Keywords
Mental Helath
Lebanese University students
Abstract
Background: Body Dysmorphic Disorder (BDD) is a psychological illness characterized by persistent and intrusive preoccupation with an imagined or slight defect in appearance. For individuals with BDD, these perceived defects are significant and prominent, leading to emotional distress, depression, anxiety, and impairment in daily functioning. Despite its impact, no prior studies have explored the prevalence of BDD among Lebanese university students. Objectives: This study aimed to determine the prevalence of BDD and investigate its association with mental health status (depression and anxiety), religiosity, eating disorder risk, and self-esteem among Lebanese University students. Methodology: A cross-sectional study was conducted in March 2020, involving students from the Lebanese University. Data were collected using the dysmorphic concern questionnaire (DCQ), Rosenberg self-esteem scale (RSE), religiosity scale, patient health questionnaire (PHQ-9), generalized anxiety disorder assessment (GAD-7), Eating Attitude test-26 scale (EAT-26). Results: A total of 6448 participants were enrolled in our study. The overall prevalence of BDD among university students was (6.4%).Our results showed that Lebanese students with BDD were more likely to have anxiety ORadj 1.3 (95% CI:1.2-1.7) p-value 0.001, depression ORadj 1.2 (95% C:1.15-1.5) p-value 0.007, and eating disorder (Bulimia & Food preoccupation ORadj 1.06 (95% CI:1.03-1.2) P-value 0.0, and oral control ORadj 1.09 (95% CI:1.05-1.1) P-value < 0.001) compared to those with no BDD. We also found that students with BDD had Lower Self-esteem ORadj 0.88 (95%CI: 0.78-0.9) P-value <0.001), and less likely to be religious ORadj 0.88 (95%CI: 0.82-0.9) P-value 0.02) compared to those with no BDD. Conclusion: This pioneering study in Lebanon sheds light on the prevalence of BDD among Lebanese university students and its associated factors. BDD was found to be significantly linked to elevated levels of depression, anxiety, and eating disorders, along with lower levels of self-esteem and religiosity. These findings underscore the importance of early detection of BDD during adolescence and young adulthood, necessitating timely psychological intervention to prevent chronicity and complications. Moreover, promoting widespread awareness through various social media and public platforms is essential to address this psychological issue effectively.
References
Hartmann, A.S., U. Buhlmann, and K. Phillips, Prevalence and underrecognition of body dysmorphic disorder. Body Dysmorphic Disorder: Advances in Research and Clinical Practice, 2017: p. 49-60.
Mufaddel, A., et al., A review of body dysmorphic disorder and its presentation in different clinical settings. The primary care companion for CNS disorders, 2013. 15(4): p. PCC.12r01464.
Cororve, M.B. and D.H. Gleaves, Body dysmorphic disorder: a review of conceptualizations, assessment, and treatment strategies. Clin Psychol Rev, 2001. 21(6): p. 949-70.
Phillips, K.A., Body dysmorphic disorder: recognizing and treating imagined ugliness. World psychiatry : official journal of the World Psychiatric Association (WPA), 2004. 3(1): p. 12-17.
Biby, E.L., The relationship between body dysmorphic disorder and depression, self-esteem, somatization, and obsessive-compulsive disorder. J Clin Psychol, 1998. 54(4): p. 489-99.
Phillips, K.A. and S.F. Diaz, Gender differences in body dysmorphic disorder. The Journal of nervous and mental disease, 1997. 185(9): p. 570-577.
Higgins, S. and A. Wysong, Cosmetic Surgery and Body Dysmorphic Disorder - An Update. International journal of women's dermatology, 2017. 4(1): p. 43-48.
Ipser, J.C., C. Sander, and D.J. Stein, Pharmacotherapy and psychotherapy for body dysmorphic disorder. The Cochrane database of systematic reviews, 2009. 2009(1): p. CD005332-CD005332.
Fischer, B.A., A Review of American Psychiatry Through Its Diagnoses: The History and Development of the Diagnostic and Statistical Manual of Mental Disorders. The Journal of Nervous and Mental Disease, 2012. 200(12).
Toro-Martínez, E., [DSM-5: OCD and related disorders]. Vertex, 2014. 25(113): p. 63-7.
Rosenfield, E., Overview of dsm-5 changes. Massachusetts general hospital ocd and related disorders program, 2015.
Phillips, K.A., Suicidality in body dysmorphic disorder. Primary psychiatry, 2007. 14(12): p. 58.
Phillips, K.A. and W. Menard, Suicidality in body dysmorphic disorder: a prospective study. American journal of psychiatry, 2006. 163(7): p. 1280-1282.
Sarwer, D.B., Awareness and identification of body dysmorphic disorder by aesthetic surgeons: results of a survey of American Society for Aesthetic Plastic Surgery members. Aesthetic Surgery Journal, 2002. 22(6): p. 531-535.
Bohne, A., et al., Prevalence of body dysmorphic disorder in a German college student sample. Psychiatry Res, 2002. 109(1): p. 101-4.
Shaffi Ahamed, S., et al., Prevalence of Body Dysmorphic Disorder and its Association With Body Features in Female Medical Students. Iran J Psychiatry Behav Sci, 2016. 10(2): p. e3868.
Koran, L.M., et al., The prevalence of body dysmorphic disorder in the United States adult population. CNS spectrums, 2008. 13(4): p. 316.
Mancuso, S.G., N.P. Knoesen, and D.J. Castle, The Dysmorphic Concern Questionnaire: A screening measure for body dysmorphic disorder. Australian & New Zealand Journal of Psychiatry, 2010. 44(6): p. 535-542.
Zaidi, U., et al., Psychometric evaluation of Arabic version of Self-Esteem, Psychological Well-being and Impact of weight on Quality of life questionnaire (IWQOL-Lite) in female student sample of PNU. European Medical, Health and Pharmaceutical Journal, 2015. 8(2).
Rosenberg, M., Rosenberg self-esteem scale (RSE). Acceptance and commitment therapy. Measures package, 1965. 61(52): p. 18.
Khalaf, D.R., et al., Developing and testing an original Arabic religiosity scale. Middle East Current Psychiatry, 2014. 21(2): p. 127-138.
Sawaya, H., et al., Adaptation and initial validation of the Patient Health Questionnaire - 9 (PHQ-9) and the Generalized Anxiety Disorder - 7 Questionnaire (GAD-7) in an Arabic speaking Lebanese psychiatric outpatient sample. Psychiatry Res, 2016. 239: p. 245-52.
Sawaya, H., et al., Adaptation and initial validation of the Patient Health Questionnaire–9 (PHQ-9) and the Generalized Anxiety Disorder–7 Questionnaire (GAD-7) in an Arabic speaking Lebanese psychiatric outpatient sample. Psychiatry research, 2016. 239: p. 245-252.
Al‐Subaie, A., et al., Validity of the Arabic version of the Eating Attitude Test. International Journal of Eating Disorders, 1996. 20(3): p. 321-324.
Bartsch, D., Prevalence of body dysmorphic disorder symptoms and associated clinical features among Australian university students. Clinical Psychologist, 2007. 11(1): p. 16-23.
Aflakseir, A., S. Jamali, and J. Mollazadeh, Prevalence of Body Dysmorphic Disorder Among a Group of College Students in Shiraz. Zahedan Journal of Research in Medical Sciences, 2021. 23(2).
Cansever, A., et al., The prevalence and clinical features of body dysmorphic disorder in college students: a study in a Turkish sample. Compr Psychiatry, 2003. 44(1): p. 60-4.
Yun-long, D., The prevalence of the body dysmorphic disorder among undergraduate students in Hainan. Journal of Hainan Medical College, 2010.
Dlagnikova, A. and R.L. van Niekerk, The prevalence of body dysmorphic disorder among South African university students. South African Journal of Psychiatry, 2015. 21: p. 104-106.
Taqui, A.M., et al., Body Dysmorphic Disorder: gender differences and prevalence in a Pakistani medical student population. BMC Psychiatry, 2008. 8: p. 20.
Baykal, B., et al., Evaluation of Relationship Between Body Dysmorphic Disorder and Self-Esteem in Rhinoplasty Candidates. J Craniofac Surg, 2015. 26(8): p. 2339-41.
Hartmann, A.S., et al., A comparison of self-esteem and perfectionism in anorexia nervosa and body dysmorphic disorder. J Nerv Ment Dis, 2014. 202(12): p. 883-8.
Kuck, N., et al., Body dysmorphic disorder and self-esteem: a meta-analysis. BMC Psychiatry, 2021. 21(1): p. 310.
Agorastos, A., C. Demiralay, and C.G. Huber, Influence of religious aspects and personal beliefs on psychological behavior: focus on anxiety disorders. Psychology research and behavior management, 2014. 7: p. 93-101.
Bonelli, R., et al., Religious and spiritual factors in depression: review and integration of the research. Depression research and treatment, 2012. 2012: p. 962860-962860.
Gupta, S., A. Avasthi, and S. Kumar, Relationship between religiosity and psychopathology in patients with depression. Indian journal of psychiatry, 2011. 53(4): p. 330.
Papazisis, G., et al., Religious and spiritual beliefs, self‐esteem, anxiety, and depression among nursing students. Nursing & health sciences, 2014. 16(2): p. 232-238.
Hakim, R.F., et al., Association of body dysmorphic disorder with anxiety, depression, and stress among university students. Journal of Taibah University Medical Sciences, 2021.
Liao, Y., et al., Body dysmorphic disorder, social anxiety and depressive symptoms in Chinese medical students. Soc Psychiatry Psychiatr Epidemiol, 2010. 45(10): p. 963-71.
Shaw, A.M., et al., Body dysmorphic disorder symptoms and risk for suicide: The role of depression. Body Image, 2016. 19: p. 169-174.
Phillips, K.A., J.M. Siniscalchi, and S.L. McElroy, Depression, anxiety, anger, and somatic symptoms in patients with body dysmorphic disorder. The Psychiatric quarterly, 2004. 75(4): p. 309-320.
Kollei, I., et al., Body dysmorphic disorder and nonweight-related body image concerns in individuals with eating disorders. Int J Eat Disord, 2013. 46(1): p. 52-9.
Rabe-Jablonska Jolanta, J. and M. Sobow Tomasz, The links between body dysmorphic disorder and eating disorders. Eur Psychiatry, 2000. 15(5): p. 302-5.