Subthreshold body dysmorphic disorder in adolescents: Prevalence and impact

Abstract

The aim of the current study was to establish the prevalence of subthreshold body dysmorphic disorder (subthreshold-BDD) in a community sample of adolescents, and to compare disorder correlates in individuals with subthreshold-BDD to those with probable full-syndrome BDD (probable-BDD) and those without BDD (non-BDD). Self-report questionnaires assessing DSM-IV BDD criteria, past mental health service use, and symptoms of body dysmorphic disorder, anxiety, depression, obsessive-compulsive disorder and eating disorders, were completed by 3149 Australian high school students (mean age =14.6 years, 63.5% male). Male participants also completed measures assessing quality of life, muscularity concerns, emotional symptoms, conduct problems, hyperactivity, and peer problems. The prevalence of subthreshold-BDD was 3.4%, and probable-BDD was 1.7%. Compared to the non-BDD group, subthreshold-BDD was associated with elevated symptoms of comorbid psychopathology and greater past mental health service use, and in male-only measures, with poorer quality of life and elevated muscularity concerns. Subthreshold-BDD participants reported significantly lower mental health service use, and fewer symptoms of depression, eating disorders, and hyperactivity than probable-BDD participants, however, other comorbid symptoms did not differ significantly between these groups. These findings indicate that subthreshold-BDD is associated with substantial difficulties for adolescents in the general community. BDD screening should include subthreshold presentations, as these may be an important target for early intervention programs.

Dysmorphic concern and behavioural impairment related to body image in adolescents

“…With these criteria, it was found that 3.45% of the adolescents showed subthreshold BDD symptomatology, and therefore, were at risk of this disorder. This percentage is similar to what was reported by Schneider et al () who found that 3.4% of Australian adolescents of both sexes had subthreshold BDD symptoms, but lower than the 9% found by Mastro et al () and 7.4% identified by Longley et al (), who based it on a single test for detecting risk of BDD and was probably overestimated.…”

“…Buhlmann et al, ), although, among participants in the general population who meet subthreshold criteria related to this disorder, there seems to be higher frequency of these indicators among women (e.g. Schieber et al, ; Schneider et al, ).…”

“…In a systematic review analyzing studies in several different regions of Europe, Australia, Asia and the Americas, Veale, Gledhill, Christodoulou, and Hodsoll () only found one study showing a 2.2% prevalence of BDD in an ethnically diversified group of adolescents. Schneider, Mond, Turner, and Hudson () found that 3.4% of adolescents from 12 to 18 years of age showed subthreshold BDD symptoms. These findings show the importance of studying both subthreshold DC and consolidated as BDD, in adolescence.…”

The use of social networking sites, body image dissatisfaction, and body dysmorphic disorder: A systematic review of psychological research.

“…Young adults have been indicated to be the most active users on SNS, with findings from the present study showing that females spend more time online (Murray, Maras & Goldfield, 2016;Smith & Anderson, 2018). Consistent with this, recent research has demonstrated that the prevalence of subthreshold BDD is significantly higher in older adolescents, in addition to being more predominant in females (Schneider, Mond, Turner & Hudson, 2017), indicating frequent SNS use as a potential risk factor in the development of BDD in consideration of prevalence levels. It is noted however, that whilst subthreshold disorders do not meet full diagnostic criteria, they do involve the presence of core symptoms and impairment, which has been shown to predict clinical manifestations of the disorder (Wolitzky-Taylor, Dour, Zinbarg, Mineka, Vrshek-Schallhorn, Epstein et al, 2014).…”

When Adolescents Feel Ugly: Cognitive Behavioral Therapy for Body Dysmorphic Disorder in Youth

“…Subclinical or subthreshold BDD symptoms are more prevalent again, with 3.4% of adolescents reporting dysmorphic concerns that cause distress or impairment (Schneider, Mond, Turner, & Hudson, 2017b). These subclinical BDD symptoms are associated with high levels of anxiety and depression, and reduced quality of life, suggesting that even milder forms of BDD preoccupation do not represent a normal level of appearance concern (Schneider et al, 2017b). What remains unknown at present is the course of milder BDD symptoms over time.…”