Dermatologists play significant role in detecting, addressing body dysmorphic disorder
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Key takeaways:
- Overall prevalence of body dysmorphic disorder (BDD) in the U.S. is 2.4%, but among dermatology patients, it is 9% to 15%.
- BDD often begins in adolescence, putting pediatric dermatologists on the front lines.
In a new study published in the Journal of Drugs in Dermatology, researchers discussed how and why dermatologists have a significant role to play in the diagnosing and addressing of body dysmorphic disorder.
“Body dysmorphic disorder (BDD) is an often debilitating psychiatric disorder categorized within the spectrum of obsessive-compulsive and related disorders,” Zane Sejdiu, BS, an MD candidate at Drexel University College of Medicine, and colleagues wrote. “BDD is particularly prevalent among dermatology patients because the skin and hair are the two most common body areas of concern in both females and males with BDD.”
The overall prevalence of BDD in the U.S. is 2.4%, but this rate increases to between 9% and 15% among dermatology patients, according to this study. Additionally, results from a survey of 500 U.S. dermatologists showed that while 75% of dermatologists reported routinely asking about their patients’ mental health, 60% reported having no formal training in the mental health field.
Due to the high risks associated with BDD such as major depressive disorder, suicidal ideation and suicide attempts, these patients cannot rely on the work of dermatologists alone to treat their condition — they need trained mental health professionals.
As a result, Sejdiu and colleagues conducted a study discussing the signs and causes of BDD as well as the patient profile affected by this condition to help dermatologists know when and how to seek the assistance of a mental health professional for patients.
According to the study, BDD differentiates itself from normal preoccupations with appearance by causing excessive and debilitating distress over minimally noticeable flaws that eventually lead to significant impairment in functioning. BDD sufferers may engage in behaviors to an excessive degree — such as checking mirrors, grooming, picking skin, seeking reassurance and pursuing cosmetic treatments — to the point of putting pressure on physicians for procedures that they do not need or are ill-advised. In fact, cosmetic procedures often exacerbate the issue as these patients usually experience low satisfaction following a cosmetic treatment, which then continues the cycle of focusing on what patients consider a “true physical flaw.”
Approximately two-thirds of individuals with BDD experience the onset of the disorder before age 18 years, with onset most often between age 12 to 13 years.
“Pediatric dermatologists may be unaware of how common BDD is in their patient population,” the authors wrote, adding that current research showed that acne and atopic dermatitis — conditions that usually present during adolescence — are associated with a six-fold increase in developing BDD.
Research has also shown that the use of technology and social media is linked to the development or worsening of BDD. According to a 2022 Pew Research Center survey of teenagers in the U.S., 95% of adolescents have access to smartphones and 97% report daily use of the internet.
While social media is not inherently bad, 95% of dermatologists have reported that social media has caused problems for their adolescent and young adult patients. As a result, many dermatologists may think that simply telling their patients with BDD to stop using social media will solve the problem. Unfortunately, that is not the case.
“Simply recommending that adolescents stop using social media is not enough for patients who have BDD,” the authors wrote. “Dermatologists must make connections with mental health providers who are knowledgeable about BDD to facilitate comprehensive assessment and adequate treatment of BDD.”
According to the authors, dermatologists should have connections with mental health providers the same way they have a referral system with internists, pediatricians and other practitioners.
“This network would allow patients to have a more seamless and prompter referral to the appropriate mental health services once BDD is suspected,” they wrote.
The authors emphasized that while BDD is a crippling condition, it is often missed by dermatologists. This may be due to dermatologists neglecting to ask the right questions with research showing only 12% of dermatologists ask their patients about daily social media consumption. Further, BDD suffers may appear attractive to others, which could sway suspicions away from a BDD diagnosis; nevertheless, they internally suffer from debilitating fixations.
According to the study, if a dermatologist suspects that their patient has BDD, they should ask the patient to complete a self-report screening questionnaire. The BDDQ-Dermatology Version or BDDQ-Adolescent Version are two such questionnaires that can be helpful in confirming suspected BDD.
This assessment can be done once the dermatologist establishes a rapport with the patient that gradually allows for the introduction of mental health conversations. Once BDD is confirmed, the goal is to slowly transfer their relationship with the patient from one in which they are the primary care provider to one where the mental health professional is.
“The recognition and management of BDD in dermatology practice requires a holistic approach that integrates education, awareness, screening and collaboration with mental health providers,” the authors concluded. “By addressing BDD effectively, dermatologists can make an important, positive impact on the lives of their patients.”
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