Updates on the prevalence of body dysmorphic disorder: A population-based survey
Introduction
Individuals with body dysmorphic disorder (BDD) are distressed about perceived flaws in their physical appearance, commonly in their face (e.g., wrinkles, size or shape of the nose or ears; American Psychiatric Association [APA], 2000). Although these “defects” are usually not noticeable to others, individuals with BDD misperceive their body part(s) of concern as unattractive and repulsive and often spend several hours per day worrying about their appearance. They frequently engage in time-consuming repetitive behaviours such as comparing, mirror checking, camouflaging, excessive grooming or reassurance seeking (e.g., Phillips et al., 1993, Phillips, 1991). Further, BDD is associated with significant morbidity, including social or occupational impairment, being housebound, hospitalisation and suicide attempts (e.g., Phillips and Menard, 2006, Phillips et al., 1993).
Despite increased awareness of BDD in the last decade, it is a relatively unknown and under-studied disorder. Although some studies have examined the prevalence of BDD, the obtained rates vary widely, which may be due to methodological differences and limitations (e.g., nonrepresentative populations and small sample sizes). Studies examining prevalence rates in student populations, in which higher base rates might be expected, have obtained prevalence rates of self-reported BDD ranging from 5% (Cansever et al., 2003, N = 420 female nursing school students; Bohne et al., 2002, N = 133 psychology students;) to 13% (Biby, 1998, N = 102 psychology students). A few studies examined the prevalence of BDD using structured clinical interviews (Otto et al., 2001, Bienvenu et al., 2000, Faravelli et al., 1997). Specifically, Otto et al. (2001) reported a BDD prevalence rate of 0.7% in a sample of 658 nondepressed and 318 depressed women between 36 and 44 years of age. Faravelli and colleagues examined the prevalence of BDD in 637 subjects from the general population of Tuscany (Italy) and also obtained a prevalence of 0.7% (Faravelli et al., 1997). In addition, Bienvenu et al. (2000) found a BDD prevalence of 3% in a small community sample (N = 73). Taken together, these results suggest that BDD prevalence rates vary significantly depending on the subject population, sample size and assessment methods.
To our knowledge, only two studies have been conducted on the prevalence of BDD using a representative sample (N > 2,000) of the general population. Rief et al. (2006) conducted a survey study in 2004 with 2552 participants selected by an independent agency that divided Germany into 258 sample point regions (the sample point regions were derived from representative data of the last federal elections). The prevalence of current BDD was 1.7% (N = 42). Moreover, consistent with previous research emphasising the morbidity associated with BDD (e.g., Phillips and Menard, 2006), individuals with BDD reported significantly higher rates of appearance-related suicidal ideation (19% vs. 3%) and suicide attempts (7% vs. 1%) than did individuals without BDD. Individuals with BDD also reported significantly higher rates of cosmetic surgeries than did those without BDD (7.2% vs. 2.8%). In addition, 27% of males and 41% of females without BDD reported being preoccupied with the appearance of at least one body part (though not meeting Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) criteria for BDD), suggesting that body dissatisfaction is a common phenomenon in the general population (Rief et al., 2006). Further, Koran et al. (2008) conducted a national household telephone survey in 2004 with 2513 participants, of whom 2048 participants qualified for a more detailed BDD screening, based on their initial responses. They obtained an estimated point prevalence of 2.4% (N = 49), which is comparable to the one obtained by Rief et al., further stressing that BDD is a common psychiatric disorder.
In the absence of large replication studies, the stability of previous findings remains unknown. Hence, in the current study, we sought to replicate previous findings (Koran et al., 2008, Rief et al., 2006) using another large, representative, nation-wide community sample. Specifically, we investigated the prevalence of BDD, associated features of BDD, such as suicidality or a history of cosmetic surgery, and rates of preoccupation with single body parts in the general population.
Section snippets
Subjects
The sample consisted of 2510 participants from the general German population (51.6% females), ranging from 14 to 93 years of age (mean 46.9; S.D. 18.4). Approximately 57.8% were married, 0.8% were separated, 26% were single, 7.5% were divorced and 7.9% were widowed.
Subject selection
As in our previous study (Rief et al., 2006), an independent agency (USUMA, Berlin) divided Germany into 258 sample point regions, which were derived from representative data from the last federal elections. The selection process
Appearance concerns in the general population
Overall, 35.3% of the general German population (26.7% males, 42.2% females) reported being concerned about at least one body part. Body parts of concern differed between men and women (Table 3). Specifically, relative to men, women were significantly more often dissatisfied with their breasts, hands, hips/buttocks, legs, skin, stomach and weight, whereas men were slightly more often dissatisfied with their overall muscle build, although it failed to reach statistical significance.
Base rates
Discussion
To our knowledge, this is the third study reporting a nation-wide prevalence rate of BDD using a representative sample of the general population. Because of the great variability in BDD prevalence rates obtained from research with smaller samples, we aimed to replicate recent findings of two nation-wide studies on the prevalence and associated features of BDD (Koran et al., 2008, Rief et al., 2006). The prevalence rate in our current study (1.8%) was very similar to the one obtained in our
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