Body Dysmorphic Disorder

Abstract

The disorder is characterized by preoccupations with perceived defects or flaws in one’s own appearance, mostly in the face or head, which might not be present or might only be slight according to others. The concerns are often obsessive in nature and are thus reported to consume a significant amount of time and to be difficult to resist and control. Furthermore, some individuals with BDD show poor or no insight, meaning that they have trouble realizing that they actually look normal. Delusionality might be greater in the younger patients. Some individuals also show delusions of reference (i.e., thinking that others are talking or laughing about them because of their perceived flaw), and most engage in compulsive behaviors to check on, hide, or try to improve their perceived flaw. Further, mirror checking is very common. Most individuals with BDD also avoid situations in which others might become increasingly aware of the flaw(s). Clinical features of BDD in adolescents and adults appear to be largely similar across age groups, while no comparisons have been made with children. Individuals with BDD usually report a great impact on their psychosocial functioning, and the disorder is associated with high rates of suicidality. In addition, BDD in childhood and adolescence might be associated with various developmental challenges. Epidemiological studies report a rate of 1.7–2.4% point prevalence in the general population. Prevalence rates in high school students are comparable. The onset of the disorder is in adolescence, with a few mentions of childhood cases. Symptoms might often be interpreted as age-appropriate developmental concerns, with non-pathological valence during teenage years, and therefore not identified in the early stages. The disorder exhibits a chronic course if not treated. Despite the relevance of body image and the potential damage on, for instance, the development of identity by such a severe body image disturbance, research on BDD in youth is rare. Factors identified as maintaining factors of the disorder in adults have not yet been confirmed in youth, and successful treatment components in adults (CBT and SRIs) neither have been tested yet in youth in large randomized controlled trials, but have been positively evaluated in case studies and case series.