Prevalence of Body Dysmorphic Disorder among patients seeking orthodontic treatment.
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ABSTRACT: Background
Body Dysmorphic Disorder (BDD) is a psychiatric disorder with delusions about defects in appearance for which patients seek various treatments. Patients with BDD often seek cosmetic procedures, and orthodontic treatment is one among them. This is the first Indian study to determine the prevalence of BDD in an orthodontic outpatient department.Materials and method
A total of 1184 patients with varying degrees of malocclusion completed the BDD-YBOCS questionnaire, while an experienced orthodontist assessed the severity of malocclusion with a rating scale.Results
Sixty-two patients (5.2%) were screened positive for BDD. Most of the BDD-positive patients were single (p value of 0.02) and had multiple previous consultations for orthodontic treatment (p value of < 0.00**) with a gender predilection toward males (p value of 0.00**), and age was not statistically significant with a p value of 0.3.Conclusion
From our study, the prevalence of BDD among orthodontic patients was 5.2%. The orthodontist should be aware of the high prevalence of BDD among orthodontic patients and identify the expectations of the patient at the time of history taking and refer the patient to a psychiatrist for diagnosis and appropriate management.
SUBMITTER: Sathyanarayana HP
PROVIDER: S-EPMC7396409 | biostudies-literature | 2020 Aug
REPOSITORIES: biostudies-literature
Publications
Prevalence of Body Dysmorphic Disorder among patients seeking orthodontic treatment.
Sathyanarayana Haritha Pottipalli HP Padmanabhan Sridevi S Balakrishnan R R Chitharanjan Arun B AB
Progress in orthodontics 20200803 1
<h4>Background</h4>Body Dysmorphic Disorder (BDD) is a psychiatric disorder with delusions about defects in appearance for which patients seek various treatments. Patients with BDD often seek cosmetic procedures, and orthodontic treatment is one among them. This is the first Indian study to determine the prevalence of BDD in an orthodontic outpatient department.<h4>Materials and method</h4>A total of 1184 patients with varying degrees of malocclusion completed the BDD-YBOCS questionnaire, while ...[more]
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Project description:BackgroundAlthough effective treatments are available, most individuals with body dysmorphic disorder (BDD) do not receive an appropriate diagnosis or treatment. We aimed to examine treatment utilization and barriers to treatment, and to identify associated socio-demographic and clinical characteristics.MethodsGerman individuals completed an online self-report survey of appearance concerns. A sample of N = 429 individuals met criteria for BDD. We examined the frequency of treatment utilization and barriers, analyzed comparisons between treated and untreated individuals and assessed the relationships of socio-demographic and clinical features with mental health treatment utilization and treatment barriers, respectively.ResultsOnly 15.2% of the individuals with BDD had been diagnosed with BDD, and lifetime rates of mental health treatment were low (39.9%). Individuals endorsed multiple barriers to mental health treatment, especially shame, low perceived need and a preference for cosmetic and medical treatments. Associated features were identified, including age, a BDD diagnosis, body dysmorphic symptom severity, a likely major depressive disorder, prior cosmetic surgery, and insight.ConclusionsThe results of this largest study to date highlight that BDD is still underrecognized and undertreated even in a country with extensive mental health care and few financial barriers. We discuss modifiable factors and strategies to foster awareness of BDD in sufferers and professionals to improve treatment dissemination and to reduce treatment barriers.
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Project description:Pediatric body dysmorphic disorder (BDD) is challenging to treat. This study aimed to establish the prevalence of insomnia in youth with BDD and explore its impact on clinical outcomes. Sixty-six children and adolescents with BDD consecutively referred to a specialist clinic completed a range of clinical measures, including the Yale-Brown Obsessive-Compulsive Scale Modified for BDD-Adolescent Version (BDD-YBOCS-A), and the Insomnia Severity Index (ISI). Patients with clinical insomnia (ISI score ≥ 9) were compared to the rest of the sample on socio-demographic and clinical features. Fifty-six patients who received multimodal treatment were re-assessed post-treatment. A mixed-model ANOVA was performed to compare treatment outcomes between the insomnia vs. no insomnia groups, and Chi-squared tests were used to compare response and remission rates. According to the ISI, 48% of the sample qualified as having insomnia at baseline. These participants showed significantly higher self-reported BDD symptom severity, more depressive symptoms, and more functional impairment in daily activities. Patients with insomnia improved less on the BDD-YBOCS-A than those without insomnia, although the difference did not reach statistical significance. The rates of responders and remitters were lower in the insomnia group, compared to the non-insomnia group. Insomnia is prevalent in pediatric BDD, and is associated with more severe psychopathology and worse functioning in daily activities. Furthermore, youth experiencing BDD and insomnia may benefit from multimodal treatment to a lesser extent than those without insomnia. If these results are replicated in larger samples, treatment refinements for pediatric BDD could include specific modules to directly target insomnia.
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Project description:BackgroundBody dysmorphic disorder (BDD) is a psychiatric disorder characterized by a preoccupation with an imagined or slight defect which causes significant distress or impairment in functioning. Few studies have assessed gender differences in BDD in a non clinical population. Also no study assessed BDD in medical students. This study was designed to determine the point prevalence of BDD in Pakistani medical students and the gender differences in prevalence of BDD, body foci of concern and symptoms of BDD.MethodsThe medical students enrolled in a medical university in Karachi, Pakistan filled out a self-report questionnaire which assessed clinical features of BDD. BDD was diagnosed according to the DSM-IV criteria.ResultsOut of the 156 students, 57.1% were female. A total of 78.8% of the students reported dissatisfaction with some aspect of their appearance and 5.8% met the DSM-IV criteria for BDD. The male to female ratio for BDD was 1.7. Regarding gender differences in body foci of concern, the top three reported foci of concern in male students were head hair (34.3%), being fat (32.8%), skin (14.9%) and nose(14.9%), whereas in females they were being fat (40.4%), skin (24.7%) and teeth (18%). Females were significantly more concerned about being fat (p = 0.005). Male students were significantly more concerned about being thin (p = 0.01) and about head hair (p = 0.012).ConclusionBDD is fairly common in our medical student population, with a higher prevalence in males. Important gender differences in BDD symptomatology and reported body foci of concern were identified which reflected the influence of media on body image perception. The impact of cultural factors on the prevalence as well as gender differences in BDD symptomatology was also established.
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Project description:BackgroundBody dysmorphic disorder (BDD) is a prevalent mental disorder, particularly in those seeking plastic surgery, leading to unnecessary surgeries and postsurgical dissatisfaction. Among the plastic surgeries, rhinoplasty is the most commonly sought, yet the data on prevalence of BDD among the candidates of rhinoplasty is limited. Therefore, this systematic review and meta-analysis aimed to estimate the prevalence of BDD in rhinoplasty candidates.MethodsThe online libraries of Web of Science, PubMed, Cochrane Library, ProQuest, Research Square, Scopus, and Google Scholar were searched up to August 2022. Statistical analyses were performed using STATA software (v. 16). The heterogeneity was determined using the I 2 statistic, and an overall estimated analysis was conducted. Subgroup analyses were performed on study year, age, gender, World Health Organization regional classification, sociodemographic index, country, sample size, and employed diagnostic tool. A meta-regression analysis was performed to identify potential sources of heterogeneity.ResultsOut of 12,999 studies assessed, 18, with a combined sample size of 2132 individuals, met our criteria and were included in the study. The pooled prevalence of BDD was 32.7% (95% CI: 23.6-41.7; I 2 = 96.45%). Subgroup analyses revealed the studies that were conducted in the European region (42.8%), with a sample size of ≥100 (40.2%), utilized the BDD modification of the Y-BOCS (BDD-YBOCS) diagnostic method (47.3%), and with a quality score of ≥6 (34.2%) demonstrated higher prevalence of BDD. The meta-regression analysis identified a higher prevalence in the BDD-YBOCS diagnostic method than in the BDD questionnaire (β: 0.23; 95% CI: 0.04-0.43; p = 0.022).ConclusionsThe prevalence of BDD is high in those seeking rhinoplasty. Clinicians should be aware of BDD symptoms to prevent unnecessary surgery and dissatisfaction. Public awareness through the media and access to affordable medical services should also be provided.
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Project description:BACKGROUND:Body dysmorphic disorder (BDD) is a prevalent and disabling preoccupation with a slight or imagined defect in appearance. Trials have investigated the use of serotonin reuptake inhibitors (SRIs) and cognitive behaviour therapy (CBT) for BDD. OBJECTIVES:To assess the efficacy of pharmacotherapy, psychotherapy or a combination of both treatment modalities for body dysmorphic disorder. SEARCH STRATEGY:We searched the Cochrane Depression, Anxiety and Neurosis Trial Register (December 2007), the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 4, 2007), MEDLINE (January 1966 to December 2007), and PsycINFO (1967 to December 2007). Ongoing and unpublished trials were located through searching the metaRegister of Controlled Trials, the CRISP and WHO ICTRP search portals (databases searched in December 2007), and through contacting key researchers and pharmaceutical companies. Additional studies were located through study reference lists. SELECTION CRITERIA:Randomised controlled trials (RCTs) of patients meeting DSM or ICD diagnostic criteria for BDD, in which the trials compare pharmacotherapy, psychotherapy or multi-modal treatment groups with active or non-active control groups. Short or long-term trials were eligible. DATA COLLECTION AND ANALYSIS:Two review authors independently assessed RCTs for inclusion in the review, collated trial data, and assessed trial quality. Investigators were contacted to obtain missing data. Summary effect sizes for dichotomous and continuous outcomes were calculated using a random effects model and heterogeneity was assessed. MAIN RESULTS:Two pharmacotherapy and three psychotherapy trials were eligible for inclusion in the review, with data from four short-term RCTs (169 participants) available for analysis. Response data from a single placebo-controlled trial of fluoxetine suggested overall superiority of medication relative to placebo (relative risk (RR) 3.07, 95% CI 1.4 to 6.72, n = 67). Symptom severity was also significantly reduced in the RCTs of fluoxetine and clomipramine (relative to desipramine), as well as in the two CBT trials (WMD -44.96, 95% CI -54.43 to -35.49, n = 73). A low relapse rate (4/22) was demonstrated in one trial of CBT. AUTHORS' CONCLUSIONS:Results from the small number of available RCTs suggest that SRIs and CBT may be useful in treating patients with BDD. The findings of these studies need to be replicated. In addition, future controlled studies in other samples, such as adolescents, and using other selective SRIs, as well as a range of psychological therapy approaches and modalities (alone and in combination), are essential in supplementing the sparse data currently available.
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Project description:Body dysmorphic disorder (BDD) is a relatively common and disabling psychiatric disorder characterised by excessive and persistent preoccupation with perceived defects or flaws in one's appearance, which are unnoticeable to others, and associated repetitive behaviours (eg, mirror checking). The disorder generally starts in adolescence, but often goes unnoticed and is severely underdiagnosed. Left untreated, BDD typically persists and causes marked functional impairment in multiple domains. This clinical review considers recent advances in the epidemiology and classification of BDD, including its reclassification in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders under the new 'Obsessive-Compulsive and Related Disorders' chapter. Key issues in assessment are outlined including the use of validated screening instruments to minimise misdiagnosis and the importance of risk assessment in this population given the high rates of suicidality and inappropriate use of cosmetic treatments. In addition, current knowledge regarding the causes and mechanisms underlying BDD are summarised. The recommended treatments for BDD are outlined, namely cognitive behavioural therapy (CBT) and antidepressants, such as selective serotonin reuptake inhibitors. Both CBT and pharmacotherapy have been shown to be efficacious treatments for BDD in adult populations, and evidence is emerging to support their use in young people. Although the majority of patients improve with existing evidence-based treatment, a large proportion are left with clinically significant residual symptoms. Priorities for future research are therefore discussed including the need to further refine and evaluate existing interventions with the goal of improving treatment outcomes and to increase their availability.
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Project description:The available literature on the orthodontic treatment of patients with rare disorders is extremely scarce. The aim of this study was to analyze the diagnosis and orthodontic treatment of a group of 94 individuals with rare diseases, referred for orthodontic evaluation to a university special care dentistry center (University of Santiago de Compostela, Spain). We created a control group of 94 systemically healthy individuals, paired by sex and age range. For all participants, we recorded their dental and skeletal abnormalities, oromotor dysfunctions and the characteristics of their orthodontic treatment. Some of the morphological and functional abnormalities were more prevalent in the rare disorders group than in the control group, including dental agenesis, microdontia, enamel defects, maxillary hypoplasia, overbite, cleft lip/palate, mouth breathing, atypical swallowing, lingual/labial interposition, labial incompetence, modified consistency diet, bruxism, and muscle tone abnormalities. Compared with the control group, the 56 patients with rare disorders who underwent orthodontic treatment required more desensitization sessions, used mixed appliances (fixed and removable) more often and for longer periods and had more frequent complications, such as gingivitis, caries, mucosal ulcers and recurrent debonding of the device. In conclusion, for selected patients with rare disorders, it is feasible to perform orthodontic treatment, whose planning will be determined by the dental-skeletal abnormalities and oromotor dysfunctions. Although complications are more frequent, they can typically be solved without having to stop treatment.
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Project description:Body dysmorphic disorder (BDD) is characterized by preoccupation with misperceived defects of appearance, causing significant distress and disability. Previous studies suggest abnormalities in information processing characterized by greater local relative to global processing. The purpose of this study was to probe whole-brain and regional white matter network organization in BDD, and to relate this to specific metrics of symptomatology. We acquired diffusion-weighted 34-direction MR images from 14 unmedicated participants with DSM-IV BDD and 16 healthy controls, from which we conducted whole-brain deterministic diffusion tensor imaging tractography. We then constructed white matter structural connectivity matrices to derive whole-brain and regional graph theory metrics, which we compared between groups. Within the BDD group, we additionally correlated these metrics with scores on psychometric measures of BDD symptom severity as well as poor insight/delusionality. The BDD group showed higher whole-brain mean clustering coefficient than controls. Global efficiency negatively correlated with BDD symptom severity. The BDD group demonstrated greater edge betweenness centrality for connections between the anterior temporal lobe and the occipital cortex, and between bilateral occipital poles. This represents the first brain network analysis in BDD. Results suggest disturbances in whole brain structural topological organization in BDD, in addition to correlations between clinical symptoms and network organization. There is also evidence of abnormal connectivity between regions involved in lower-order visual processing and higher-order visual and emotional processing, as well as interhemispheric visual information transfer. These findings may relate to disturbances in information processing found in previous studies.
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Project description:Body Dysmorphic Disorder (BDD) is defined as a constant obsession with one's external appearance and flaws, and it falls under the criteria of neuropsychiatric disorders. Individuals suffering from this disorder may seek unnecessary cosmetic procedures from cosmetic treatment providers such as dermatologists or plastic surgeons. Cosmetic treatments have become readily available, which has led to an influx of undiagnosed BDD patients electing to undergo such treatments. Therefore, physicians should have the clinical knowledge about BDD to diagnose and manage these cases to avoid psychological and physical harm to these patients. However, there were no studies conducted in our region to assess the awareness of BDD among physicians who provide cosmetic treatments with regards to their attitude toward such cases and how they would manage it. This study aims to assess the awareness of Body Dysmorphic Disorder among Saudi physicians who provide cosmetic treatments. We conducted an observational cross-sectional study among physicians practicing in hospitals and cosmetic clinics in Riyadh and Jeddah city (Saudi Arabia), who perform cosmetic procedures, namely dermatologists, plastic surgeons, and otorhinolaryngologists. A paper-based questionnaire consisting of multiple-choice questions was distributed among them. The total number of participants was 155 physicians: 113 (72.9%) males and 42 (27.1%) females. Eighty-two (52.9%) participants reported that they have been familiar with the diagnostic criteria of BDD for a long time and ninety-nine (63.8%) reported being familiar with the clinical picture of BDD. Sixty-three (40.6%) participants estimated the prevalence of BDD cases seen in cosmetic practice to range from 1%-5%, and most agreed on an equal prevalence of BDD among female and male patients. Half of the participants (n = 76) (49%) reported that they sometimes share knowledge about BDD with patients whom they suspect to suffer from this condition. In conclusion, cosmetic treatment providers in Saudi Arabia are aware of BDD, but we have identified a discrepancy between the self-reported participant knowledge of diagnostic criteria and their ability to accurately estimate the prevalence of BDD cases seen in clinical practice.
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Project description:BackgroundBody dysmorphic disorder (BDD) is a highly debilitating mental disorder associated with notable psychosocial impairment and high rates of suicidality. This study investigated BDD from a network perspective, which conceptualizes mental disorders as systems of symptoms that cause and exacerbate one another (e.g., preoccupation with perceived appearance defect triggering compulsive checking in the mirror).MethodsIn a sample of BDD patients (N = 148), we used cross-sectional network models to explore the network structure of 1) BDD symptoms and 2) BDD symptoms and major depressive disorder (MDD) symptoms, and tested which symptoms were most central (i.e., most strongly associated to other symptoms).ResultsInterference in functioning due to appearance-related compulsions (BDD), feelings of worthlessness (MDD), and loss of pleasure (MDD) were most central.ConclusionThese symptoms were most strongly predictive of other BDD and MDD symptoms and may be features of BDD that warrant prioritization in theory development and treatment. A limitation of our study is that the precision of these findings may be limited due to a small sample size relative to the number of parameters. Replication studies in larger samples of BDD patients are needed.
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