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7/20/16
www.caleblack.com 1
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
0
10
20
30
40
50
60
70
80
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
MediaCri@que#3