Epidemiology of Body Dysmorphic Disorder and Appearance Preoccupation in Youth: Prevalence, Comorbidity and Psychosocial Impairment - 12/04/24

Doi : 10.1016/j.jaac.2024.01.017

Georgina Krebs, PhD, DClinPsy ^a,^b,^⁎ , Bruce R. Clark, MB ChB, MRCPsych ^b, Tamsin J. Ford, PhD ^c, Argyris Stringaris, MD, PhD, FRCPsych ^a,^d
^a University College London, London, United Kingdom
^b South London and Maudsley NHS Foundation Trust, United Kingdom
^c University of Cambridge, United Kingdom, and Cambridge and Peterborough, NHS Foundation Trust, Cambridgeshire, United Kingdom
^d National and Kapodistrian University of Athens, Athens, Greece

^∗Correspondence to Georgina Krebs, PhD, DClinPsy, Research Department of Clinical, Educational and Health Psychology, University College London, 1-19 Torrington Place, London WC1E 7HB, UKResearch Department of ClinicalEducational and Health PsychologyUniversity College London1-19 Torrington PlaceLondonUK

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Abstract

Objective

Little is known about how common and impairing body dysmorphic disorder (BDD) is in the general population of youth. We evaluated the prevalence, comorbidity, and psychosocial impairment associated with BDD and more broadly defined appearance preoccupation in young people.

Method

Data were drawn from the 2017 Mental Health of Children and Young People in England survey. BDD and psychiatric comorbidity were assessed in individuals 5 to 19 years of age (N = 7,654) according to DSM-5 criteria, using a clinician-rated standardized diagnostic assessment. Psychosocial impairment was measured with a quantitative scale and was indexed by reported self-harm and suicide attempts, as well as service use, assessed using structured interviews.

Results

The point prevalence of BDD was 1.0% (95% CI = 0.8%-1.3%). BDD was significantly more common among adolescents than children (1.9 vs 0.1%; OR = 22.5, p < .001), and among female than male participants (1.8% vs 0.3%; OR = 7.3, p < .001). Approximately 70% of young people with BDD had psychiatric comorbidity, most commonly internalizing disorders. BDD was associated with self- and parent-reported psychosocial impairment, self-harm and suicide attempts, and service utilization. Appearance preoccupation was more common than full-syndrome BDD, but showed similar age and sex effects, patterns of comorbidity, and associated impairment.

Conclusion

BDD and appearance preoccupation are relatively common, especially among adolescent girls, and are associated with substantial co-occurring psychopathology, impairment, and risk. Improved screening is needed to increase detection and diagnosis of BDD, and to facilitate access to evidence-based treatment.

Study preregistration information

The epidemiology of body dysmorphic disorder the youth: prevalence, comorbidity and psychosocial impact; g83jy.

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Key words : body dysmorphic disorder, prevalence, epidemiology, childhood, adolescence

Plan

Characteristics of BDD and Self-Reported Appearance Preoccupation

Comorbidity

Impairment

Discussion

CRediT authorship contribution statement

	The authors have reported no funding for this work.
	The research was performed with permission from the West London & GTAC Research Ethics Committee (16/LO/0155) and the Health Research Authority Confidentiality Advisory Group (16/CAG/ 0016).
	This work has been previously posted on a preprint server: zmd2h.
	This work has been prospectively registered: g83jy.
	Disclosure: Dr. Krebs has received research funding from the Wellcome Trust, the British Academy, and honoraria from Elsevier for editorial work. Prof. Ford’s research group has received funds from the National Institute of Health Research, the Medical Research Council, and Place2Be (the latter relates to research methods consultancy). Prof. Stringaris has received research funding from the Wellcome Trust. Dr. Clark has reported no biomedical financial interests or potential conflicts of interest.