Age at onset and clinical correlates in body dysmorphic disorder

Abstract

OBJECTIVE Age at onset is an important clinical feature of all disorders. However, no prior studies have focused on this important construct in body dysmorphic disorder (BDD). In addition, across a number of psychiatric disorders, early age at disorder onset is associated with greater illness severity and greater comorbidity with other disorders. However, clinical correlates of age at onset have not been previously studied in BDD. METHODS Age at onset and other variables of interest were assessed in two samples of adults with DSM-IV BDD; sample 1 consisted of 184 adult participants in a study of the course of BDD, and sample 2 consisted of 244 adults seeking consultation or treatment for BDD. Reliable and valid measures were used. Subjects with early-onset BDD (age 17 or younger) were compared to those with late-onset BDD. RESULTS BDD had a mean age at onset of 16.7 (SD=7.3) in sample 1 and 16.7 (SD=7.2) in sample 2. 66.3% of subjects in sample 1 and 67.2% in sample 2 had BDD onset before age 18. A higher proportion of females had early-onset BDD in sample 1 but not in sample 2. On one of three measures in sample 1, those with early-onset BDD currently had more severe BDD symptoms. Individuals with early-onset BDD were more likely to have attempted suicide in both samples and to have attempted suicide due to BDD in sample 2. Early age at BDD onset was associated with a history of physical violence due to BDD and psychiatric hospitalization in sample 2. Those with early-onset BDD were more likely to report a gradual onset of BDD than those with late-onset in both samples. Participants with early-onset BDD had a greater number of lifetime comorbid disorders on both Axis I and Axis II in sample 1 but not in sample 2. More specifically, those with early-onset BDD were more likely to have a lifetime eating disorder (anorexia nervosa or bulimia nervosa) in both samples, a lifetime substance use disorder (both alcohol and non-alcohol) and borderline personality disorder in sample 1, and a lifetime anxiety disorder and social phobia in sample 2. CONCLUSIONS BDD usually began during childhood or adolescence. Early onset was associated with gradual onset, a lifetime history of attempted suicide, and greater comorbidity in both samples. Other clinical features reflecting greater morbidity were also more common in the early-onset group, although these findings were not consistent across the two samples.

Cognitive-behavioral therapy for body dysmorphic disorder: A systematic review and meta-analysis of randomized controlled trials

“…Since approximately 70% of patients report symptom onset during adolescence (Bjornsson et al, 2013), further trials are warranted in this age group, preferably in the incipient phases of the disorder, with the aim of preventing school failure, suicide risk, and chronicity. Unfortunately, the disorder often goes undetected in young people, as the symptoms of BDD may be mistakenly interpreted as normal developmental concerns (i.e., most teenagers worry about their appearance to some extent).…”

“…BDD is relatively common, with prevalence estimates ranging from 1.7% to 2.4% (Buhlmann et al, 2010;Koran, Abujaoude, Large, & Serpe, 2008;Rief, Buhlmann, Wilhelm, Borkenhagen, & Brähler, 2006). The onset typically occurs during adolescence, with earlier onsets associated with a more insidious form of illness, a higher frequency of suicide attempts, and greater comorbidity (Bjornsson et al, 2013). High comorbidity with major depressive disorder, social anxiety disorder, and obsessive-compulsive disorder (OCD), amongst others, is frequently reported (Gunstad & Phillips, 2003).…”

The Body Shape as Body Image Determinant in University Students

“…During this period, several lifestyle changes occur in youth related to their own body self-perception, due to the acquisition of stereotype habits and the social desire to be "in good shape" associated to social models imposed by the mass media (1), while sedentarism and consumption of energy-dense nutrient-low foods are also prevalent at this age. In addition, youth are resistant to behavioral change (3,4), experiencing a plethora of abnormal eating behaviors and body dysmorphic disorders (BDD) (2,5). According to the Diagnostic and statistical manual of mental disorders (DSM-5), preoccupation with flaw in appearance associated to repetitive behaviors, distress, impairment with or without a clinically defined eating disorder are major symptoms of BDD (6).…”

Body Dysmorphic Disorder: Common, Severe and in Need of Treatment Research

“…supportive psychotherapy), studies of CBT augmentation of SRIs and vice versa, and studies of other psychotherapies, non-SRI medications, and other somatic treatments. Treatment studies in youth are especially needed; two thirds of individuals with BDD have an onset of the disorder before the age of 18, yet no manualized psychosocial treatment is available for youth with BDD [44]. BDD is common enough and severe enough that such studies should be done.…”