Psychometric evaluation of the appearance anxiety inventory in adolescents with body dysmorphic disorder.

The Appearance Anxiety Inventory (AAI) is a self-report measure assessing the typical cognitions and behaviours of body dysmorphic disorder (BDD). Despite its use in research and clinical settings, its psychometric properties have not been evaluated in young people with BDD. We examined the factor structure, reliability, validity, and sensitivity to change of the AAI in 182 youths with BDD (82.9% girls; Mage = 15.56, SD = 1.37) consecutively referred to two specialist outpatient clinics in Stockholm, Sweden (n = 97) and London, England (n = 85). An exploratory factor analysis identified three factors, namely "threat monitoring", "camouflaging", and "avoidance", explaining 48.15% of the variance. The scale showed good internal consistency (McDonalds omega = 0.83) and adequate convergent validity with the Yale-Brown Obsessive-Compulsive Scale Modified for Body Dysmorphic Disorder for Adolescents (BDD-YBOCS-A; rs = 0.42) and the Clinical Global Impression-Severity Scale (rs = 0.32). Sensitivity to change was adequate, with AAI total scores and individual factor scores significantly decreasing over time in the subgroup of participants receiving multimodal treatment for BDD (n = 79). Change of AAI scores over treatment showed a positive statistically significant moderate-to-good correlation (r = 0.55) with changes in BDD symptom severity, measured by the BDD-YBOCS-A. The study provides empirical support for the use of the AAI in young people with BDD in clinical settings.

Aesthetic Medicine Across Generations: Evolving Trends and Influences.

Aesthetic medicine has grown exponentially in recent decades, becoming a key part of healthcare and wellness, with distinct generational demands shaping its landscape. Baby Boomers seek youthful rejuvenation, preferring noninvasive treatments like botulinum toxin injections and dermal fillers. Generation X favors natural, minimally invasive enhancements, often influenced by authentic testimonials. Millennials, driven by social media and self-care trends, prioritize preventive and enhancement procedures, sharing their experiences online. Generation Z, influenced by social media and digital beauty standards, focuses on prejuvenation and temporary enhancements. For industry professionals, understanding these generational dynamics and leveraging social media is essential to meet diverse patient expectations and enhance engagement.Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Before-and-After Photography on Social Media: The Pursuit of Impossible Beauty.

Plastic surgeons and aesthetic medicine professionals often share "before" and "after" clinical cases on social media, but this practice can lead to unintended consequences, such as dysmorphophobia and unrealistic expectations. These before-and-after images, frequently posted on social media, tend to promote unreachable, sometimes retouched, beauty standards, downplaying the complexities of the surgical process, omitting details about postoperative care, recovery, and potential complications. This can create the illusion that perfection is easily attainable through surgery, fostering unrealistic ideals and negatively impacting viewers' self-image and self-worth. Dysmorphophobia, characterized by an excessive preoccupation with perceived flaws in one's appearance, is closely linked to social media usage, especially among Caucasian women. Plastic surgeons hold the responsibility to provide honest insights into cosmetic procedures on social media, emphasizing the healing process, potential risks, and limitations. Celebrating diversity in appearance and sharing genuine patient stories can combat idealized beauty standards and reduce the stigma surrounding cosmetic surgery. They must prioritize honesty, provide comprehensive context for their images, and promote a broader view of beauty that includes mental health and individual diversity. Their ethical responsibility extends beyond the operating room and should guide all aspects of their professional practice.Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Psychometric Evaluation of the Yale-Brown Obsessive-Compulsive Scale Modified for Body Dysmorphic Disorder for Adolescents (BDD-YBOCS-A).

The Yale-Brown Obsessive-Compulsive Scale Modified for Body Dysmorphic Disorder for Adolescents (BDD-YBOCS-A) is a clinician-rated measure of BDD symptom severity in youth. Despite widespread use in both research and clinical practice, its psychometric properties have not been formally evaluated. The current study examined the factor structure, reliability, validity, and sensitivity to change of the BDD-YBOCS-A in 251 youths with BDD attending two specialist clinics. A principal component analysis identified two factors, explaining 56% of the variance. The scale showed good internal consistency (Cronbach's alpha = 0.87) and adequate convergent and divergent validity. In a subgroup of participants receiving BDD treatment (n = 175), BDD-YBOCS-A scores significantly decreased over time, demonstrating sensitivity to change. BDD-YBOCS-A change scores over treatment were highly correlated with severity changes measured by the Clinical Global Impression - Severity scale (r = .84). The study provides empirical support for the use of the BDD-YBOCS-A in children and adolescents with BDD.

Body Dysmorphic Disorder Questionnaire-Dermatology Version (BDD-DV): formation and validation of the Polish language version.

Introduction: Body dysmorphic disorder (BDD) is a mental health condition defined by preoccupation with a non-existent or minimal flaw (defect) in appearance. This preoccupation causes significant social and occupational impairment, lot of distress and is not better accounted for by another mental disorder. The defect often regards the skin, face or body build. Data show that 8-14% of dermatological patients suffer from BDD, whereas in the cosmetic dermatology setting the incidence is reported as high as 8-37%. The Body Dysmorphic Disorder Questionnaire-Dermatology version (BDDQ-DV) is a screening tool that may help to diagnose patients with BDD in dermatology settings. The questionnaire is self-reported, therefore it can be used in daily dermatology practice. Aim: To create and validate the Polish language version of the BDDQ-DV. Material and methods: The Polish version of BDDQ-DV was created in accordance with international standards. To assess reliability of the questionnaire the Cronbach's α coefficient was used. The reproducibility (test-retest reliability) of the Polish language version of the questionnaire was evaluated using the interclass correlation coefficient (ICC) coefficient. Results: The Polish version of BDDQ-DV was created. The Cronbach's α coefficient based on the first completion of the questionnaire was 0.92 indicating a correspondingly high internal consistency between the questions of the questionnaire. ICC was assessed at 0.998, which indicates excellent reliability. Conclusions: The Polish version of BDDQ-DV may help to identify patients with BDD among Polish-speaking individuals.

[Healing the mind by healing the body in anorexia nervosa]. / Soigner le mental en soignant le corps dans l'anorexie mentale.

In anorexia nervosa, physical and psychological vulnerability confines the sufferer to the confines of his or her pathology. The physical body is the first victim of undernutrition, but also the first resource for restoring the psychic and emotional body. Reduced food intake has repercussions on cognition and affect, all of which affect relational capacities. Accompanying, understanding and caring for people means reaching out to them and their bodies, to re-establish the link between what has been broken, and to establish a relationship of trust with them.

Clinical characteristics of 172 children and adolescents with body dysmorphic disorder.

Body dysmorphic disorder (BDD) often starts in childhood, with most cases developing symptoms before age 18. Yet, BDD research has primarily focused on adults. We report the clinical characteristics of the world's largest cohort of carefully diagnosed youths with BDD and focus on previously unexplored sex and age differences. We systematically collected clinical data from 172 young people with BDD consecutively referred to 2 specialist pediatric obsessive-compulsive and related disorders outpatient clinics in Stockholm, Sweden and in London, England. A series of clinician-, self-, and parent-reported measures were administered. The cohort consisted of 136 girls, 32 boys, and 4 transgender individuals (age range 10-19 years). The mean severity of BDD symptoms was in the moderate to severe range, with more than one third presenting with severe symptoms and more than half showing poor or absent insight/delusional beliefs. We observed high rates of current psychiatric comorbidity (71.5%), past or current self-harm (52.1%), suicide attempts (11.0%), current desire for cosmetic procedures (53.7%), and complete school dropout (32.4%). Compared to boys, girls had significantly more severe self-reported BDD symptoms, depression, suicidal thoughts, and self-harm. Compared to the younger participants (14 or younger), older participants had significantly more severe compulsions and were more likely to report a desire for conducting cosmetic procedures. Adolescent BDD can be a severe and disabling disorder associated with significant risks and substantial functional impairment. The clinical presentation of the disorder is largely similar across sexes and age groups, indicating the importance of early detection and treatment. More research is needed specifically focusing on boys and pre-pubertal individuals with BDD.

[Adolescent surgery, psychological aspect - dysmorphophobia]. / Chirurgie de l'adolescente, aspect psychologique ­ dysmorphophobie.

Adolescence is a period of personal and relational construction. The adolescent must reclaim her body in transformation and nurture her self-esteem. Aesthetic, restorative and reconstructive surgery performed on this population must take into account the psychological aspects specific to this age group.Dysmorphisms or physical difference in adolescent girls can be the cause of rejection by the group. This rejection impacts an already low self-esteem. Some patients may try to compensate for the lack of reassuring relationships with a desire for perfection that goes as far as dysmorphophobia. The plastic surgeon must look for the relational issues at the origin of the requests for care. Preoperative meetings are an opportunity to identify patients for whom surgery is not the answer and those who will need associated psychological support.

Childhood maltreatment and trauma is common and severe in body dysmorphic disorder.

BACKGROUND: Childhood maltreatment and trauma may be risk factors for the development of body dysmorphic disorder (BDD). However, the limited research to date on these topics has been constrained by either the absence of a matched healthy control group or non-comprehensive assessments. METHODS: This study assessed the prevalence and severity of childhood maltreatment and other traumatic events in 52 BDD participants (56% female) and 57 matched controls (51% female) with no history of mental illness, using the Childhood Trauma Questionnaire and a checklist assessing broader traumatic events. RESULTS: In comparison with controls, participants with BDD showed a higher prevalence of emotional abuse (61.5% vs. 33.3%) and physical neglect (59.6% vs. 28.1%), as well as more severe overall maltreatment, emotional abuse, and emotional and physical neglect. BDD participants were also more likely to meet cut-offs for multiple types of maltreatment and reported an elevated number and variety of broader traumatic childhood events (e.g., life-threatening illness). In BDD, increasingly severe maltreatment was correlated with greater severity of BDD symptoms, anxiety and suicidal ideation. CONCLUSIONS: These data suggest that childhood maltreatment and exposure to other traumatic events are common and severe in BDD and are cross-sectionally associated with the severity of clinical symptoms. Adversity linked to maladaptive family functioning during childhood may therefore be especially relevant to people with BDD and could relate to social and emotional processing problems in the disorder.

Dysmorphophobia: When Should the Plastic Surgeon Say No?

Dysmorphophobia is the phobia that arises from the distorted view that one has of one's external appearance, caused by the excessive concern for one's body image, in most cases not justified. The role of the plastic surgeon is to recognize the dysmorphophobic patient, make him aware of the non-existence of the defect and direct him towards a path that can help him. The body is a living organism that has its own characteristics and with its own uniqueness. Performing a cosmetic surgery means improving an imperfection by enhancing the positive traits of each patient. For this reason, the ultimate goal of surgery is to seek a positive aesthetic improvement and never a transformation. A dysmorphophobic patient is a dissatisfied person who is constantly looking for a mutation by entering a loop from which he will not be able to get out easily. When the patient suffers from dysmorphophobia, he generally complains of a blemish that cannot be objectified and must be an alarm bell for the specialist who is visiting him. The visit serves to analyze the patient as a whole. Relying on a specialist in plastic, reconstructive and aesthetic surgery means that you are faced with a professional trained in this branch of medicine, who can guide the patient towards the most suitable path and with the safest and most predictable results, or is a capable professional. To recognize a psychological weakness of the patient, blocking from the beginning a process that would not be indicated.

[The influence of signs of dysmorphophobia on the evaluation of the result of rhinoplasty]. / Vliyanie priznakov dismorfofobii na otsenku rezul'tata rinoplastiki.

The object of the clinical research was 367 patients after rhinoplasty. All patients before the operation fill in a special questionnaire, allowing to evaluate quantify the signs of dysmorphophobia. Patients with low index of dysmorphophobia (within 5-6 points) adequately estimated the result of the operation because their opinion coincided with the opinion of the doctor and in some cases they didn't notice even insignificant defects the doctor saw. The total number of these results satisfying the patient and the doctor composed 93% (341 patients). The patients who attaches great importance to insignificant defect of their appearance the index of desmorphophobia was high (16 patients - the average index of dysmorphophobia - 15). Questionnaires containing questions that allows to expose the signs of dysmorphophobia may be useful in the time of selection of patients for plastic surgery, in particular rhinoplasty. According to the questionnaire worked out by us, the index of dysmorphophobia of 5 points and below allows to count up on an adequate evaluation. The importance of index from 6 to 10 points may require psychological support of the patient who will much evaluate the result.

[Body dysmorphic disorder: Future prospects of medical care]. / L'obsession de dysmorphie corporelle : perspectives d'évolution de la prise en charge.

Body dysmorphic disorder (BDD) is characterized by excessive preoccupation with a slight or imagined defect in one's physical appearance, believing they look ugly, abnormal or deformed. While the most common preoccupations focus on the skin, hair and nose, any part of the body may be involved. Preoccupations are intrusive, time-consuming and hard to control. Repetitive behaviors are performed in response to the preoccupations. BDD is associated with marked impairment in socio-professional functioning, poor quality of life and high suicide rates. CLINICAL CHARACTERISTICS: BDD appears to be relatively common with a prevalence rate between 1 and 2% in general population with a chronic course evolution without treatment, it is also associated with a high rate of depression and suicide. The current prevalence in adult psychiatric population is estimated over 10%; prevalence is also elevated in dermatology and cosmetic surgery patients. THERAPEUTIC: Adequate treatments may improve symptoms and quality of life. International guidelines recommend cognitive behavior therapy (CBT) as first line of treatment. Several studies have shown evidence of CBT benefit. High dose selective serotonin reuptake inhibitors (SRI) for at least 12weeks are recommended in more severe cases. SRI augmentation strategies with antipsychotic adjunction do not report benefit in small-size sample. Antipsychotic medication for BDD even with delusional beliefs is not indicated. Attachment based interpersonal psychotherapy, analyzing and correcting interpersonal relationship from individuals with BDD may represent an alternative therapy improving self-esteem. COSMETIC TREATMENTS: Insight is generally poor and patients often require cosmetic and surgical treatments to "correct" their imagined defect with sometimes a transitional initial benefit but without positive impact on long-term remission and can exacerbate preoccupation. SCREENING AND AWARENESS: Healthcare professionals need to be aware of an early detection of this trouble, clinical tools validated in cosmetic population can help them to identify BDD in order to provide education about diagnosis and refer patients to a psychiatrist. More collaboration between psychiatrists and cosmetic practitioners is necessary.

Narrative: The Fear of Disfigurement in Cancer Patients.

Fear of disfigurement affects patients with cancer, in whom the disease or its treatment leaves them permanently marked. Contrary to our thought, disfigurement is equally distressing to male patients, and it causes severe dislocation in their lives. We describe two cases in which disfigurement caused tremendous change in our patients; these cases underline the need for psychotherapy in patients suffering from cancer.

Eumorphic Plastic Surgery: Expectation Versus Satisfaction in Body Dysmorphic Disorder.

BACKGROUND: Eumorphic Plastic Surgery aims at improving the severe psychosocial pain caused by a deformity. Dysmorphopathology is an increasingly relevant problem facing the plastic surgeon. OBJECTIVE: The aim of this study is to describe the perioperative questionnaires created by the senior author and to present a cohort of plastic surgery patients suffering from dysmorphopathies. These patients were prospectively followed and evaluated with the proposed questionnaires through their surgical pathway to explore the degree of satisfaction or disappointment compared to expectations. METHODS: All candidates for plastic surgery procedures between April 2011 and June 2013 were included in the study. Preoperatively, all patients completed the Patient Expectation Questionnaire (E-pgm). Twelve months postoperatively, they completed the Patient Satisfaction Questionnaire (S-pgm). The E-pgm and S-pgm were compared to evaluate the consistency between the patient's preoperative expectations and postoperative evaluations. RESULTS: A total of 158 patients were included in the study. Out of them, 79 % experienced an improvement or no variation between preoperative expectations and postoperative satisfaction. With regard to the motivation for undergoing surgery, 91 % showed that the surgical procedure met the motivation. An overall positive perioperative change in life was experienced by 93 % of patients. CONCLUSIONS: The E-pgm questionnaire proved to be a valid and reliable tool for the selection of suitable candidates for surgery and for identification of dysmorphophobic patients. Enhancing the doctor-patient relationship and communication can reduce ambiguity and avoid troublesome misunderstandings, litigation and other legal implications. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

[Body dysmorphic disorder]. / Körperdysmorphe störung.

Body dysmorphic disorder (BDD) is a relatively common disorder with a point prevalence of 0.7-2.4 %. BDD is characterized by the patient's excessive concern with an imagined or slight defect in physical appearance. BDD usually begins in adolescence. Comorbidity rates and also suicidality rates are high. The course of BDD tends to be chronic. According to the present state of knowledge, cognitive-behavioral therapy and pharmacotherapy with selective serotonin reuptake inhibitors are valuable options in the therapy of BDD. The case report describes a recent case of BDD with typical clinical and therapy-related characteristics. The aim of this work is to strengthen the awareness of BDD in clinical practice of child and adolescent psychiatry, facilitating an adequate diagnosis and treatment of the affected individuals.

[Pathomimia and plastic surgery, a case report]. / Pathomimie en chirurgie esthétique, à propos d'un cas.

Pathomimia is defined as a dummy pathology self-induced deliberately and is neither associated with mental confusion nor disturbance of consciousness. This article reports a case of pathomimia in plastic surgery. One of our patients had intentionally injected physiological saline solution into her breast implants in order to increase their volume. Implants removal was necessary because of severe local inflammatory signs. Psychiatric assessment revealed body dysmorphic disorder (BDD) developed on an hysterical personality, which explained the self-induced injuries. This nosologic entity must be promptly identified because it's diagnosis remains problematic and a multidisciplinary medical management is essential.

[Body dysmorphic disorder and aesthetic surgery: A systematic review]. / Body Dysmorphic Disorder et chirurgie esthétique: une revue de la littérature.

Patients suffering from body dysmorphic disorder (BDD) are preoccupied with an imagined or minor defect in appearance that causes significant distress and impairment in social and occupational functioning. Despite a rate of up to 15% of BDD patients reported in cosmetic surgery settings, there is no consensus on the best management for these patients. The main purpose of this article was to conduct a literature review on BDD and cosmetic surgery. Properly trained healthcare professionals in recognizing and diagnosing this pathology is essential for the delivery of quality psychiatric care while taking into account the high prevalence of body dysmorphic disorder patients in cosmetic surgery and the poor outcome of these patients following cosmetic procedures.

Intentional Self-Harm and Death by Suicide in Body Dysmorphic Disorder: A Nationwide Cohort Study.

BACKGROUND: Body dysmorphic disorder (BDD) is thought to be associated with considerable suicide risk. This nationwide cohort study quantified the risks of intentional self-harm-including nonsuicidal self-injuries and suicide attempts-and death by suicide in BDD. METHODS: Individuals with a validated ICD-10 diagnosis of BDD in the Swedish National Patient Register, registered between January 1, 1997, and December 31, 2020, were matched with 10 unexposed individuals (i.e., without BDD) from the general population on birth year, sex, and county of residence. Conditional Poisson regression models estimated incidence rate ratios and 95% CIs for intentional self-harm. Stratified Cox proportional hazards models estimated hazard ratios and 95% CIs for death by suicide. Models adjusted for sociodemographic variables and lifetime psychiatric comorbidities. RESULTS: Among 2833 individuals with BDD and 28,330 unexposed matched individuals, 466 (16.45%) and 1071 (3.78%), respectively, had at least 1 record of intentional self-harm during the study period (incidence rate ratio = 3.37; 95% CI, 3.02-3.76). In the BDD group, about two-thirds (n = 314; 67%) had their first recorded self-harm event before their first BDD diagnosis. A total of 17 (0.60%) individuals with BDD and 27 (0.10%) unexposed individuals died by suicide (hazard ratio = 3.47; 95% CI, 1.76-6.85). All results remained robust to additional adjustment for lifetime psychiatric comorbidities. A higher proportion of individuals with BDD who died by suicide had at least 1 previous record of intentional self-harm compared with unexposed individuals (52.94% vs. 22.22%; p = .036). CONCLUSIONS: BDD was associated with a 3-fold increased risk of intentional self-harm and death by suicide.

Web-Based Therapist-Guided Mindfulness-Based Cognitive Behavioral Therapy for Body Dysmorphic Disorder: Pilot Randomized Controlled Trial.

BACKGROUND: Internet-based cognitive behavioral therapy (CBT) and stand-alone mindfulness meditation interventions are gaining empirical support for a wide variety of mental health conditions. In this study, we test the efficacy of web-based therapist-guided mindfulness-based cognitive behavioral therapy (CBT-M) for body dysmorphic disorder (BDD), a psychiatric disorder characterized by preoccupations with perceived defects in appearance. OBJECTIVE: This study aims to determine whether CBT-M for BDD delivered on the web is feasible and acceptable and whether mindfulness meditation adds to CBT treatment effects for BDD. METHODS: In this 8-week, 2-arm, parallel pilot randomized controlled trial, n=28 adults (aged between 18 and 55 years) were randomly allocated to an experimental group (web-based therapist-guided CBT-M) or a control group (web-based therapist-guided CBT). Study retention, accrual, and intervention adherence were assessed, along with self-report measures for BDD, depression, anxiety, and pain intensity taken at baseline and postintervention. RESULTS: This study was feasible to implement and deemed acceptable by participants. After 8 weeks, significant improvements were found on all outcome measures for both treatment groups, and large between-group effect sizes favoring CBT-M were found for BDD symptom severity (d=-0.96), depression (d=-1.06), pain severity (d=-1.12), and pain interference (d=-1.28). However, linear mixed models demonstrated no significant differences between the groups over 8 weeks. CONCLUSIONS: The results suggest that mindfulness meditation may add to beneficial web-based CBT treatment effects for BDD. An adequately powered randomized control trial of web-based CBT-M is warranted. TRIAL REGISTRATION: ClinicalTrials.gov NCT05402475, http://clinicaltrials.gov/ct2/show/NCT05402475.

European Association of Urology Guidelines on Penile Size Abnormalities and Dysmorphophobia: Summary of the 2023 Guidelines.

CONTEXT: Recommendations regarding the management of penile size abnormalities and dysmorphophobia are important in guiding evidence-based clinical practice. OBJECTIVE: To present a summary of the 2023 European Association of Urology sexual and reproductive health evidence-based recommendations for the management of penile size abnormalities and dysmorphophobia. EVIDENCE ACQUISITION: A broad and comprehensive scoping exercise covering all areas of the guidelines was performed. Databases searched included Medline, EMBASE, and the Cochrane Libraries. A level of evidence and a strength of recommendation were assigned for each recommendation according to the evidence identified. The evidence cutoff date for the 2023 guidelines is June 1, 2022. EVIDENCE SYNTHESIS: Well-structured studies reporting high level of evidence, with standardized PROMS were deficient on penile size abnormalities and dysmorphohobia. A shared definition for short penis/micropenis was also lacking. Categorisation of penile abnormalities according to congenital, acquired, and dysmorphophobic aetiology is deemed compulsory. A detailed medical and psychosexual history and precise measurements of penile size are essential in the diagnostic pathway. Patients with normal penile size who are seeking penile augmentation should be referred for psychological evaluation for potential dysmorphophobic disorders. Penile length and girth enhancements can be achieved via a multitude of treatments, but a personalised management plan is crucial for satisfactory results. Endocrinological therapies, when indicated, are effective in the prepubertal setting only. Vacuum therapy has a limited evidence base in treatment protocols, although acceptable outcomes have been reported for penile traction therapy. Surgical techniques to enhance penile length and girth have limited evidence and should only be proposed after extensive patient counselling. CONCLUSIONS: Management of penile abnormalities and dysmorphophobia is a complex issue with considerable ethical concerns. The adoption of a structured diagnostic and therapeutic pathway is crucial, as recommended in the guidelines. PATIENT SUMMARY: Requests for medical/surgical treatments to increase penis size have increased dramatically worldwide. Several conservative and surgical treatments are available. However, few patients receive clear information on the benefits and possible harms of these treatments. These guidelines aim to provide a structured path to guide both physicians and patients in the selection of appropriate treatment(s) to increase penis size.