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disorder.96 These findings suggest that some persons with body dysmorphic disorder may use substances to self-medicate distress.96 Eating Disorders Anorexia and bulimia appear to be relatively common in persons with body dysmorphic disorder. The lifetime comorbidity rate ranges from 7 to 14 percent, with a current rate of 4 percent.92 In a study of 41 patients hospitalized for anorexia, 39 percent met criteria for body dysmorphic disorder.97 Personality Disorders The rate of personality disorders among persons with body dysmorphic disorder appears to be quite high. In a study of Axis II comorbid diagnoses (n 148), 57 percent met criteria for at least one personality disorder, most commonly avoidant personality disorder.98 Paranoid, obsessive-compulsive, and dependent personality disorPlastic and Reconstructive Surgery • December 2006 172e ders may also co-occur with body dysmorphic disorder.73,98,99 PREVALENCE Body Dysmorphic Disorder in the General Population The prevalence of body dysmorphic disorder in the general population has yet to be firmly established. However, body dysmorphic disorder is estimated to affect approximately 1 to 2 percent of the general population.45 Two large studies of community samples both reported body dysmorphic disorder rates of 0.7 percent.100,101 Another study of community samples reported that the rate of body dysmorphic disorder ranged from 1 to 3 percent.53 A study of 566 high school students reported a rate of 2 percent.102 In college populations, rates of body dysmorphic disorder range from 2.5 to 5 percent.103–106 Earlier studies of college students suggested higher rates of body dysmorphic disorder (e.g., 13 to 28 percent).107,108 However, the discrepancy in rates between early and more recent studies is likely attributable to the use of less rigorous assessments in the early studies. Overall, studies suggest that body dysmorphic disorder is not uncommon. Table 1 provides an overview of the prevalence studies that have been conducted to date in a variety of populations. Body Dysmorphic Disorder in Cosmetic Surgery and Dermatology Populations Body dysmorphic disorder was initially thought to occur in approximately 2 percent of cosmetic surgery patients, a rate similar to that in the general population.109 However, empirical studies suggest that the rate of body dysmorphic disorder among cosmetic surgery and dermatology populations appears to be higher than the reported rate in the general population. In American cosmetic surgery populations, 7 to 8 percent of patients met diagnostic criteria for body dysmorphic disorder.34,110 Internationally, rates of body dysmorphic disorder ranged from 6 to 53 percent among patients presenting for cosmetic surgery.20,111–115 However, several of these studies had significant methodological flaws, including small sample sizes, selection biases, and the use of unstructured interviews. Two international studies that had larger samples and imTable 1. Studies of the Prevalence of BDD among Community, Student, Cosmetic Surgery, Reconstructive Surgery, and Dermatology Samples Authors Year Country No. Population Assessment Rate (%) Community Faravelli et al. 1997 Italy 673 Community sample Clinical interview 0.70 Bienvenu et al. 2000 United States 373 Community sample Clinical interview 1–3 Otto et al. 2001 United States 976 Community sample Clinical interview 0.70 Students Fitts et al. 1989 United States 258 College students Self-report 28 Biby 1998 United States 102 College students Self-report 13 Mayville et al. 1999 United States 566 High school students Self-report 2.2 Bohne et al. 2002 Germany 133 College students Self-report 5.3 Bohne et al. 2002 United States 101 College students Self-report 4 Cansever et al. 2003 Turkey 420 College students Self-report, clinical interview 4.8 Sarwer et al. 2005 United States 559 College students Self-report 2.5 Cosmetic Surgery Sarwer et al. 1998 United States 100 Cosmetic surgery Self-report 7 Ishigooka et al. 1998 Japan 415 Cosmetic surgery Clinical interview 15 Altamura et al. 2001 Italy 487 Aesthetic medical Clinical interview 6.3 Vargel et al. 2001 Turkey 20 Cosmetic surgery Clinical interview 20 Vindigni et al. 2002 Italy 56 Cosmetic surgery Clinical interview 53.6 Aouizerate et al. 2003 France 132 Cosmetic surgery Clinical interview 9.1 Veale et al. 2003 United Kingdom 29 Rhinoplasty Self-report 20.7 Crerand et al. 2004 United States 91 Cosmetic surgery Self-report 8 Castle et al 2004 Australia 137 Nonsurgical cosmetic Self-report 2.9 Reconstructive Surgery Sarwer et al. 1998 United States 43 Reconstructive surgery Self-report 16 Crerand et al. 2004 United States 50 Reconstructive surgery Self-report 7 Dermatology Phillips et al. 2000 United States 268 Dermatology Self-report 11.9 Dufresne et al. 2001 United States 46 Dermatology Self-report, clinical interview 15 Harth et al. 2001 Germany 13 Dermatology (hyperhidrosis) Clinical interview 23.1 Uzun et al. 2003 Turkey 159 Dermatology (acne) Clinical interview 8.8 BDD, body dysmorphic disorder. Volume 118, Number 7 • Body Dysmorphic Disorder 173e proved methodologies reported rates of 6.3 and 9 percent, respectively, rates more consistent with those found in American studies.113,114 Two studies have investigated the rate of body dysmorphic disorder among patients presenting for nonsurgical cosmetic
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