Caring for Patients With Body Dysmorphic Disorder Seeking to Undergo Plastic Surgery and/or Aesthetic Interventions.

In the field of medical aesthetics and plastic surgery, it is not uncommon to interact with clients who never seem to be satisfied, regardless of the success of an intervention. Medical professionals may attribute this to the patient having an overly critical nature; however, this continual dissatisfaction could also be the result of a mental health disorder known as body dysmorphic disorder (BDD) that is significantly underdiagnosed and prevalent within the plastic surgery and aesthetic patient population. According to the Diagnostic and Statistical Manual of Mental Health Disorders (DSM-5; American Psychiatric Association, 2013), BDD is defined as, "a preoccupation with one or more perceived defects or flaws in physical appearance that are not observable or appear slight to others" (Substance Abuse and Mental Health Services Administration, 2016, Table 23). Having the ability to identify the signs of BDD, utilize appropriate communication skills with individuals who may have BDD, and understand the implications of providing additional aesthetic treatments for patients who present with BDD allows aesthetic practitioners to prioritize and promote patient safety, well-being, and satisfaction.

The association between use of social media and the development of body dysmorphic disorder and attitudes toward cosmetic surgeries: a national survey.

Introduction: Body dysmorphic disorder (BDD) causes distress due to one's negative appraisal of their body image. The development of BDD has been linked to the passive use of social media and photo-editing apps. People with BDD typically pursue cosmetic surgeries to remedy their perceived flaws. The dramatic increase in the use of photo-editing apps and their well-established effects on mental health is a public health concern. Purpose: To study the association between use of social media and the development of BDD and acceptance toward cosmetic surgeries (ACSS) among Saudis. Methods: An online, cross-sectional, validated survey conducted among Saudis 18 and older. Descriptive analyses were utilized for demographics and prevalence rates of main study variables. ANOVA was used to compare mean scores in BDD and ACSS among different demographic groups. Tukeys post-hoc test was done to identify the categories that were different when the ANOVA test showed a statistically significance. A p-value of <0.05 was considered statistically significant. Results: A total of 1,483 Saudi adults completed the questionnaire. Key results showed that BDD was found in 24.4 % of the sample. The percentage of participants with BDD who spent 4-7 h per day on Instagram and Snapchat (29%) was significantly higher than those who spent only less than an hour per day on these platforms (19%) (p < 0.001). Individuals with BDD had a significantly higher risk of accepting cosmetic surgery compared to those without BDD (p < 0.001). Conclusion: A growing body of evidence suggests that social media may impact mental health in different ways. This study reveals that heavy use of these platforms is associated with negative appraisals about one's physical appearance, and it fosters one's tendency toward cosmetic surgery, especially among females.

Investigating the prevalence of body dysmorphic disorder among Jordanian adults with dermatologic and cosmetic concerns: a case-control study.

Body Dysmorphic Disorder (BDD) is an underexplored psychiatric condition in Middle Eastern countries, particularly in patients with dermatologic concerns, where alterations in appearance may elevate the risk of BDD. We studied patients at Jordan University Hospital's general dermatology and cosmetic clinics from July to September 2022, comparing them to healthy controls. Patients with dermatologic conditions were evaluated per the International Classification of Diseases (ICD-10) criteria by trained dermatologists. All participants completed the Dysmorphic Concerns Questionnaire (DCQ), Perceived Stress Scale, Patient Health Questionnaire-2, General Anxiety Disorder Assessment tool-2. We assessed BDD prevalence using four DCQ cutoffs: 9, 11, 14, and 17, reporting effect sizes as odds ratios (OR). Our study involved 1500 participants, with an average age of 29.3 (± 14.8) years and a female-to-male ratio of 3.15-to-1. At the 9, 11, 14, and 17 DCQ cutoffs, BDD prevalence was 78.2%, 54.2%, 26.5%, and 11.7%, respectively. Patients with dermatologic concerns were more likely to exhibit clinical BDD symptoms than controls at the 11-cutoff (OR: 1.26; 95% CI 1.01-1.58; p < 0.05). Conversely, those with cosmetic concerns were more prone to clinical BDD than controls at cutoffs 9 (OR: 2.26; 95% CI 1.28-3.97; p < 0.05) and 11 (OR: 1.50; 95% CI 1.03-2.20; p < 0.05). Our logistic regression revealed consistent associations between higher DCQ scores and elevated anxiety, depression, perceived skin disease-related stigma, and reduced quality of life (p < 0.05). In conclusion, patients with dermatologic issues and those seeking cosmetic procedures are at significant risk of developing BDD, necessitating proactive screening and referrals for specialized care by dermatologists due to the associated psychological distress and unproductive consultations. Providing specialized training for healthcare professionals to establish an integrated care approach to address the needs of patients with BDD should be the focus of future research projects.

Predicting response to a smartphone-based cognitive-behavioral therapy for body dysmorphic disorder.

BACKGROUND: Body dysmorphic disorder (BDD) is a severe, chronic disorder if untreated. Smartphone cognitive behavioral therapy (CBT) for BDD is efficacious and can reduce key treatment barriers (e.g., lack of clinicians, cost, stigma). While promising, little is known about who is more or less likely to benefit from this approach. METHODS: This is a secondary data analysis of a randomized, waitlist-controlled trial of smartphone CBT for BDD. Participants (N = 80) were recruited nationally and randomized to receive a 12-week, coach-guided CBT for BDD app, either immediately or after a 12-week waitlist. The main outcome for this analysis was BDD severity (BDD-YBOCS) over time (baseline, week 6, week 12) during the active app use phase in each randomized group (n = 74). Secondary outcomes included treatment response (≥30 % reduction in BDD-YBOCS) and remission (total BDD-YBOCS ≤16) at end-of-treatment. RESULTS: Immediate (vs. delayed) CBT predicted better outcomes (symptom improvement), as did gender identity (symptom improvement), higher baseline treatment credibility and expectancy (response, remission), lower baseline BDD severity (remission), and sexual minority status (vs. heterosexual; response, remission). LIMITATIONS: Limitations include the relatively small sample, drop-out rate of 22 %, and limited gender and racial-ethnic diversity. CONCLUSIONS: These results highlight a potential advantage of smartphone CBT in historically marginalized populations, and the importance of efforts to hasten treatment access, bolster confidence in the treatment at treatment onset, and develop stratified care models to optimize treatment allocation and efficacy.

Enhancing self-esteem in adults with body dysmorphic symptoms: experimental testing and initial evaluation of a brief internet-based training.

BACKGROUND: Low self-esteem is an important factor associated with body dysmorphic concerns. In treatment, self-esteem cannot always be adequately addressed. Internet-based interventions offer a low-threshold and cost-efficient possibility for treating body dysmorphic disorder (BDD). AIMS: For this reason, we conducted two studies to explore the effectiveness of an internet-based intervention targeting improving self-esteem in adults with BDD symptoms. METHOD: The first study investigated the differential effects of a 1-week self-esteem training compared with a 1-week attention-focus training. Two hundred twenty adults with elevated body dysmorphic symptoms were randomly assigned to one of the two trainings. Our second study (n = 58 adults with body dysmorphic symptoms) evaluated an extended 2-week stand-alone self-esteem training. RESULTS: In the first study, self-esteem in different domains (appearance, performance and social), self-focused attention, and BDD symptom severity improved in both groups. Other-focused attention only increased in the attention training group. Participants' overall adherence was high. In the second study we observed significant improvements in self-esteem, BDD symptom severity, and other secondary outcomes, with additional improvements in most outcomes in the second week. Adherence was again high. CONCLUSIONS: Together, these findings show that a brief internet-based intervention may be a highly accepted and effective way of improving self-esteem in people suffering from BDD symptoms.

"Tattoo Characteristics and Testing for Body Dysmorphic Disorder: An Internet-based Self-questionnaire Survey of 4,809 Individuals with Tattoos".

Tattoos have become very popular worldwide in recent years. The aim of this study was to analyse a group of people interested in having tattoos, and screen them for body image disturbances. This cross-sectional self-administered internet-based survey included 4,809 individuals interesting in having tattoos. The majority of the study population were female (79.1%). The survey was conducted using a self-created questionnaire and the Body Dysmorphic Disorder Questionnaire - Dermatology version. Most tattoos in the study group were located on the forearms and hands (28.1%). The most popular motifs were plants (17.5%) and animals (16.9%). Out of 4,809 individuals, 19.9% had problems with acceptance of some parts of their body and 9.8% were screened for body dysmorphic disorder with the Body Dysmorphic Disorder Questionnaire - Dermatology version. Four percent of individuals reported that tattoos helped to improve their own perception of the appearance of their body by distracting attention from the other problems. Limitations of this study include possible participant selection bias and the overrepresentation of women. In conclusion, clinicians may expect to see more patients with tattoos and, of these, approximately 10% may be screened for body dysmorphic disorder.

Is cognitive behavioral therapy an efficacious treatment for psychological interventions in body dysmorphic disorders? A meta-analysis based on current evidence from randomized controlled trials.

BACKGROUND: Clinical guidelines and some studies recommend cognitive-behavioral therapy (CBT) as the most effective treatment for body dysmorphic disorder (BDD). However, owing to the lack of randomized controlled trials (RCTs), the research evidence is insufficient. This study aimed to explore the effectiveness of CBT in the treatment of BDD using RCTs. This meta-analysis was registered in PROSPERO (CRD42023410577). METHODS: After a literature search and screening, 11 RCTs with 667 patients were included. The ROB 2.0 tool, funnel plots, sensitivity analysis, and meta-regression analysis were used to assess the quality, publication bias, and sources of heterogeneity. RESULTS: After CBT intervention, the severity of BDD (SMD = -1.73, 95 % CI (confidence interval) = [-2.90; -0.57]), depression symptoms (SMD = -1.72, 95 % CI = [-3.16; -0.28]), and anxiety levels were all reduced in the patients of the experimental group; the remission of BDD (OR = 7.37, 95 % CI = [2.17; 24.98]) and the response of BDD (OR = 8.86, 95 % CI = [4.85; 16.18]) were all increased; incorrect beliefs such as disability and BABS were also reduced; the quality of life was improved. The difference between the groups was statistically significant (p < 0.01). Meta-regression analysis showed that age and sample size were the predictive factors of the effectiveness of CBT. LIMITATIONS: The heterogeneity of most meta-analyses was high (I2 > 75 %). CONCLUSIONS: Although CBT is effective in treating BDD, there is insufficient evidence to suggest that it is the best psychological intervention for BDD. More high-quality evidence is still needed in the future.

Time to Response in Therapy for Body Dysmorphic Disorder: A Comparison of Cognitive Behavioral Therapy and Supportive Psychotherapy.

Psychotherapy has been shown to be effective for individuals with body dysmorphic disorder (BDD); however, time to treatment response for different treatments have not yet been examined. We randomized 120 patients to either weekly cognitive behavioral therapy (CBT) or supportive psychotherapy (SPT) at two academic medical research centers. In this secondary data analysis, we aimed to determine the time to first response (30% or greater reduction in BDD symptom severity) in both treatment conditions among those who attended at least one post-baseline assessment (n = 109). As previously reported, CBT for BDD was associated with more consistent improvement in symptom severity and quality of life than SPT. In a pooled analysis combining both sites, the median time to first response was shorter for CBT (76 days [10.9 weeks], 95% CI: 76-107 days) than for SPT (88 days [12.6 weeks], 95% CI: 88-nonestimable days; Χ2df=1 = 3.85, p = .0498). For CBT, the estimated 75th percentile response times were 148 days [21.1 weeks] at site 1 and 134 days [19.1 weeks] at site 2. Response times were not estimable for SPT at either site because the response rate was too low. Thus, therapy clients seeking treatment for BDD and clinicians should be aware that an initial treatment response requires more than 11 therapy sessions for the majority of clients, and that 21 or even more sessions may be required. Treatment response is likely to occur earlier with CBT for BDD (the first-line therapy for BDD) than with supportive psychotherapy.

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.

Body image perception and dissatisfaction in resistance training practitioners: A critical review of the literature of Brazilian studies and assessment tools used.

This study aimed to review the findings on body image (BI) dissatisfaction and muscle dysmorphia (MD) in Brazilian RT practitioners and the differences in the assessment tools used. A critical review of studies with searches in PubMed, Brazilian Virtual Health Library, SciELO, PsycInfo, and SPORTDiscus databases was conducted. A total of 23 studies were included. Nine tools were used to assess BI dissatisfaction or MD: three questionnaires and six visual scales. The overall mean BI dissatisfaction was 56.5% (59.2% in men vs 57.3% in women). The mean MD was 42.4% (45.1% in women vs 38.5% in men). BI dissatisfaction and MD are related to women seeking slimness and men wanting to increase muscle mass. In conclusion, the frequency of BI was high in both sexes, and MD, when identified, was higher in women. The scales and questionnaires used differ significantly in depth and scope for the same purpose.

Going deeper into eating and body image pathology in males: Prevalence of muscle dysmorphia and eating disorders in a university representative sample.

Disorders associated with body dissatisfaction such eating disorders (ED) and muscle dysmorphia (MD) in males are understudied and surrounded by controversy regarding their nosological aspects. The current study examined the prevalence rates of clinical cases of ED and MD through a two-phase study with gold standard clinical interview in a representative sample of 850 Spanish undergraduate men, of whom 141 were interviewed. Levels of body dissatisfaction, compulsive exercise, anxious-depressive symptoms and the amount of physical activity were also explored. A prevalence rate for ED of 1.4% and 1.3% for MD was found. No differences were observed between the clinical groups on scales related to body image, supporting the current perspective that MD as well as ED and Body Dysmorphic Disorder could be clustered in a new spectrum of body image disorders, where the behaviours performed to achieve body change could range from restriction or muscularity-oriented eating alterations to pathological exercise or cosmetic surgery. The usefulness of the cut-off points of the screening questionnaires in MD and ED in males are discussed.

Psychological evaluation of Asian female patients with rhinoplasty.

BACKGROUND: Patients requiring plastic surgery exhibit more abnormal psychological trends (e.g., body dysmorphic disorder [BDD], depression, and anxiety) than those requiring other surgeries. However, there are only a few domestic studies on the psychological aspects of the population requiring plastic surgery. Therefore, we analyzed the psychological characteristics and psychological impact of rhinoplasty in female patients. METHODS: In this study, patients were classified into 2 groups: 151 males and 60 females. The self-rating scale of body image (SSBI), self-rating anxiety scale, self-rating depression scale, and postoperative satisfaction questionnaire were used to examine the patients before and after surgery. The results were analyzed using t-test, analysis of variance, chi-square test, paired rank sum test, and Pearson correlation analysis. RESULTS: The total prevalence of BDD in female patients who underwent rhinoplasty was 7.3%. The prevalence of anxiety disorders was 31.8% and that of depression was 45.0%. Female patients with BDD were more likely to exhibit depression (55.5%) and anxiety (36.4%). The SSBI score was related to marital status (p = 0.001) and history of rhinoplasty (p = 0.000). Moreover, there was a significant negative correlation between preoperative BDD score and postoperative satisfaction (r = -0.392, p = 0.002) as well as between the previous history of rhinoplasty and postoperative satisfaction (r = -0.603, p = 0.000). CONCLUSION: Pathological psychologies such as anxiety, depression, and BDD are common in patients scheduled to undergo rhinoplasty, and BDD is more likely to be associated with depression. Rhinoplasty has little psychological impact on patients, i.e., it neither causes improvement nor deterioration. Female patients who have undergone rhinoplasty should be considered to a have high risk of BDD. Although the outcomes of surgery are generally quite positive, patients diagnosed with BDD are more likely to be dissatisfied.

Body dysmorphic disorder among Lebanese females: A cross-sectional study.

BACKGROUND: Body dysmorphic disorder (BDD) is a mental health disorder characterized by an excessive preoccupation with perceived flaws or defects in one's appearance. This study aimed to assess the prevalence of BDD, identify the predictors of BDD, explore the associations of BDD with social anxiety and social phobia, and examine the effect of social media on BDD. METHODS: In this cross-sectional study that was conducted between January and March 2023, Lebanese adult females completed an online survey that included questions about sociodemographic characteristics, cosmetic interventions, BDD, social media use, and Social Interaction Anxiety Scale (SISA-6)/Social Phobia Scale (SPS-6). The collected information was analyzed using descriptive statistics and regression analysis. Statistical significance was set at p value <0.05. RESULTS: A sample of 1048 were eligible for analysis and the mean age was 29.94 ± 10.01 years. It was shown that 141 (13.5%) participants were BDD positive. The results of the multivariable logistic regression showed that only females living in urban areas (aOR = 2.351 [95% CI 1.502-3.680], p < 0.001), unmarried (aOR = 1.672 [95% CI 1.041-2.684], p = 0.033), reporting higher social media use score (aOR = 1.526 (95% CI 1.401-1.661), p < 0.001), and higher SIAS/SPS score (aOR = 1.040 (95% CI 1.022-1.060), p < 0.001) were significantly positively associated with BDD. CONCLUSION: This study found a high BDD prevalence (13.5%) among Lebanese adult females compared with other regions and was associated with anxiety and increased social media platforms use. This highlights the need for a comprehensive approach in the assessment of BDD, along with preventive measures to address the negative impacts of social media on well-being and promote healthy body image.

Impact of sleep disruption on BDD symptoms and treatment response.

BACKGROUND: Body dysmorphic disorder (BDD) is severe, undertreated, and relatively common. Although gold-standard cognitive behavioral therapy (CBT) for BDD has strong empirical support, a significant number of patients do not respond. More work is needed to understand BDD's etiology and modifiable barriers to treatment response. Given its high prevalence and impact on the development, maintenance, and treatment of related, frequently comorbid disorders, sleep disruption is a compelling, but not-yet studied factor. METHODS: Data were drawn from a randomized controlled trial of guided smartphone app-based CBT for BDD. Included participants were offered 12-weeks of treatment, immediately (n = 40) or after a 12-week waitlist (n = 37). Sleep disruption and BDD symptom severity were assessed at baseline, week-6, and week-12. RESULTS: Hypotheses and analysis plan were pre-registered. Two-thirds of patients reported significant insomnia symptoms at baseline. Baseline severity of sleep disruption and BDD symptoms were not related (r = 0.02). Pre-treatment sleep disruption did not predict BDD symptom reduction across treatment, nor did early sleep improvements predict greater BDD symptom improvement. Early BDD symptom improvement also did not predict later improvements in sleep. LIMITATIONS: Limitations include the small sample, restricted ranges of BDD symptom severity and treatment response, and few metrics of sleep disruption. CONCLUSIONS: Although insomnia was disproportionately high in this sample and both BDD symptoms and sleep improved in treatment, results suggest sleep and BDD symptoms may function largely independent of one another. More work is encouraged to replicate and better understand findings as well as potential challenges and benefits of addressing sleep in BDD.

[Towards perfection: the ethical downside of the ideal of beauty]. / Op weg naar perfectie: de ethische keerzijde van het schoonheidsideaal.

Beauty, it seems, is a fascination inherent in human nature. Research shows that an attractive face plays a significant factor in human life, such as in the areas of appreciation and judgment.The growing demand for cosmetic treatments is amplified by social media and influencer marketing. However, there are possible negative effects, such as addiction and dissatisfaction with treatment outcome in people with Body Dysmorphic Disorder. It remains important to recognize that risks are inherent in medical procedures.

PREVALENCE OF BODY DYSMORPHIC DISORDER AMONG ATTENDANCES SEEKING FACIAL COSMETIC PROCEDURES IN BAGHDAD.

OBJECTIVE: Aim: To find out the prevalence of body dysmorphic disorder among patients seeking facial cosmetic procedures, find out association of social demographic (age, gender, occupation, marital status, friends relationship, and dating status) ampatientsient with body dysmorphic disorder. PATIENTS AND METHODS: Materials and Methods: A cross-sectional study was done on a sample of 100 patients from Al-waste Hospital and Ghazy Al-Hariri Hospital for surgical specialties in Baghdad by using a body dysmorphic disorder questionnaire to diagnose a probable case and then a semi-structured questionnaire based on DSM5 criteria to diagnose body dysmorphic disorder during the period extended from beginning of January 2019 to the end of April 2019. RESULTS: Results: The chi-square test proved the association between female gender and body dysmorphic disorder is significant P=0.026. Significant associations were also noticed between single patients and body dysmorphic disorder 76.8% in comparison with married 37.8, and divorced or widowed 42.9% (P=0.001). It was found that 68.6% of unemployed patients think that they need to correct their body dysmorphic disorder so they attended the hospital while only 40% of employed persons did so P=0.008. The mean age of patients exposed to a second operation was significantly higher than the mean age of other patients P=0.022. CONCLUSION: Conclusions: High prevalence of body dysmorphic disorder among patients seeking plastic surgery which is about 60%. Body dysmorphic disorder is more common among single and unemployment and among young adults and gender female. There is no significant association between the mean age of male and female patients of body dysmorphic disorder group.

The heart of it all: Body dysmorphic disorder in cosmetic surgery.

BACKGROUND: Body Dysmorphic Disorder (BDD) represents a prevalent mental health condition characterized by distress arising from self-perceived physical imperfections. BDD serves as a contraindication to aesthetic surgery. Recognizing BDD holds paramount importance for plastic surgeons, as it is instrumental in averting the exacerbation of this condition while ensuring appropriate referrals. OBJECTIVE: This study aimed to investigate the prevalence of BDD in cosmetic surgery patients and to pinpoint key characteristics associated with BDD. This information provides plastic surgeons with specific factors to consider during preoperative evaluations. METHODS: We employed TriNetX database to identify patients with BDD who underwent cosmetic surgery identified by Current Procedural Terminology codes. Demographics and patient characteristics were identified using the International Classification of Diseases 10 codes. We calculated odds ratios (OR) by using chi-squared tests to assess risk factors among patients with BDD. RESULTS: Of 226,374 patients who underwent plastic surgery between August 2002 and August 2022, fewer than 0.1% were diagnosed with BDD. Of the BDD patients, 52.1% were diagnosed after cosmetic surgery. Compared with the control group, BDD patients were more likely to undergo rhinoplasty (OR=1.784, p = 0.004) and nonlocalized lipectomy (OR=1.448, p = 0.021) and less likely to undergo blepharoplasty (OR=0.451, p = 0.002). Findings indicated a strong association between BDD patients undergoing cosmetic procedures and comorbid psychiatric conditions such as depression (OR=4.279, p < 0.05), anxiety (OR=5.490, p < 0.05), and Attention-Deficit Hyperactivity Disorder (OR=3.993, p < 0.05). CONCLUSIONS: These findings underscore the ongoing significance of BDD in the context of cosmetic surgery, potentially indicating a lower surgery rate among BDD patients compared with previous estimates. Nevertheless, avenues for further improvement persist. Our data affirm the noteworthy occurrence of postsurgery BDD development, thereby highlighting the ongoing necessity for psychiatric evaluation in surgical patients.

Involvement in sex work is associated with muscle dysmorphia symptomatology among a sample of Canadian adolescents and young adults.

BACKGROUND: The aim of this study was to investigate the association between lifetime sex work involvement and muscle dysmorphia symptomatology. METHODS: Data from the Canadian Study of Adolescent Health Behaviours (N =912) were analysed. Multiple adjusted linear regression models were estimated with lifetime sex work involvement as the independent variable and muscle dysmorphia symptomatology, measured using the Muscle Dysmorphic Disorder Inventory, as the dependent variable. RESULTS: Among the sample, 3.7% of participants reported engaging in lifetime sex work. Significant associations were found between self-reported lifetime sex work and greater total muscle dysmorphia symptomatology (B =5.03, 95% CI 1.80, 8.26), greater Drive for Size symptomatology (B =2.36, 95% CI 0.74-3.97), and greater Functional Impairment symptomatology (B =2.11, 95% CI 0.54, 3.67), while adjusting for relevant sociodemographic variables. CONCLUSIONS: Findings from this study expand prior research that has documented poor mental health among individuals involved in sex work. Clinical and community health professionals should consider screening for muscle dysmorphia symptomatology among young people who have been involved in sex work.

Development of a body dysmorphic disorder screener for DSM-5 (BDDS-5).

Early identification of individuals with Body dysmorphic disorder (BDD) is essential to direct them to appropriate care and to reduce the chance of developing or maintaining comorbid psychiatric disorders (like an eating disorder (ED)). The present study aimed to develop a simple screener, the Body Dysmorphic Disorder Screener for DSM-5 (BDDS-5), to overcome existing screeners' limitations and test its psychometric properties. The BDDS-5 consists of 12 statements with dichotomous answer options. Specific attention is paid to the readability of the screener for those with lower reading skills. Additional eating disorder screening questions (S section) were added to investigate whether these questions are necessary for detecting potential BDD cases. Finally, the factor structure, internal consistency, and validity of the BDDS-5 were examined within populations with a high risk of screening positive for BDD or ED. Principal axis factor analysis showed that two factors accounted for 63.5% of the variance. The factor analysis was based on polychoric correlation. Based on the BDDS-5, 33 persons (14% of N = 235) were screened as likely BDD cases. Nineteen persons were excluded as potential BDD cases based on the eating disorder related question (question D). Based on the S-section, this turned out to be largely correct for the majority, however, in 8% (n = 4) of the cases BDD was probably missed. The convergent validity appeared to be high (r > 0.80) with three other BDD measures. The BDDS-5 is a valid and widely applicable screener for BDD that may help in the early detection of BDD. The BDDS-5 uses simple wording and is thus suitable for people 8 years and older.

Body Dysmorphic Disorder and Self-esteem in Adolescents and Young Adults with Acne Vulgaris.

Body dysmorphic disorder is a mental health disorder characterized by a preoccupation with a perceived flaw, which is commonly seen among dermatology patients. The objective of this study was to determine the frequency of body dysmorphic disorder and assess self-esteem among a clinical sample of adolescents and young adults being managed for acne vulgaris. A total of 105 patients, age range 13-24 years, receiving acne treatment at 1 of 2 dermatology outpatient clinic were included. A self-report questionnaire was used, which included a body dysmorphic disorder screening tool (based on the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) diagnostic criteria) and the Rosenberg Self-Esteem Scale (RSES). Acne was graded with the Cook's acne grading scale. Out of 105 adolescents and young adults visiting a dermatologist due to acne, 13 (12.4%) screened positive for body dysmorphic disorder (95% confidence interval (95% CI) 6.8-20.2%). Patients with body dysmorphic disorder were more likely to have female gender (p = 0.020) and had lower self-esteem (RSES 15.8 vs 20.5, respectively, p = 0.013) compared with patients without body dysmorphic disorder. No differences were found in the frequency of body dysmorphic disorder with DSM-IV or DSM-5 criteria. This is the first study to report on the frequency of body dysmorphic disorder and self-esteem in adolescents and young adults with acne. Ultimately, more awareness of body dysmorphic disorder among adolescents and young adults presenting with dermatological disorders could lead to more rapid recognition and referral to psychiatric units.