Body dysmorphic disorder common among adolescent girls, linked to psychiatric comorbidity

Key takeaways:

• Body dysmorphic disorder is more prevalent in adolescence than childhood, particularly among girls.
• Screening for this disorder in young people with anxiety and depressive disorders may improve detection.

Body dysmorphic disorder and appearance preoccupation were relatively common among youth, especially adolescent girls, according to a study published in Journal of the American Academy of Child & Adolescent Psychiatry.

Additionally, body dysmorphic disorder (BDD) was associated with high levels of comorbid psychopathology, risk and psychosocial impairment.

“Underdiagnosis and undertreatment of BDD is a major concern and likely to reflect a range of barriers including reluctance to seek help, but also limited awareness of BDD among mental health professionals,” Georgina Krebs, PhD, associate professor of young person’s mental health and cognitive behavioral therapy at University College London, and colleagues wrote. “Increasing knowledge of BDD among clinicians is therefore an important clinical priority.”

Using data from 7,654 children and young people aged 5 to 19 years (mean age, 11.18 years; 49.7% girls) who completed the 2017 Mental Health of Children and Young People in England survey, researchers evaluated the prevalence, comorbidity and psychosocial impairment associated with BDD and appearance preoccupation, the latter of which they noted may be a precursor to BDD and therefore a target for early intervention.

Researchers used the Development and Well-being Assessment, a standardized diagnostic tool for measuring psychiatric disorders in young people, to assess BDD and psychiatric comorbidity according to DSM-5 criteria. Researchers also conducted structured interviews to evaluate psychosocial impairment — including self- and parent-reported psychosocial impact, self-harm and suicide attempts — and service utilization.

In the overall sample, the point prevalence of BDD was 1% (95% CI, 0.8-1.3).

BDD was significantly more common among adolescents than children (1.9% vs. 0.1%; OR = 22.57; 95% CI, 8.18-62.3), and also significantly more common among female than male participants (1.8% vs. 0.3%; OR = 7.03; 95% CI, 3.29-15.01).

“Overall, our results suggest that the prevalence of BDD increases sharply from childhood to adolescence, particularly among girls, although in our analyses this interaction effect did not reach statistical significance,” the researchers wrote. “Nevertheless, findings highlight that adolescent girls are at the highest risk of experiencing BDD, with an estimated prevalence of 3.4%.”

Researchers noted similar patterns with appearance preoccupation, with higher rates among adolescents than children (self-report, 8.5% vs. 1.4%; parent-report, 5.9% vs. 1.6%) and among girls than boys (self-report, 11.4% vs. 4.3%; parent-report, 4.7% vs. 2.4%). Appearance preoccupation also showed a higher prevalence overall than BDD by self-report (7.8%) and parent-report (3.5%).

In addition, 69.8% (95% CI, 56.8-80.4) of young people with BDD had at least one psychiatric comorbidity, most commonly anxiety-related (58.7%; 95% CI, 45.6-70.8) and depressive disorders (31.7%; 95% CI, 20.9-44.8).

The researchers also found that self-harm or suicide attempts were common among those with BDD, including 46.3% by self-report and 35% by parent-report. Self-harm or suicide attempts occurred more frequently among those with vs. without BDD (OR by self-report = 8.57; 95% CI, 4.67-15.8; OR by parent-report = 14.75; 95% CI, 7.5-29.12).

Although BDD participants were more likely than those without BDD to have sought professional help (59.7% vs. 20.8%, OR = 5.11; 95% CI, 2.9-8.98) and currently take a selective serotonin reuptake inhibitor (7.9% vs. 0.6%, OR = 13.52; 95% CI, 4.94-37.01) or other psychotropic medication (15.9% vs. 3.2%, OR = 5.35; 95% CI, 2.53-11.31), the researchers noted that “a large proportion of young people with BDD do not access services and evidence-based treatments, namely cognitive behavior therapy and SRI medication.”

“Efforts are needed to raise awareness of BDD, improve screening practices and reduce barriers to evidence-based treatment,” the researchers added.