Psychological aspects of body dysmorphic disorder

Abstract

Body dysmorphic disorder (BDD) is charaterized by great suffering and severe impairment of psychological and social functions. The core symptom of this psychiatric illness is a serious disturbance in the perception of ones own body, which leads to low self-esteem, anxiety, depression, and social isolation, all of which cause great difficulties in education, work, and starting a family. Psychiatric comorbidity is frequent, and the risk of death by suicide is high. The nosological status of BDD has changed in DSM-5. Biological, psychological, environmental and sociocultural factors play a role in the development and maintenance of BDD. The authors aim is to review psychological factors. BDDs most salient symptom, body image disorder are underlied by characteristic changes in cognitive functions (perception, attention, information processing, executive functions). Face perception and emotion recognition were studied most thoroughly. Disturbance of emotion regulation also predisposes to BDD. Characteristic personality traits are shyness, sensitivity to rejection and criticism, low self-esteem, perfectionism. BDD patients dominant feeling, shame, prevents them from asking help for their problem. The disease begins early, mostly in adolescence (on average at the age of 16.7 years). Traumatic experiences, stressful life events, and unpleasant comments about the body are common in the early years of life. BDD patients frequently report emotional, physical, and sexual abuse. It is noteworthy that they are not only victims of bullying, but also often perpetrators. The social environment may also contribute to the etiology of BDD, e.g. by means of the social media (Facebook, Instagram, Snapchat, TikTok). The prevalence is 2% in the general population, 7.4% in psychiatric inpatients, and over 10% in cosmetic surgery and dermatology patients. BDD has become more common in recent years, and in the era of COVID, snapchat dysmorphia and zoom dysmorphia appeared. The effectiveness of SSRI-type antidepressants and cognitive behavioral therapy has been confirmed. Acceptance-commitment therapy, metacognitive therapy, and online versions of proven therapeutic methods seems to be promising alternatives. Any psychological factor relevant in BDD can be the target of therapy and prevention.