Body Dysmorphic disorder

Question 1

DSM-5 TR Diagnosis Body Dysmorphic Disorder

Answer 1

Criterion A: Pre-occupation with one or more perceived defects or flaws in physical appearance
- Think about appearance 3-8 hours per day
B: Repetetive behaviours and mental acts
- 6 per day
C: Distress and functional impairment
D: Not better explained by another mental disorder/condition

Question 2

Cosmetic pursuits?

Answer 2

71-76% seek cosmetic treatment
64-66% receive cosmetic treatment
- Some engage in DIY procedures which rarely work and can be dangerous

Question 3

Statistics?

Prevalence?

Answer 3

General statistics

• 48% require psychiatric hospitalisation
• 78-81% report suicidal thoughts, 24% have attempted suicide
• 77% report moderate, severe or extreme interference with occupational/academic functioning
• 39% did not work for at least one week in past month due to BDD symptoms
• 18% adolescents left school
• 27-31% completely housebound for at least a week due to BDD symptoms, some are housebound for years

Prevalence and sociodemographic characteristics

1.7-2.9% according to epidemiologic studies
Psychiatric adult inpatient settings: 13-16%
Cosmetic surgery settings 5.2-20.1%
Can affect any age (reports of BDD in children aged 4 and adults as old as 80)
Close to 50:50 men/women
Risk factors: single, divorced and unemployed

Question 4

Specifiers?

Answer 4

Muscle dysmorphia
- Good or fair insight, poor insight, absent insight
- Insight is usually poor, 32% have delusional beliefs

Question 5

Causes and Maintenance factors

Answer 5

• Genetic, Neurobiological, information-processing biases
• Psychological and sociocultural, evolutionary
• Males: sociocultural pressures regarding hypermasculinity and the male body ideal
• Abnormalities in visual processing - BDD patients show hyper-activity in left hemispheric areas (areas processing detail), even in blurry images
• Focus too much on little details, ignore the bigger picture

Question 6

Cognitive behavioural model for BDD

Answer 6

Selective attention and overfocusing
- Life experiences,
- personality traits, core beliefs
- Neurobiology and genetics

Maladaptive interpretations
- Triggers (stress, negative comments, physical changes during adolescence, negative mood)

Both contribute to:
- Distressed feelings
- Self-defeating coping strategies (avoidance behaviours, rituals)

Question 7

Treatments?

Answer 7

CBT
Cognitive restructuring
- Identifying and challenging thought patterns (perfectionistic thinking, delusions of reference/mind reading)
The woman looked at me funny and whispered to her friend about me. They are laughing about how scrawny I look –> it is possible that they are talking about a memory they had which has nothing to do with me

• Aims to eliminate ritualistic and safety seeking behaviours that maintain BDD preoccupation and related distress
• Exposure to situations to elicit appearance related distress repeated, while helping them to reduce the urge to engage in ritualistic and safety behaviours as a response

Exposure and ritual prevention
1. First exposure task mildly-to-moderately challenging and success likely
2. Then move up “ladder” of exposure tasks
3. Provide patient with strategies to resist rituals
4. Help patients learn to tolerate distress and not resort to rituals/safety-seeking behaviours to cope

Mindfulness/perceptual retraining
- People with BDD show problematic global processing of visual information and tend to focus on detail
- Aim is to let the patient to form a holistic view as opposed to specific details of themselves

Telling the patient to move away from the mirror and describe each part of their body in a holistic, reasonable, non-evaluative/judgemental way

“My eyes make me look like a monster” –> “My eyes are blue and allow me to see”