04 - body dysmorphic disorder - caleb lack

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BodyDysmorphicDisorder

BodyImage•  Asubjec@veevalua@onofyouroutwardappearance,contrastedwithanobjec@veevalua@on

•  Morethan50%ofAmericanwomenand45%ofAmericanmenaredissa@sfiedwiththeiroverallappearanceandbodyimage

•  Bodyimagedissa@sfac@onleadstomanyappearanceenhancingbehaviors,includingweightloss,exercise,cosme@csuse,cosme@csurgery,andhairrestora@on.

InfluencesonBodyImage

•  Mediaandpopularculture– Underweightmodelsandcelebri@essendthemessagethatbeingthinisbest

– StrivingtoachievethesethinstandardsoOenmakespeopleill

– Astudyofmorethan4,000televisioncommercialsrevealedthatmorethanoneoutofeveryfoursendssomesortof“aQrac@venessmessage”

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InfluencesonBodyImage

•  Family,community,andculturalgroups– Parentsareespeciallyinfluen@al–  Interac@onswithsiblingsandotherrela@ves,peers,teachers,coworkers,andothercommunitymemberscanalsoinfluence

– Associa@onsofphysicalfeatureswithcertaintraitswithincultures

– EuropeanAmericanfemalesexperiencethehighestratesofbodydissa@sfac@on

Opera@onalDefini@on

A.  Preoccupa@onwithoneormoreperceiveddefectsorflawsappearancethatarenotobservableorappearslighttoothers.

B.  Atsomepointduringthecourseofthedisorder,theindividualhasperformedrepe@@vebehaviors(e.g.,mirrorchecking,excessivegrooming,skinpicking,reassuranceseeking)ormentalacts(e.g.,comparinghisorherappearancewiththatofothers)inresponsetotheappearanceconcerns.

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Opera@onalDefini@on

C.  Thepreoccupa@oncausesclinicallysignificantdistressorimpairmentinsocial,occupa@onal,orotherimportantareasoffunc@oning.

D.  Thepreoccupa@onisnotbeQeraccountedforbyanothermentaldisorder(e.g.,dissa@sfac@onwithbodyshapeandsizeinAnorexiaNervosa).

BDDSpecifiers

•  WithMuscleDysmorphia– Theindividualispreoccupiedwiththeideathathisorherbodybuildistoosmallorinsufficientlymuscular

– Thisspecifierisusedeveniftheindividualispreoccupiedwithotherbodyareas(whichisoOenthecase)

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AssociatedFeatures

•  Preoccupa@onwithyourphysicalappearancewithextremeself-consciousness

•  Frequentexamina@onofyourselfinthemirror,ortheopposite,avoidanceofmirrorsaltogether

•  Strongbeliefthatyouhaveanabnormalityordefectinyourappearancethatmakesyouugly

AssociatedFeatures

•  Beliefthatotherstakespecialno@ceofyourappearanceinanega@veway

•  Avoidanceofsocialsitua@ons

•  Feelingtheneedtostayhousebound

AssociatedFeatures

•  Theneedtoseekreassuranceaboutyourappearancefromothers

•  Frequentcosme@cprocedureswithliQlesa@sfac@on

•  Excessivegroomingorexerciseinanunsuccessfulefforttoimprovetheflaw

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AssociatedFeatures

•  Theneedtocamouflageperceivedflaws

•  Comparisonofyourappearancewiththatofothers

•  Reluctancetoappearinpictures

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Skin

Hair

Nose

Eyes

Teeth

"Ugly"face

Lips

Chin

Eyebrow

sEars

Loca%onofPerceivedDefect

Comorbidity

0102030405060708090

Depression Personalitydisorder

SubstanceUse

SocialAnxiety

OCD Ea@ngdisorder

PercentageofBDDpa%entswith…

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Epidemiology

•  InUnitedStates,prevalenceof2.4%– 2.5%femalesvs.2.2%males

•  OutsideUS,prevalenceof1.7-1.8%

•  Commoninmedicalseings– 10%indermatologyclinics– Upto50%ofplas@csurgerypa@ents

GenderDifferences

•  Commonbodypartfocus– Men:physicalbuild,genitalia,thinninghair– Women:breasts/nipples,buQocks,excessivebodyhair,nose,skinblemishes,stomach,teeth,thighs,bodyweight

•  Typicalbehaviors– Men:weightliOing(5-6hours/day),substanceuse– Women:camouflage,ea@ngdisorder,skinpicking

ImpactofBDD

•  80%havehistoryofsuicidalidea@on,50%havefrequentsuicidalthoughts,25%haveaQempted

•  Over25%haveplas@csurgery,withpoorresults

•  70%nevermarry

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ImpactofBDD

•  Frequentunemploymentandloweduca@onalaQainment– Athirdlostaweekofworkormorepermonth– 11%hadpermanentlydroppedoutofschool

•  Over40%werehospitalizedatsomepoint

•  About30%reportbeinghouseboundat@mes

CourseofBDD

•  Meanageofonsetis16-17– 2/3rdsofthosewiththedisorderdevelopitbeforeage18

– Thosewhodevelopitbefore18aremorelikelytoaQemptsuicideandhavecomorbids

•  Chronic,typicallyunremiingproblem– Fewerthan6%ofpa@entsachievedremissioninathreeyearlongitudinalstudy

E@ology

•  Developmentalfactorsespeciallyprominent

•  Almost80%ofBDDpa@entsreportchildhoodmaltreatment(40%was“severe”)– Emo@onalneglect 68%– Emo@onalabuse 56%– Physicalabuse 35%– Physicalneglect 33%– Sexualabuse 28%

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E@ology

•  Gene@caspectaswell;4-8xmorelikelytohaveafamilymemberwithBDD

•  Par@cularneurocogni@vedeficits– Visualmemoryproblems– Poorworkingmemoryandplanning– Pooremo@onrecogni@on– Visualprocessingabnormali@es

EBTforBDD

•  Aspecifically-basedmodularCBThasbeendevelopedandevaluated

•  Over80%weretreatmentresponders(showeda30%dropinsymptoms)–  Alsoshoweddecreaseddepressionandincreasedqualityoflife

CBT-BDD

•  22sessions,sixcoreaspects– Psychoeduca@onandcaseformula@on– Mo@va@onalenhancement– Cogni@verestructuring– Exposurewithresponsepreven@on– Mindfulnessinstruc@onandperceptualretraining– Relapsepreven@on

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CBT-BDD

•  Fourop@onaltreatmentmodules– Compulsiveskinpickingandhairpulling– Concernsaboutmuscularity/shape/weight– Cosme@ctreatment– Moodmanagement

PharmacologyforBDD

•  SRIsarefirst-linechoice,moreeffec@vethanplacebos(effectsizeaverageof.70)

•  DosesoOenneedtobequitehighfortreatmentresponse,whichmaytakeupto12weeks

•  Supplemen@ngwithanan@psycho@cisunlikelytobehelpful

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