Body dysmorphic disorder (BDD), defined as excessive preoccupation with perceived flaws in personal appearance, affects almost two in every 100 teens, according to a report in the Journal of the American Academy of Child and Adolescent Psychiatry. The report also found that BDD is much more common in girls than boys.
Moreover, children and adolescents with BDD are highly likely to have other psychiatric disorders—especially depression and anxiety—and to experience psychosocial problems, self-harm and/or suicide attempts.
“Since young people with BDD tend not to spontaneously disclose their symptoms unless directly asked, it is crucial that clinicians utilize BDD screening tools and ask young people directly about appearance concerns,” wrote lead author Georgina Krebs, Ph.D., D.Clin.Psy., of University College London, and colleagues. “Screening for BDD in young people with anxiety disorders and depression, the most common comorbidities, is likely to improve detection.”
The researchers analyzed data from 7,654 children and young people aged 5-19 who completed the 2017 Mental Health of Children and Young People in England survey with their parents/guardians. BDD was assessed using the Developmental and Well-Being Assessment, a standardized screening tool that includes a question on whether the child is ever concerned how he/she looks. Children who answered ‘A little’ or ‘A lot’ were presented with a series of other questions related to DSM-5 diagnostic criteria for BDD.
Among all children and teens aged 5-19, the prevalence of BDD was 1.0%. BDD was more common among teens ages 12-19 (1.9%) than among children ages 5-11 (0.1%). Across all ages, BDD was also more common in girls (1.8%) than in boys (0.3%).
Nearly 70% of young people with BDD met diagnostic criteria for at least one additional psychiatric disorder. The most common comorbidities were anxiety-related disorders and depressive disorders, occurring in 58.7% and 31.7% of those with BDD, respectively.
Further, 46% of young people with BDD reported a lifetime history of self-harm or suicide attempts, compared to 8% of those without BDD. Teens with BDD also reported higher levels of psychosocial impairment and healthcare utilization.
Excessive preoccupation with appearance that fell short of meeting criteria for BDD was also common among teens and showed similar patterns of comorbidity and impairment. “Appearance preoccupation is a significant clinical phenomenon in its own right, linked with substantial morbidity,” the researchers concluded. “Efforts are needed to raise awareness of BDD, improve screening practices, and reduce barriers to evidence-based treatment.”
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