Physique Dysmorphic Dysfunction and Consuming Issues: Overlapping Displays, Differing Remedies.

There could be confusion when differentiating between physique dysmorphic dysfunction (BDD) and consuming problems (EDs). BDD entails obsessive ideas, repetitive behaviours, and psychological acts in response to perceived look flaws. Consuming problems contain disturbances in ideas and behaviours associated to consuming, weight, and form (in Anorexia Nervosa, Bulimia Nervosa, and OSFED) (APA, 2022).   

Similarities 

BDD and EDs contain pre-occupying appearance-related ideas and repetitive behaviours, an appearance-oriented self-evaluation, and comparable feelings. Related persona traits (perfectionism, obsessive-compulsiveness, rejection sensitivity, introversion, & neuroticism) are seen (Fisher, Neziroglu, & Feusner, 2023), as are the comorbidities of OCD, despair, substance abuse, anxiousness, and low shallowness (Angelakis, Gooding, & Panagioti, 2016). Different likenesses embody teen onset (usually), chronicity, excessive mortality charges, poor perception, and visible perceptual disturbances (Grant, Leppink, & Redden, 2017). 

What Differentiates EDs?  

An ED prognosis requires a disturbance in consuming in try to manage physique weight/form akin to: dietary restriction, fasting, bingeing and purging, or rumination. Weight could be (however is just not at all times) affected. While BDD and EDs can contain dietary restriction, BDD hardly ever entails these different behaviours associated to consuming. In BDD behaviours are often centered on perceived defects of the face/head (pores and skin, hair, nostril). In EDs the focus is on meals, weight, and form (notably abdomen, hips, and legs), with an intense concern of weight acquire. This differing focus can result in related behaviours (e.g., extreme grooming, mirror use, physique checking, extreme train), however in EDs also can result in weight reduction, purging, laxative/diuretic use, and rituals round consuming. There’s threat of significant medical issues in EDs (Grant et al., 2017) and EDs are typically extra “ego syntonic” than BDD. 

I discover these questions helpful in in my apply: 

Purchasers with BDD can have a give attention to physique fats or weight (Grant et al., 2017). I have a tendency to contemplate a further ED prognosis if there’s disturbed consuming, intense preoccupation with general physique weight/form, and different disordered eating-related behaviours akin to purging or laxative use. 

Therapy 

CBT (with ERP) and SSRI’s are first-line remedies for BDD (NICE, 2005). CBT, Specialist Supportive Medical Administration (SSCM), Maudsley Mannequin of Anorexia Nervosa Therapy for Adults (MANTRA), guided self-help, Household Based mostly Therapy, and Adolescent Targeted Remedy are evidence-based remedies for EDs (NICE, 2017). For EDs, the chosen remedy modality is set by analysis proof, scientific experience, and affected person values, preferences, and traits (Sackett et al., 1996), and should deal with cognitions, behaviours, emotional regulation, interpersonal relationships, temperament, organic components, developmental duties, and sense of identification. Therapy entails medical monitoring, a multi-disciplinary group (therapist, dietitian, GP, psychiatrist, paediatrician), and household involvement (NICE, 2013). 

There are similarities within the CBT remedy of BDD and EDs together with: motivational interviewing, addressing self-evaluation, decreasing compulsive behaviours, publicity remedy, and behavioural experiments. Variations embody a give attention to addressing consuming and weight-control behaviours, collaborative weighing, decreasing binges, creating emotional regulation expertise, and weight restoration (if wanted). Additionally, CBT for BDD addresses perceptual retraining and different particular signs (e.g., beauty surgical procedure looking for) (Wilhelm, Phillips, & Steketee , 2013).  

How will we proceed when BDD and EDs co-occur? The one suggestion I’ve discovered within the scientific literature, is that remedy could be extra intensive and longer (Grant et al., 2017). I usually proceed by collaborating with the shopper round which situation is essentially the most clinically and medically regarding. This typically ends in concentrating on the ED first given the medical dangers (particularly when low weight, purging, fasting, or extreme train are current). Dietary restoration typically reduces preoccupation, which can profit each problems. Given overlap in self-evaluation and appearance-related repetitive behaviours, it could be doable to deal with these signs concurrently, however provided that medical threat has been mitigated, and certain provided that CBT is the remedy for each problems. 

This publish is introduced in collaboration with ADAA’s OCD and Associated Issues SIG. Be taught extra in regards to the SIG.

References 

American Psychiatric Affiliation (APA). (2022). Diagnostic and statistical handbook of psychological problems (fifth ed., textual content rev.). https://doi.org/10.1176/appi.books.9780890425787 

Angelakis, I., Gooding, P.A., & Panagioti, M. (2016). Suicidality in physique dysmorphic dysfunction (BDD): A scientific overview with meta-analysis. Medical Psycholgy Assessment, 49, 55-66. https://doi.org/10.1016/j.xpe.2016.08.002 

Fisher, E., Neziroglu, F., & Feusner, J. (2023, Summer time). Consuming problems usually are not the identical as physique dysmorphic dysfunction (and why it issues). OCD Publication, 37(2. https://iocdf.org/obtain/summer-2023-vol-37-num-2/ 

Grant, J. E., Leppink, E. W., & Redden, S.A. (2017). The Relationship Between Physique Dysmorphic Dysfunction and Consuming Issues. In Ok.A. Phillips (Ed.), Physique dysmorphic dysfunction: Advances in analysis and scientific apply (pp. 503-513). New York: Oxford College Press. 

Nationwide Institute for Well being and Care Excellence. (2005). Obsessive-compulsive dysfunction and physique dysmorphic dysfunction: remedy. [NICE Guideline NO. 31]. https://www.good.org.uk/steerage/cg31 

Nationwide Institute for Well being and Care Excellence, (2017). Consuming problems: recognition and remedy. [NICE Guideline No. 69]. https://www.good.org.uk/steerage/ng69 

Sackett, D.L., Rosenberg, W. M., Grey, J.A., Haynes, R.B., & Richardson, W.S. (1996). Proof primarily based medication: what it’s and what it isn’t. BMJ, Vol 312 (7023): 71–73.  

Wilhelm, S., Phillips, Ok.A., Steketee, G (2013). Cognitive-Behavioural Remedy for Physique Dysmorphic Dysfunction. The Guilford Press, New York.