Epidemiology of Body Dysmorphic Disorder and Appearance Preoccupation in Youth: Prevalence, Comorbidity and Psychosocial Impairment

Georgina Krebs; Bruce R Clark; Tamsin J Ford; Argyris Stringaris

doi:10.1016/j.jaac.2024.01.017

Epidemiology of Body Dysmorphic Disorder and Appearance Preoccupation in Youth: Prevalence, Comorbidity and Psychosocial Impairment

J Am Acad Child Adolesc Psychiatry. 2024 Mar 18:S0890-8567(24)00126-6. doi: 10.1016/j.jaac.2024.01.017. Online ahead of print.

Authors

Georgina Krebs¹, Bruce R Clark², Tamsin J Ford³, Argyris Stringaris⁴

Affiliations

¹ University College London, London, United Kingdom; South London and Maudsley NHS Foundation Trust, United Kingdom. Electronic address: g.krebs@ucl.ac.uk.
² South London and Maudsley NHS Foundation Trust, United Kingdom.
³ University of Cambridge, United Kingdom, and Cambridge and Peterborough, NHS Foundation Trust, Cambridgeshire, United Kingdom.
⁴ University College London, London, United Kingdom; National and Kapodistrian University of Athens, Athens, Greece.

PMID: 38508411
DOI: 10.1016/j.jaac.2024.01.017

Abstract

Objective: Little is known about how common and impairing body dysmorphic disorder (BDD) is in the general population of youth. We evaluated the prevalence, comorbidity, and psychosocial impairment associated with BDD and more broadly defined appearance preoccupation in young people.

Method: Data were drawn from the 2017 Mental Health of Children and Young People in England survey. BDD and psychiatric comorbidity were assessed in individuals 5 to 19 years of age (N = 7,654) according to DSM-5 criteria, using a clinician-rated standardized diagnostic assessment. Psychosocial impairment was measured with a quantitative scale and was indexed by reported self-harm and suicide attempts, as well as service use, assessed using structured interviews.

Results: The point prevalence of BDD was 1.0% (95% CI = 0.8%-1.3%). BDD was significantly more common among adolescents than children (1.9 vs 0.1%; OR = 22.5, p < .001), and among female than male participants (1.8% vs 0.3%; OR = 7.3, p < .001). Approximately 70% of young people with BDD had psychiatric comorbidity, most commonly internalizing disorders. BDD was associated with self- and parent-reported psychosocial impairment, self-harm and suicide attempts, and service utilization. Appearance preoccupation was more common than full-syndrome BDD, but showed similar age and sex effects, patterns of comorbidity, and associated impairment.

Conclusion: BDD and appearance preoccupation are relatively common, especially among adolescent girls, and are associated with substantial co-occurring psychopathology, impairment, and risk. Improved screening is needed to increase detection and diagnosis of BDD, and to facilitate access to evidence-based treatment.

Study preregistration information: The epidemiology of body dysmorphic disorder the youth: prevalence, comorbidity and psychosocial impact; https://osf.io/g83jy.

Keywords: adolescence; body dysmorphic disorder; childhood; epidemiology; prevalence.