q21-15q26.3. This duplication is frequently associated with deletions in another chromosome resulting in unbalanced translocations. Authors report here, a rare case of partial trisomy 15, with breakpoints between 15q11.1 to q23, probably the first reported case with these breakpoints. Irrespective of the breakpoints, the phenotypic features are consistent in all affected cases and predominantly consist of craniofacial anomalies. In addition, finger abnormalities, very short neck, skeletal malformations and congenital heart disease may be present. Our neonate had typical dysmorphic features of arachnocamptodactyly, narrow face, large prominent, nose with broad nasal bridge, long philtrum, pointed chin, short neck, and low set deformed ears.' Neonates' cytogenetic analysis revealed additional chromosomal material on the long arm of the chromosome 15 from q11.1 to q23.1, which was suggestive of partial trisomy of chromosome 15. Most cases reported have had a stormy clinical course, however, our proband had only mild respiratory distress at birth and she was discharged in a few days.

Transtorno dismórfico corporal sob a perspectiva do cirurgião plástico / Body dysmorphic disorder from the perspective of the plastic surgeon

O transtorno dismórfico corporal é encontrado com uma certa frequência nos atendimentos relacionados à estética. Entretanto, permanece subdiagnosticado devido à dificuldade de diferenciar uma insatisfação pessoal natural com a imagem corporal de uma queixa patológica. Para os pacientes com TDC, o incômodo gerado pelo seu "defeito" costuma ser desproporcional ao que observamos no exame físico. Além disso, na tentativa de corrigir aquilo que não lhe agrada, ele se submete a diversos procedimentos cirúrgicos que, em grande parte das vezes, considerará insuficiente para a resolução do seu problema. Nesse sentido, buscamos, com este trabalho, ampliar as discussões já existentes na literatura especializada. Assim, assumindo a escassa bibliografia, tencionamos, além de construir discussões acerca dessa afecção, o que pode contribuir para a identificação dos traços desse transtorno, evitando, por conseguinte, a realização de procedimentos cirúrgicos desnecessários e nortear as ações do especialista no que diz respeito à possibilidade de uma disputa judicial.

Body dysmorphic disorder (BDD) is found with a certain frequency in aesthetic-related care. However, it is underdiagnosed due to the difficulty in differentiating a personal dissatisfaction with body image of a pathological complaint. For BDD patients, the discomfort generated by their "defect" is often disproportionate to that observed on physical examination. In addition, in an attempt to correct their "defect", the patients undergoes various surgical procedures, which are often considered insufficient by the patients to solve their problem. Hence, this study aimed to expand the already existing discussions in the specialized literature. Since there are only a few studies on the topic, we plan to discuss this condition so as to contribute towards identification of the characteristics of this disorder, thus, avoiding unnecessary surgical procedures and guiding the specialist's actions in case of a legal dispute.

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)

Thanatophoric dysplasia: a case report

Thanatophoric Dysplasia (TD) is a congenital, sporadic and most lethal skeletal dysplasia caused by new mutation in FGFR3 gene. Authors report such a rare case of a term alive baby with dysmorphic features, born to an unbooked, 40 years old G4P3+0 with non-consanguineous marriage; admitted at 9 months of gestation to present hospital with complain of pain abdomen for 2 days. Patient delivered a term female baby of vaginally which had delayed cry after birth, Admitted in NICU immediately with respiratory distress. The baby looked dysmorphic and suggested TD as most likely diagnosis. The case is being reported for its rarity and for high importance of early booking and anomaly scan. Early diagnosis is important since it provides alternative options of termination of pregnancy when an affected foetus is detected.

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.

Three-dimensional computed tomography analysis and clinical application of sacroiliac screw placement / 中华外科杂志

Objective@#To evaluate the possibility of transverse sacroiliac screw placement in different segments of the sacrum.@*Methods@#Data of 80 pelvic CT scans (slice thickness ≤1.0 mm) archived in CT department of the Third Hospital of Hebei Medical University from September 2016 to October 2017 were retrospectively collected. Mimics software was used to rebuild the pelvis three-dimensional model. According to whether the sacral 1(S1) segment could place the transverse sacroiliac screws or not, all the sacrums were divided into normal group (n=55) and dysmorphic group (n=25). Simulation the S1, sacral 2(S2) transverse sacroiliac screw placement in 3-Matic software. Analysis whether there was any difference in maximum diameter and length of S2 transverse sacroiliac screw between the normal group and the dysmorphic group. The pelvic CT data of the dysmorphic group were measured, and the optimal tilt angle and length of the oblique S1 screw were obtained. The feasibility of transverse sacroiliac screw insertion in sacral 3(S3) segment was evaluated.t-test, rank sum test, and χ2 test was used to analyze data, respectively.@*Results@#In the dysmorphic group, the largest diameter of the S1 transverse screw was (4.9±1.6)mm, and the normal group was (13.6±3.6)mm (t=-15.07, P=0.00). In the dysmorphic group, the largest diameter of S2 transverse screw was (13.8±3.0)mm, and was (12.4±2.2)mm in the normal group(t=2.11, P=0.04). There was no significant difference in the length of S2 transverse sacroiliac screw between the two groups (t=0.47, P=0.64). In the dysmorphic group, the anterior vertebral height of S1 was (23.1±4.0)mm, which was significantly higher than that of the normal group ((14.1±4.2)mm)(t=9.01, P=0.00). The angle of S1S2 in the dysmorphic group was 10.9°(3.8°, 17.6°), which was significantly larger than that of the normal group (2.0°(1.0°, 2.0°) (Z=-4.03, P=0.00). In the dysmorphic group, the incline angle of the oblique S1 sacroiliac screw was (35.6±6.2)°, the anteversion angle was (37.2±4.4)°, and the mean screw length was (90.2±4.7)mm. In the dysmorphic group, the placement rate of S3 transverse sacroiliac screw was 48.0%, and that of the normal sacral group was 9.1%.@*Conclusions@#There is often dysmorphic in the sacrum in patients with large S1 anterior vertebral height and S1S2 angle. Sacral dysmorphic patients with posterior pelvic ring injury may be treated with S1 pedicle oblique sacroiliac screws. S3 transverse sacroiliac screws should be carefully placed, especially for the absence of sacral dysmorphic in patients.

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.

Transtornos psiquiátricos na medicina estética: a importância do reconhecimento de sinais e sintomas / Psychiatric disorders in aesthetic medicine: the importance of recognizing signs and symptoms

Transtornos psiquiátricos são amplamente evidenciados em pacientes que buscam tratamentos estéticos. Apesar de não configurarem necessariamente uma contraindicação para a realização de procedimentos, o reconhecimento desses sintomas pelo profissional tende a contribuir para o fortalecimento da relação profissional-paciente e para um melhor prognóstico, reduzindo as chances de insatisfação, complicações e agravos nos sintomas psiquiátricos, além de evitar complicações legais. No presente artigo, os transtornos psiquiátricos mais comuns no domínio cosmético e estético foram apresentados e discutidos, assim como as orientações para o reconhecimento de sintomas e de manuseio destes pacientes por profissionais de saúde.

Psychiatric disorders are widely reported in patients seeking aesthetic treatments. Although they are not necessarily a contraindication for procedures, the recognition of these symptoms by the professional tends to strengthen the professional-patient relationship, thus leading to a better prognosis. This reduces the chances of dissatisfaction, complications, and aggravation of psychiatric symptoms, in addition to avoiding legal complications. In this article, the most common psychiatric disorders arising in cosmetic and aesthetic treatment are presented and discussed, as well as guidelines for recognizing the symptoms and managing these patients.