Embedded Files
of the largest studies of persons with body dysmorphic disorder, the mean age of onset was 16.4 7.0 years, although dislike of appearance began at 12.9 5.8 years.52 Symptom development may be sudden or gradual. It is not uncommon for body dysmorphic disorder to be misdiagnosed, given its comorbid conditions (see discussion below) and the reluctance of persons with body dysmorphic disorder to discuss their concerns with others.70,73 Course Body dysmorphic disorder tends to be continuous rather than episodic.52 Symptom severity and degree of insight can fluctuate over the course of the disorder. Complete remission of symptoms appears to be rare, even after treatment.51,70,74 A naturalistic study of the course of body dysmorphic disorder found that persons with severe symptoms of long duration, and those with personality disorders, were less likely to experience partial or full remission at 1-year follow-up.74 Gender Differences Somewhat counterintuitively, body dysmorphic disorder appears to affect men and women with equal frequency.45,72 Some studies have reported higher frequencies among women52,73 or men.20,47 Nevertheless, men and women tend to be similar with respect to most demographic and clinical features.72,75 Male patients, however, may be more likely to be unmarried.72 Clinical Features To date, no large-scale epidemiologic studies of body dysmorphic disorder have been comPlastic and Reconstructive Surgery • December 2006 170e pleted. However, retrospective studies72,73 and baseline data from the first naturalistic prospective study of the course of body dysmorphic disorder52 have provided rich descriptions of the disorder’s clinical characteristics. Preoccupation with Perceived Defects Most frequently, persons with body dysmorphic disorder become preoccupied with their skin, hair, and nose, although any body part can be a source of concern.52,72,76 Men may become preoccupied with their genitals, height, hair, and body build, whereas women typically report concerns with their weight, hips, legs, and breasts.72,75 On average, persons with body dysmorphic disorder report preoccupation with five to seven body parts over the course of the disorder.52 Some may present with highly specific concerns (e.g., perceived asymmetry of a body part), whereas others may have vague complaints (e.g., concern that the part does not “look right”).70 Obsessive Thoughts Persons with body dysmorphic disorder typically experience uncontrollable, intrusive thoughts about their appearance. These thoughts may increase in situations where the person fears that his or her “defect” will be evaluated by others.61 In severe cases, persons with body dysmorphic disorder may have difficulty thinking about anything aside from their “defect.” Insight tends to vary, but it is typically poor.52 Some persons admit that their concerns are exaggerated, whereas others hold their beliefs with delusional intensity.77 Up to 77 percent of persons with body dysmorphic disorder held their appearance beliefs with delusional intensity at some point during the course of the disorder.52 Compulsive Behaviors Persons with body dysmorphic disorder often engage in compulsive, time-consuming behaviors as a means of inspecting, improving, or camouflaging their appearance concern.51,78 They may spend hours each day examining their “defects” in the mirror or other reflective surfaces, applying makeup to camouflage their flaws, or using clothes or body positions to hide areas of concern. Others may avoid mirrors and situations or clothing that may expose their defect. In the largest study of persons with body dysmorphic disorder, all participants reported engaging in at least one compulsive behavior, including comparing themselves to others, mirror checking, and skin picking.52 These behaviors can consume several hours each day and lead to impairment in relationships and occupational functioning.61,78 Although these behaviors are undertaken with the goal of reducing anxiety, they typically have the opposite effect. Spending hours in front of the mirror often increases the degree of preoccupation. Engaging in skin picking as a means of improving the appearance of “blemishes” may create or exacerbate a defect.79 Excessive application of corrective creams and makeup can also damage skin. Distress and Impairment of Functioning Body dysmorphic disorder symptoms often cause significant distress. Persons with body dysmorphic disorder report higher levels of depression, anxiety, and anger/hostility compared with other psychiatric outpatients and those free from psychiatric disorders.80 Studies and case reports suggest that persons with body dysmorphic disorder may become physically violent toward others.75,81,82 Some become so distressed about their appearance that they attempt “do-it-yourself” cosmetic procedures.70,83 Body dysmorphic disorder often causes marked impairment in psychosocial functioning.52,84 Almost all patients report inference with vocational or academic performance, and 27 percent reported being housebound for more than 1 week at some point during the course of the disorder.52 Self-esteem and quality of life for persons with body dysmorphic disorder appear to be poor.84 –87 The
Google Sites
Report abuse