Body Dysmorphic Disorder

Body Dysmorphic Disorder is a mental health condition where children or teens worry a lot about how they look. They become very upset about tiny flaws in their appearance that they think they have. Sometimes the flaw isn’t even real. This disorder is sometimes called “imagined ugliness.”

Children and teens with Body Dysmorphic Disorder often feel a lot of shame. They may not want to go to school or see their friends because of how they think they look. They might try to cover up what bothers them with clothes or make-up or even want surgery to fix it. But physical changes do not make kids with this disorder feel better. They find something to worry about no matter how they really look.

Children who have Obsessive-Compulsive Disorder (OCD) are more likely to develop Body Dysmorphic Disorder.

What are the symptoms of Body Dysmorphic Disorder?

Unlike an eating disorder, Body Dysmorphic Disorder is not always about the child’s or teen’s weight or body fat. It usually starts around age 12 or 13. Kids and teens with Body Dysmorphic Disorder show symptoms including:

Core Symptoms

– Fixation on one or more perceived physical appearance defects or flaws that are either not observable or appear slight to others

– Repetitive behaviors such as mirror checking, excessive grooming, reassurance seeking

– Mental acts such as comparing appearance to the appearance of others

Associated Symptoms

– Too much worry or shame over the way they look

– Believing that a minor flaw makes them ugly

– Fixating on worry about a specific part of the body, like the nose or the teeth

– A lot of time spent looking in the mirror, or avoiding mirrors completely

– Constantly looking for reassurance about the way they look

– Refusing to appear in photos

– Wanting cosmetic surgery

– Mood swings

– Low self-esteem or negative views about self

– Social anxiety

– Worry that gets in the way of daily life

How is Body Dysmorphic Disorder Diagnosed?

It can be hard to diagnose Body Dysmorphic Disorder because its symptoms can look like other disorders, such as OCD or eating disorders. Sometimes children or teens have a hard time telling anyone that they are upset because of their appearance.

A child-adolescent psychiatrist may diagnose a child or teen with Body Dysmorphic Disorder after checking that the child’s or teen’s symptoms are related to the disorder or another cause. The psychiatrist may interview and/or assess both the child and a caregiver to figure out the specific nature of the child’s or teen’s symptoms. The practitioner will also try to determine that the child’s or teen’s symptoms are not related to something unexpected.

Body Dysmorphic Disorder facts

Worldwide frequency of the condition:
Body dysmorphic disorder is estimated to affect between 0.5% and 3.2% of the global population, although it varies among different groups (e.g., general population, students, dermatology patients, etc.). Currently, there is no representative national data in Brazil.

Gender ratio:
Gender data on Body Dysmorphic Disorder shows that females are diagnosed more often than males, with a ratio of 1.1:1.

Peak age of onset:
The peak age for onset of Body Dysmorphic Disorder is estimated to be between 16 and 17 years.

Proportion of the condition that emerges before age 18:
Approximately 66% of individuals with Body Dysmorphic Disorder will have been diagnosed by age 18.

What are the associated factors for Body Dysmorphic Disorder?

Some common factors linked with Body Dysmorphic Disorder are:

– Genetic and familial factors: Most likely a combination of multiple genes interacting with environmental factors. Also, having a close relative with the disorder or with OCD.

– Environmental factors: These include stressful life events, such as childhood neglect or abuse; teasing or bullying; and peer rejection.

What other disorders co-occur with Body Dysmorphic Disorder?

Even though each child and teen is different, Body Dysmorphic Disorder might often happen with Major Depressive Disorder. Social Anxiety Disorder, OCD, and substance-use problems might also be common.

How is Body Dysmorphic Disorder treated?

Treatment for Body Dysmorphic Disorder usually involves a combination of cognitive-behavioral therapy (CBT) and antidepressant medication. CBT helps kids learn to change their negative thoughts and bad feelings about themselves.

In severe cases, when a child or teen is in danger of hurting themselves, they may need to be hospitalized for a while.

Cosmetic surgery is not recommended as a treatment for Body Dysmorphic Disorder. This is because children or teens with the disorder are likely to start worrying about a new flaw in their appearance as soon as the old flaw changes.

References

Clinical description, symptoms, and diagnostic information

– American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders: Fifth Edition Text Revision DSM-5-TR. American Psychiatric Association Publishing, Washington, DC.

– Child Mind Institute. (2021, September 7). Quick guide to body dysmorphic disorder. _https://childmind.org/guide/quick-guide-to-body-dysmorphic-disorder/_

– World Health Organization. (2022, February). ICD-11 for mortality and morbidity statistics. 6B21 Body Dysmorphic Disorder. _https://icd.who.int/browse11/l-m/en#/http%3a%2f%2fid.who.int%2ficd%2fentity%2f731724655_

Facts

– American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders: Fifth Edition Text Revision DSM-5-TR. American Psychiatric Association Publishing, Washington, DC.

– Bjornsson, A. S., Didie, E. R., Grant, J. E., Menard, W., Stalker, E., & Phillips, K. A. (2013). Age at onset and clinical correlates in body dysmorphic disorder. Comprehensive Psychiatry, 54(7), 893–903. _https://doi.org/10.1016/j.comppsych.2013.03.019_

– Bjornsson, A. S., Didie, E. R., & Phillips, K. A. (2010). Body dysmorphic disorder. Dialogues in Clinical Neuroscience, 12(2), 221–232. _https://doi.org/10.31887/DCNS.2010.12.2/abjornsson_

– Institute for Health Metrics and Evaluation (IHME). (2019). GBD Compare Data Visualization. Seattle, WA: IHME, University of Washington. Available from _http://vizhub.healthdata.org/gbd-compare_. (Accessed 11/15/2022)

– Minty, A., & Minty, G. (2021). The prevalence of body dysmorphic disorder in the community: A systematic review. GLOBAL PSYCHIATRY ARCHIVES, 4(2), 130–154. _https://doi.org/10.52095/gp.2021.8113_

– Phillips, K. A., & Kelly, M. M. (2021). Body Dysmorphic Disorder: Clinical Overview and Relationship to Obsessive-Compulsive Disorder. FOCUS, 19(4), 413–419. _https://doi.org/10.1176/appi.focus.20210012_

Associated factors

– American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders: Fifth Edition Text Revision DSM-5-TR. American Psychiatric Association Publishing, Washington, DC.

– Kendler, K. S. (2013). What psychiatric genetics has taught us about the nature of psychiatric illness and what is left to learn. Molecular Psychiatry, 18(10), 1058–1066. _https://doi.org/10.1038/mp.2013.50_

– Mallinger, G., & Weiler, A. (2020). Psychosocial risk and body dysmorphic disorder: A systematic review. Journal of Human Behavior in the Social Environment, 30(8), 1030–1044. _https://doi.org/10.1080/10911359.2020.1790463_

Co-occurring disorders

– American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders: Fifth Edition Text Revision DSM-5-TR. American Psychiatric Association Publishing, Washington, DC.

– Castle, D., Beilharz, F., Phillips, K. A., Brakoulias, V., Drummond, L. M., Hollander, E., Ioannidis, K., Pallanti, S., Chamberlain, S. R., Rossell, S. L., Veale, D., Wilhelm, S., Van Ameringen, M., Dell’Osso, B., Menchon, J. M., & Fineberg, N. A. (2021). Body dysmorphic disorder: A treatment synthesis and consensus on behalf of the International College of Obsessive-Compulsive Spectrum Disorders and the Obsessive Compulsive and Related Disorders Network of the European College of Neuropsychopharmacology. International Clinical Psychopharmacology, 36(2), 61–75. _https://doi.org/10.1097/YIC.0000000000000342_

– Malcolm, A., Labuschagne, I., Castle, D., Terrett, G., Rendell, P. G., & Rossell, S. L. (2018). The relationship between body dysmorphic disorder and obsessive-compulsive disorder: A systematic review of direct comparative studies. Australian & New Zealand Journal of Psychiatry, 52(11), 1030–1049. _https://doi.org/10.1177/0004867418799925_

– Phillips, K. A., & Kelly, M. M. (2021). Body Dysmorphic Disorder: Clinical Overview and Relationship to Obsessive-Compulsive Disorder. FOCUS, 19(4), 413–419. _https://doi.org/10.1176/appi.focus.20210012_

Interventions

– Castle, D., Beilharz, F., Phillips, K. A., Brakoulias, V., Drummond, L. M., Hollander, E., Ioannidis, K., Pallanti, S., Chamberlain, S. R., Rossell, S. L., Veale, D., Wilhelm, S., Van Ameringen, M., Dell’Osso, B., Menchon, J. M., & Fineberg, N. A. (2021). Body dysmorphic disorder: A treatment synthesis and consensus on behalf of the International College of Obsessive-Compulsive Spectrum Disorders and the Obsessive Compulsive and Related Disorders Network of the European College of Neuropsychopharmacology. International Clinical Psychopharmacology, 36(2), 61–75. _https://doi.org/10.1097/YIC.0000000000000342_

– Harrison, A., Fernández de la Cruz, L., Enander, J., Radua, J., & Mataix-Cols, D. (2016). Cognitive-behavioral therapy for body dysmorphic disorder: A systematic review and meta-analysis of randomized controlled trials. Clinical Psychology Review, 48, 43-51. _https://doi.org/10.1016/j.cpr.2016.05.007_