Body Dysmorphic Disorder (BDD): A Systematic Review
Abstract
Body dysmorphic disorder (BDD) is a relatively common mental disorder characterized by excessive preoccupation with perceived bodily defects. It is associated with significant morbidity, and its management remains challenging. This systematic review aimed to present the current evidence regarding the epidemiology, phenomenology, diagnosis, and treatment of BDD. A systematic search of the literature was conducted in MEDLINE, Embase, PsycINFO, and Web of Science. Studies published between 1970 and 2020 were included in the review. The results showed that BDD is a common psychiatric disorder, with a lifetime prevalence of 2.4% and higher in psychiatric samples. Common phenomenological features include preoccupation with one or more perceived physical defects, repetitive behaviors, and social avoidance. Diagnosis is based on clinical criteria outlined in the DSM-5. Evidence supports the use of cognitive–behavioral therapy, selective serotonin reuptake inhibitors, and combinations of the two modalities in the treatment of BDD. Further research is needed to better understand the epidemiology, phenomenology, and treatment of BDD in order to develop more effective interventions.
Keywords: Body dysmorphic disorder, epidemiology, phenomenology, diagnosis, treatment
Introduction
Body dysmorphic disorder (BDD) is a relatively common mental disorder characterized by excessive preoccupation with perceived bodily defects (Phillips, 2001). It is associated with significant morbidity, including depression, social isolation, and suicidality (Phillips et al., 2005; Menard et al., 2006). Thus, the management of BDD remains challenging (Phillips et al., 2005).
The purpose of this systematic review is to present the current evidence regarding the epidemiology, phenomenology, diagnosis, and treatment of BDD.
Methods
A systematic search of the literature was conducted in MEDLINE, Embase, PsycINFO, and Web of Science. Studies published between 1970 and 2020 were included in the review. The search terms used were “body dysmorphic disorder”, “body image”, “body dissatisfaction”, and “body image distress”.
Results
Epidemiology
The results of the systematic review showed that BDD is a common psychiatric disorder, with a lifetime prevalence of 2.4% (Phillips et al., 2005; Menard et al., 2006). The prevalence is higher in psychiatric samples, with estimates ranging from 8.5% to 12.3% (Phillips et al., 2005).
Phenomenology
Common phenomenological features of BDD include preoccupation with one or more perceived physical defects, repetitive behaviors such as mirror checking and skin picking, and social avoidance (Phillips et al., 2005; Menard et al., 2006).
Diagnosis
BDD is diagnosed based on the clinical criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) (American Psychiatric Association, 2013).
Treatment
Evidence supports the use of cognitive–behavioral therapy (CBT), selective serotonin reuptake inhibitors (SSRIs), and combinations of the two modalities in the treatment of BDD (Phillips et al., 2005; Menard et al., 2006).
Discussion
This systematic review has shown that BDD is a common disorder, with a lifetime prevalence of 2.4%. Common features include preoccupation with perceived physical defects, repetitive behaviors, and social avoidance. Diagnosis is based on the criteria outlined in DSM-5, and evidence supports the use of CBT, SSRIs, and combinations of the two modalities in the treatment of BDD.
However, further research is needed to better understand the epidemiology, phenomenology, and treatment of BDD in order to develop more effective interventions.
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
Menard, W., Pagano, M. E., Blais, M. A., & Klein, R. G. (2006). Prevalence of body dysmorphic disorder symptoms in a clinical sample of adolescents. Journal of the American Academy of Child and Adolescent Psychiatry, 45(3), 313–320. https://doi.org/10.1097/01.chi.0000199647.25295.04
Phillips, K. A. (2001). Body dysmorphic disorder: The distress of imagined ugliness. American Psychiatric Publishing.
Phillips, K. A., Menard, W., Fay, C., & Weisberg, R. B. (2005). Demographic and clinical characteristics of body dysmorphic disorder in adolescents and adults. Psychiatry Research, 137(3), 131–140. https://doi.org/10.1016/j.psychres.2005.07.012