Social Functioning in Body Dysmorphic Disorder: Assessment Considerations

Abstract

Individuals with body dysmorphic disorder (BDD) have markedly poor social functioning; however, previous reports may underestimate impairment. Scoring on certain functioning measures such as the Social Adjustment Scale-Self Report (SAS-SR) potentially excludes more severely ill individuals from some domains, thereby possibly underestimating functional impairment. To explore this issue, 73 individuals with BDD who reported having no primary relationship (and were therefore excluded from scoring on the SAS-SR Primary Relationship domain) were compared to 58 individuals with BDD who had a primary relationship. Subjects without a primary relationship had significantly poorer global social adjustment on several measures. They also had poorer scores on the Global Assessment of Functioning Scale and greater severity of BDD and depressive symptoms at a trend level. These findings suggest that the SAS-SR may underestimate social impairment. This underestimation may pertain to other domains of functioning, other disorders, and certain other functioning and quality of life measures. KeywordsBody dysmorphic disorder; Dysmorphophobia; Social adjustment; Assessment Body dysmorphic disorder (BDD) is a relatively common disorder that consists of a distressing or impairing preoccupation with an imagined or slight defect in appearance [1]. Individuals with BDD have very poor psychosocial functioning, markedly poor quality of life, and high rates of suicidal ideation poor and attempts [2]. Social impairment, in particular, appears to be nearly universal in BDD [2]. Persons with BDD are often single, avoid dating, have a significant reduction in the quality of their relationships and have high levels of social isolation [3,4]. Despite this disorder's severity, social functioning in BDD has received only limited attention.In a study of 188 individuals with BDD, 99% reported moderate, severe, or extreme lifetime impairment in social functioning [2] To our knowledge, only two studies [4,8] have examined social functioning in BDD using the Social Adjustment Scale-Self Report (SAS-SR; [9]). One study [8] found that depressed patients with comorbid BDD (n=28) had a mean overall social adjustment score of 2.6±0.6, which was 3.1 SD units poorer than community norms, although their SAS-SR scores were comparable to those of depressed subjects without comorbid BDD (n=322). Our group recently found a mean SAS-SR overall social adjustment score of 2.37±.52 in 126 broadly ascertained subjects with BDD [4], which was markedly poorer than community norms. Effect sizes across all SAS-SR domains were very large (d=0.82-2.07). In addition, more severe BDD symptoms were significantly correlated with poorer overall social adjustment (r=.37, p < .0001).Even though SAS-SR scores in these studies were notably poor, these findings may actually underestimate social impairment in BDD. Scoring on the SAS-SR systematically excludes possibly more seriously ill individuals from certain subscales, thereby potentially minimizing impairment in social functi...

Body dysmorphic disorder among dermatologic patients: Prevalence and clinical features

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Body Dysmorphic Disorder in Patients With Obsessive-Compulsive Disorder: Prevalence and Clinical Correlates

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Severity of Interpersonal Problems in Individuals with Body Dysmorphic Disorder

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