Skip to main content

Body Dysmorphic Disorder and Other Clinically Significant Body Image Concerns in Adolescent Psychiatric Inpatients: Prevalence and Clinical Characteristics

Abstract

Background  This study assessed prevalence and clinical correlates of body dysmorphic disorder (BDD), eating disorders (ED), and other clinically significant body image concerns in 208 consecutively admitted adolescent inpatients. It was hypothesized that adolescents with BDD would have higher levels of depression, anxiety, and suicidality. Adolescents with eating disorders were expected to have higher levels of depression, anxiety, and trauma-related symptoms. Trauma-related symptoms were also examined in relation to BDD, in the absence of specific hypotheses.

Method  Participants completed the Body Dysmorphic Disorder Questionnaire (BDDQ) and reliable and valid self-report measures of suicidality, depression, anxiety, post-traumatic stress disorder (PTSD), dissociation, and sexual preoccupation/distress. Prevalence of BDD, eating disorders, and other clinically significant body image concerns was determined, and clinical correlates were examined.

Results  6.7% (n=14) of participants met DSM-IV criteria for definite (n=10) or probable (n=4) DSM-IV BDD, 3.8% (n=8) met criteria for an eating disorder, and 22.1% (n=46) had clinically significant shape/weight concerns (SWC) that did not clearly meet criteria for BDD or an eating disorder. Both the BDD and SWC groups scored significantly higher than the group with no significant body image concerns (no BDD/ED/SWC group) on measures of anxiety and suicidality. The BDD, SWC, and ED groups all had significantly higher levels of depression than the no BDD/ED/SWC group. Only the SWC group scored significantly higher than the no BDD/ED/SWC group on measures of PTSD, dissociation, and sexual preoccupation/distress.

Conclusions  A high proportion of participants had clinically significant body image concerns or a body image disorder. These concerns/disorders were associated with higher levels of depression, anxiety, and suicidality. In addition, the group concerned with body shape or weight had significantly greater symptoms of PTSD, dissociation, and sexual preoccupation/distress. These relatively common body image concerns and disorders deserve further study in adolescents.

This is a preview of subscription content, access via your institution.

References

  1. Phillips KA, McElroy SL, Keck PE, Pope HG, Hudson JI (1993) Body dysmorphic disorder: 30 cases of imagined ugliness. Am J Psychiat 150:302–308

    PubMed  Google Scholar 

  2. Phillips KA (2000) Quality of life for patients with body dysmorphic disorder. J Nerv Ment Dis 185:170–175

    Article  Google Scholar 

  3. Veale D, Boocock A, Gournay K, Dryden W (1996) Body dysmorphic disorder. A survey of fifty cases. Brit J Psychiat 169:196–201

    Google Scholar 

  4. Phillips KA, Diaz SF (1997) Gender differences in body dysmorphic disorder. J Nerv Ment Dis 185:570–577

    PubMed  Article  Google Scholar 

  5. Levine MP, Smolak M (2002) Body image development in adolescence. In: Cash TF, Pruzinsky T (eds) Body image: A handbook of theory, research, and clinical practice. Guilford Press, New York

    Google Scholar 

  6. Albertini RS, Phillips KA, Guvremont D (1996) Body dysmorphic disorder in a young child. J Am Acad Child Psy 35:1425–1426

    Article  Google Scholar 

  7. El-Khatib HE, Dickey TO (1995) Sertraline for body dysmorphic disorder. J Am Acad Child Psy 34:1404–1405

    Article  Google Scholar 

  8. Heimann SW (1997) SSRI for body dysmorphic disorder. J Am Acad Child Psy 36:868

    Article  Google Scholar 

  9. Horowitz K, Gorfinkle K, Lewis O, Phillips K (2002) Body dysmorphic disorder in an adolescent girl. J Am Acad Child Psy 4:1503–1509

    Article  Google Scholar 

  10. Phillips KA, Atala KD, Albertini RS (1995) Case study: Body dysmorphic disorder in adolescents. J Am Acad Child Psy 34:1216–1220

    Article  Google Scholar 

  11. Sobanski E, Schmidt MH (2000) ‘Everybody looks at my pubic bone’: A case report of an adolescent patient with body dysmorphic disorder. Acta Psychiat Scand 101:80–82

    PubMed  Article  Google Scholar 

  12. Sondheimer A (1988) Clomiprimine treatment of delusional disorder, somatic type. J Am Acad Child Psy 27:188–192

    Article  Google Scholar 

  13. Albertini RS, Phillips KA (1999) Thirty-three cases of body dysmorphic disorder in children and adolescents. J Am Acad Child Psy 38:453–459

    Google Scholar 

  14. Bienvenu OJ, Samuels JF, Riddle MA, et al. (2000) The relationship of obsessive-compulsive disorder to possible spectrum disorders: results from a family study. Biol Psychiat 48:287–293

    PubMed  Article  Google Scholar 

  15. Otto MW, Wilhelm S, Cohen LS, Harlow BL (2001) Prevalence of body dysmorphic disorder in a community sample of women. Am J Psychiat 158:2061–2063

    PubMed  Article  Google Scholar 

  16. Mayville S, Katz RC, Gipson MT, Cabral K (1999) Assessing the prevalence of body dysmorphic disorder in an ethnically diverse group of adolescents. J Child Fam Stud 8:357–362

    Article  Google Scholar 

  17. Grant JE, Won Kim S, Crow SJ (2001) Prevalence and clinical features of body dysmorphic disorder in adolescent and adult psychiatric inpatients. J Clin Psychiat 62:517–522

    Article  Google Scholar 

  18. Harter SL (2003) Visions of self: Beyond me in the mirror. In: Jacobs J (eds) Nebraska Symposium on Motivation 1992: Developmental Perspectives in Motivation. Current theory and research in motivation (vol. 40). University of Nebraska Press, Lincoln

  19. Olivardia R, Pope H (2002) Body image disturbance in childhood and adolescence. In: Castle D, Phillips KA (eds) Disorders of body image. Wrightson Biomedical, Hampshire, pp 1–1

    Google Scholar 

  20. Koff E, Rierdan J (1993) Advanced pubertal development and eating disturbance in early adolescent girls. J Adolescent Health 14:433–439

    Article  Google Scholar 

  21. Phillips KA, Nierenberg AA, Brendel G, Fava M (1996) Prevalence and clinical features of body dysmorphic disorder in atypical major depression. J Nerv Ment Dis 184:125–129

    PubMed  Article  Google Scholar 

  22. Zimmerman M, Mattia JI (1998) Body dysmorphic disorder in psychiatric outpatients: Recognition, prevalence, comorbidity, demographic, and clinical correlates. Compr Psychiat 39:265–270

    PubMed  Article  Google Scholar 

  23. Phillips, KA (1996) The broken mirror: understanding and treating body dysmorphic disorder. Oxford University Press, New York

    Google Scholar 

  24. Phillips KA, Siniscalchi JM, McElroy SL (2004) Depression, anxiety, anger, and somatic symptoms in patients with body dysmorphic disorder. Psychiat Q 75:309–320

    PubMed  Article  Google Scholar 

  25. Phillips KA, Menard W, Fay C, Weisberg R (2005) Demographic characteristics, phenomenology, comorbidity, and family history in 200 individuals with BDD. Psychosomatics 46:317–325

    PubMed  Article  Google Scholar 

  26. Becker CB, Dviva JC, Zayfert C (2004) Eating disorder symptoms among female anxiety disorder patients in clinical practice: the importance of anxiety comorbidity assessment. J Anxiety Disord 18:255–274

    PubMed  Article  Google Scholar 

  27. Evans L, Wertheim EH (1998) Intimacy patterns and relationship satisfaction of women with eating problems and the mediating effects of depression, trait anxiety, and social anxiety. J Psychosom Res 44:355–365

    PubMed  Article  Google Scholar 

  28. Grave RD, Rigamonti R, Tidisco P, Olioosi E (1996) Dissociation and traumatic experiences in eating disorders. Eur Eat Disorder Rev 4:232–240

    Article  Google Scholar 

  29. Milos GF, Spindler AM, Buddeberg C, Crameri A (2003) Axes I and II comorbidity and treatment experiences in eating disorder subjects. Psychother Psychosom 72:276–285

    PubMed  Article  Google Scholar 

  30. Perez M, Joiner TE, Lewinsohn P (2004) Is major depressive disorder or dysthymia more strongly associated with bulimia nervosa? Int J Eat Disorder 36:55–61

    Article  Google Scholar 

  31. Schneer A (2002) Eating disorders: A disorder of in and out. Eat Disord J Treatment Prevention 10:161–176

    Google Scholar 

  32. Wonderlich SA, Crosby RD, Mitchell JE, Thompson KM, Redlin J, Demuth G, et al. (2001) Eating disturbance and sexual trauma in childhood and adulthood. Int J Eat Disorder 30:401–412

    Article  Google Scholar 

  33. Phillips KA, Atala KD, Pope HG (1995) Diagnostic instruments for body dysmorphic disorder. New Research Program and Abstracts, American Psychiatric Association 148th Annual Meeting, Miami, 1995. American Psychiatric Press Washington, DC

  34. Dufresne RG, Phillips KA, Vittorio CC, Wilkel CS (2001) A screening questionnaire for body dysmorphic disorder in a cosmetic dermatologic surgery practice. Dermatol. Surg. 27:457–462

    PubMed  Article  Google Scholar 

  35. Veale D, Kinderman P, Riley S, Lambrou C (2003) Self-discrepancy in body dysmorphic disorder. Brit J Clin Psychol 42:157–169

    Article  Google Scholar 

  36. Hammer LD, Kraemer HC, Ritter PL, Dornbusch SM (1991) Standardized percentile curves of body-mass index for children and adolescents. Am J Dis Child 145:259–263

    PubMed  Google Scholar 

  37. Cull JG, Gill WS (1982) Manual for the Suicide Probability Scale (SPS). Western Psychological Services, Los Angeles

    Google Scholar 

  38. Reynolds WM (1987) Reynolds adolescent depression scale manual. Psychological Assessment Resources Odessa

  39. March JS (1997) Multidimensional anxiety scale for children short version (MASC-10). Multi-Health Systems, New York

    Google Scholar 

  40. Briere D (1995) Manual for the Trauma Symptom Checklist for Children and Adolescents (TSCC). Psychological Assessment Resources Liaz

  41. Koff E, Rierdan J (1991) Perceptions of weight and attitudes toward eating in early adolescent girls. J Adolescent Health 12:307–312

    Article  Google Scholar 

  42. Rodin J, Silberstein L, Striegel-Moore R (1984) Women and weight: A normative discontent. In: Sonderegger TB (eds) Nebraska Symposium on Motivation: Psychology and Gender, vol 32. University of Nebraska Press, Lincoln

    Google Scholar 

  43. Thompson SH, Rafiroiu AC, Sargent RG (2003) Examining gender, racial, and age differences in weight concern among third, fifth, eighth, and eleventh graders. Eating Behavi 3:307–323

    Article  Google Scholar 

  44. Vervaet M, Van Heeringen C (2000) Eating style and weight concerns in young females. Eating Disord J Treatment Prevent 3:233–240

    Google Scholar 

  45. Thompson KJ, Smolak L (2002) Body image, eating disorders, and obesity in youth: Assessment, prevention, and treatment. Adolescence 37:658

    Google Scholar 

  46. Grant JE, Phillips, KA (2004) Is anorexia nervosa a subtype of body dysmorphic disorder?. Harvard Rev Psychiat 12:123–126

    Article  Google Scholar 

  47. Rosen JC, Reiter J, Orosan P (1995) Cognitive-behavioral body image therapy for body dysmorphic disorder. J Consult Clin Psych 63:282–287

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Jennifer Dyl.

Additional information

This research was supported by the Bradley Hospital Adolescent Unit and a Mid-Career Investigator Award in Patient-Oriented Research (1 K24 MH63975) from the National Institute of Mental Health to Dr. Phillips

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Dyl, J., Kittler, J., Phillips, K.A. et al. Body Dysmorphic Disorder and Other Clinically Significant Body Image Concerns in Adolescent Psychiatric Inpatients: Prevalence and Clinical Characteristics. Child Psychiatry Hum Dev 36, 369–382 (2006). https://doi.org/10.1007/s10578-006-0008-7

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10578-006-0008-7

Keywords

  • Body dysmorphic disorder
  • adolescence
  • Eating disorders
  • Body image
  • Psychiatric inpatients