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Body Dysmorphic Disorder: Capturing a prevalent but under-recognized disorder
Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Paediatrics in Linköping.
2017 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background

Individuals with body dysmorphic disorder (BDD) are highly distressed due to defects they perceive in their physical appearance that are not noticeable to others. The condition often leads to impaired functioning in relationships, socialization, and intimacy and a decreased ability to function in work, school, or other daily activities. Although BDD seems to be relatively prevalent, it is under-recognized by people in general and by health care professionals. Individuals with BDD are secretive about their symptoms, and they usually do not recognize that they are suffering from a psychiatric disorder. Instead, in an attempt to relieve their symptoms by correcting their perceived defects, they commonly seek dermatological treatment or cosmetic surgery. However, such interventions usually do not result in any decrease in BDD symptom severity, but can rather aggravate the symptoms. Therefore, it is crucial that health care professionals recognize BDD in order to offer adequate care. Prior to the studies conducted for this thesis, there were no known data regarding the prevalence of BDD in Sweden.

Main aims

(i) To translate a screening questionnaire for BDD (the Body Dysmorphic Disorder Questionnaire, BDDQ) into Swedish and validate the questionnaire in a community sample. (ii) To estimate the prevalence of BDD in the general population of Swedish women and in female dermatology patients. (iii) To explore BDD patients’ experiences of living with the disorder, including their experiences of the health care system.

Methods

The BDDQ was validated using the Structured Clinical Interview for DSM-IV (SCID) as the gold standard for diagnosing BDD (Study I). The validated BDDQ was used to estimate the prevalence of BDD in a randomly selected population-based sample of Swedish women (n=2 885) (Study II) and in a consecutive sample of female dermatology patients (n=425) (Study III). In Studies II and III, the Hospital Anxiety and Depression Scale was used to assess symptoms of depression and anxiety. In Study III, quality of life was evaluated by the Dermatology Life Quality Index. BDD patients’ lived experiences were explored using a qualitative research design (Study IV). Fifteen individuals with BDD were interviewed, and the interviews were analysed using Interpretive Description.

Results

The Swedish translation of the BDDQ displayed a sensitivity of 94%, a specidicity of 90% and a (positive) likelihood ratio of 9.4. The prevalence of women screening positive for BDD was 2.1% (95% CI 1.7–2.7) in the population-based sample of women and 4.9% (95% CI 3.2–7.4) in the dermatology patients’ sample. The positive predictive value of the BDDQ (71%) gave an estimated BDD prevalence of 1.5% (95% CI 1.1–2.0) in the female Swedish population. Women screening positive for BDD had signidicantly more symptoms of anxiety and depression compared to those screening negative for BDD in both samples. In the dermatology patients, quality of life was severely impaired in patients with positive BDD screening. The overarching concept found in Study IV was that patients with BDD felt imprisoned and were struggling to become free and to no longer feel abnormal. The participants had encountered difdiculties in accessing health care and had disappointing experiences of the health care system.

Conclusion

The findings of this thesis indicate that BDD is a relatively common disorder in the Swedish female population, and that it is more prevalent in dermatology patients. BDD patients struggle to be free from a feeling of imprisonment, and in this struggle they encounter difficulties in accessing health care. Therefore, it is important to increase awareness and recognition of BDD among health care professionals to ensure that patients with BDD receive the appropriate care.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2017. , 83 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1557
National Category
Psychiatry Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
URN: urn:nbn:se:liu:diva-133368DOI: 10.3384/diss.diva-133368ISBN: 9789176856116 (print)OAI: oai:DiVA.org:liu-133368DiVA: diva2:1059504
Public defence
2017-02-10, Berzeliussalen, Campus US, Linköping, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2016-12-22 Created: 2016-12-22 Last updated: 2017-01-18Bibliographically approved
List of papers
1. Validation of the Body Dysmorphic Disorder Questionnaire in a community sample of Swedish women
Open this publication in new window or tab >>Validation of the Body Dysmorphic Disorder Questionnaire in a community sample of Swedish women
2013 (English)In: Psychiatry Research, ISSN 0165-1781, E-ISSN 1872-7123, Vol. 210, no 2, 647-652 p.Article in journal (Refereed) Published
Abstract [en]

Body Dysmorphic Disorder (BDD) is characterized by a distressing and impairing preoccupation with a nonexistent or slight defect in appearance. Patients with the disorder present to both psychiatric and non-psychiatric physicians. A few studies have assessed BDD prevalence in the general population and have shown that the disorder is relatively common. To date, no BDD assessment instruments have been validated in the general population. Our aim was to validate a brief self-screening instrument, the Body Dysmorphic Disorder Questionnaire (BDDQ), in a female community sample. The BDDQ was translated into Swedish and filled out by 2891 women from a randomly selected community sample. The questionnaire was validated in a subsample of 88 women, using the Structured Clinical Interview for DSM-IV (SCID) together with clinical assessment as the gold standard. In the validation subsample, the BDDQ showed good concurrent validity, with a sensitivity of 94%, a specificity of 90% and a likelihood ratio of 9.4. The questionnaire can therefore be of value when screening for BDD in female populations.

Place, publisher, year, edition, pages
Elsevier, 2013
Keyword
Self-report instrument; Measurement; Somatoform disorders; Appearance concerns; Body image
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-103301 (URN)10.1016/j.psychres.2013.07.019 (DOI)000328518600044 ()
Available from: 2014-01-17 Created: 2014-01-16 Last updated: 2016-12-22
2. Prevalence of body dysmorphic disorder among Swedish women: A population-based study
Open this publication in new window or tab >>Prevalence of body dysmorphic disorder among Swedish women: A population-based study
2015 (English)In: Comprehensive Psychiatry, ISSN 0010-440X, E-ISSN 1532-8384, Vol. 58, 108-115 p.Article in journal (Refereed) Published
Abstract [en]

Background: Body dysmorphic disorder (BDD) is characterized by a highly distressing and impairing preoccupation with nonexistent or slight defects in appearance. Patients with BDD present to both psychiatric and non-psychiatric physicians. A few studies have assessed BDD prevalence in representative samples of the general population and have demonstrated that this disorder is relatively common. Our primary objective was to assess the prevalence of BDD in the Swedish population because no data are currently available. Methods: In the current cross-sectional study, 2891 randomly selected Swedish women aged 18-60 years participated. The occurrence of BDD was assessed using the Body Dysmorphic Disorder Questionnaire (BDDQ), which is a validated self-report measure derived from the Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV criteria for BDD. In addition, symptoms of depression and anxiety were measured using the Hospital Anxiety and Depression Scale (HADS). Results: The prevalence of BDD among Swedish women was 2.1%. The women with BDD had significantly more symptoms of depression and anxiety than the women without BDD. Depression (HADS depression score greater than= 8) and anxiety (HADS anxiety score greater than= 8) were reported by 42% and 72% of the women with BDD, respectively. Conclusions: The results of the present study indicate that BDD is relatively common among Swedish women (2.1%) and that it is associated with significant morbidity.

Place, publisher, year, edition, pages
WB Saunders, 2015
National Category
Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-117368 (URN)10.1016/j.comppsych.2014.12.014 (DOI)000351807800015 ()25617963 (PubMedID)
Note

Funding Agencies|Linkoping University; Ostergotland County Council

Available from: 2015-04-24 Created: 2015-04-24 Last updated: 2016-12-22
3. I will be at deaths door and realize that Ive wasted maybe half of my life on one body part: the experience of living with body dysmorphic disorder
Open this publication in new window or tab >>I will be at deaths door and realize that Ive wasted maybe half of my life on one body part: the experience of living with body dysmorphic disorder
2016 (English)In: International journal of psychiatry in clinical practice (Print), ISSN 1365-1501, E-ISSN 1471-1788, Vol. 20, no 3, 191-198 p.Article in journal (Refereed) Published
Abstract [en]

Objectives: The purpose of this study was to explore the experiences of patients living with body dysmorphic disorder (BDD), including their experiences with the health care system. Methods: Fifteen individuals with BDD were interviewed, and interpretive description was used to analyse the interviews. Results: The following six themes were identified: being absorbed in time-consuming procedures, facing tension between ones own ideal and the perceived reality, becoming the disorder, being restricted in life, attempting to reduce ones problems and striving to receive care. The overarching concept derived from the themes was feeling imprisoned - struggling to become free and to no longer feel abnormal. Conclusions: Ideas of imprisonment and abnormality compose the entire experience of living with this disorder. Although the participants suffered greatly from their BDD, these patients encountered difficulties in accessing health care and had disappointing experiences during their encounters with the health care system. Therefore, it is important to increase awareness and knowledge of BDD among health care professionals to ensure that patients with BDD receive the appropriate care.

Place, publisher, year, edition, pages
TAYLOR & FRANCIS LTD, 2016
Keyword
Body dysmorphic disorder; body image; interview; qualitative research
National Category
Psychiatry
Identifiers
urn:nbn:se:liu:diva-131206 (URN)10.1080/13651501.2016.1197273 (DOI)000380144000013 ()27314665 (PubMedID)
Available from: 2016-09-16 Created: 2016-09-12 Last updated: 2016-12-22

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