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Previous research indicates an association of body dysmorphic disorder (BDD) with suicidal thoughts and behaviours, but has largely relied on small cohorts drawn from specialist clinics. Anonymised health-records from the South London and Maudsley NHS Foundation Trust between 2007 and 2019 were systematically searched using the Clinical Record Interactive Search data system. 298 patients diagnosed with BDD between age 12 and 65 years were identified. 206 (69 %) had experienced lifetime suicidal ideation. 149 (50 %) had recorded lifetime acts of self-harm or suicide attempts, most commonly involving cutting and self-poisoning. Rates of self-harm/suicide attempts were similar in those diagnosed before or after 18 years. Comorbid depression was associated with suicidal ideation (OR: 4.26 95% CI 2.07–9.72). Additionally, comorbid depression, OCD and anxiety were all associated with self-harm/suicide attempts (OR: 1.94 95% CI 1.15–3.31, OR: 1.99 95% CI 1.09–3.73, and OR: 1.93 95% CI 1.09–3.45, respectively). The presence of two or more psychiatric comorbidities was associated with a significantly elevated likelihood of suicidal ideation (OR: 7.06 95% CI 2.80–21.7) and self-harm/suicide attempts (OR: 4.62 95% CI 2.32–9.62). It is likely that BDD was under-diagnosed in the cohort, and those identified may not be representative. Additionally, the frequency and detail with which suicidal thoughts and behaviours were assessed varied and may also represent underestimates. Suicidal ideation and self-harm/suicide attempts are common among individuals with BDD accessing mental health services. Psychiatric comorbidity and suicidal ideation should be assessed in all BDD patients. • Suicidal thoughts and behaviours are frequently observed in people with Body Dysmorphic Disorder (BDD). • Co-morbidity significantly increases the risk of suicidality in people with BDD. • Multiple co-morbidities are associated with a particularly high risk of suicidality. • Methods of self-harm in BDD are similar to those seen in other psychiatric conditions. [ABSTRACT FROM AUTHOR]

• Visual AI showed that females, but not males, had lower perceived BF% than actual. • Body image distortion generated by DIA were associated with MBSRQ-AS subscales. • Body image dissatisfaction from DIA were associated with MBSRQ-AS subscales. • Remote smartphone-based DIA may provide a feasible analog to assessing body image. Given that mobile digital imaging analyses (DIA) are equipped to automate body composition and subsequently alter one's appearance at a given objective body fat percent (BF%), the purpose of this study was to validate the use of this tool for assessments of body image. Participants (f = 134, m = 89) from two separate centers underwent body composition scans using a mobile DIA and completed the Multidimensional Body Self-Relations Questionnaire–Appearance Scale (MBSRQ-AS). Using a DIA-generated avatar, participants altered their figure so that it represented their perceived body, ideal body, and what a partner would find attractive. Distortion was calculated as perceived minus actual BF% and dissatisfaction was calculated as either ideal or partner minus perceived BF%. The total sample and females (p < 0.050), but not males, had significantly lower perceived BF% compared to their actual. Ideal and partner BF% was significantly lower than the perceived BF% for all groups (all p < 0.050). Ideal and partner BF% mean differences (MD) from perceived were positively associated with appearance evaluation (AE) and body area satisfaction (BAS) and negatively associated with overweight preoccupation and self-classified weight for the total sample (all p < 0.050). Perceived MD demonstrated negative associations with AE and BAS (p < 0.050), but only for females when separated by sex. Perceptual body image measured by DIA is significantly associated with attitudinal body image and may allow practitioners to better quantify this growing issue. [ABSTRACT FROM AUTHOR]

Individuals elevated in distress intolerance (DI) may engage in dysfunctional behavioral strategies to cope with their distress. One behavioral strategy that may be related to DI is appearance related safety behavior (ARSB; i.e., maladaptive behavior that seeks to mitigate the feared consequences of the negative evaluation of appearance). We examined the relationship between DI and ARSBs in two separate samples of women. In Study 1 (N = 91), we found in an unselected sample that ARSBs were robustly associated with DI cross-sectionally while accounting for symptoms of depression and body dysmorphia. Further, greater ARSBs predicted increases in DI longitudinally. In Study 2, among a clinical sample of women with elevated appearance concerns (N = 94), we examined the experimental effect of reducing ARSBs compared to a self-monitoring control. Relative to control, instructions to reduce ARSBs led to lower DI, but this effect was only found for individuals low in baseline DI. Overall, we found preliminary evidence that ARSBs may be a salient factor in contributing to and maintaining DI; and SB fading may be a helpful strategy for reducing DI. We discuss these findings in the context of existing literature and provide directions for future research. • Appearance-related safety behaviors (ARSBs) were found to be strongly related to distress intolerance (DI). • ARSBs prospectively predicted DI in an unselected sample of women. • In Study 2, we examined the experimental effect of reducing these behaviors. • In a clinical sample, ARSB fading led to lower DI, but only for those low in DI at baseline. [ABSTRACT FROM AUTHOR]

Highlights • BDD appears to be common in young adults, and is associated with traits of both impulsivity and compulsivity. • University students with BDD are more likely to endorse symptoms of compulsive sexual behavior, depression, PTSD, anxiety and depression. • University students with BDD have poor scholastic performance and low self-esteem. Abstract This study sought to examine the prevalence of probable body dysmorphic disorder (BDD) in a university sample and its associated physical and mental health correlates. A 156-item anonymous online survey was distributed via email to a randomly chosen subset of 10,000 university students, at a large public university. The survey queried current use of alcohol and drugs, psychological and physical status, academic performance, sexual behaviors, and questionnaire-based measures of impulsivity and compulsivity. A total of 3,459 participants (59.1% female) completed the survey and were included in the analysis. The overall prevalence of BDD was 1.7% (n = 59). Compared to students without BDD, those with BDD were significantly more likely to endorse symptoms of compulsive sexual behavior, depression, PTSD, and anxiety. Questionnaire-based measures revealed higher levels of both compulsivity and impulsivity associated with BDD. BDD appears to be common in young adults, and is associated with specific mental health comorbidities, as well as both impulsive and compulsive traits. Clinicians should be aware of the presentation of BDD and screen for it in primary care and mental health settings. [ABSTRACT FROM AUTHOR]

Highlights • Explored relationship between disgust propensity and body dysmorphic disorder. • Disgust propensity predicted greater self-reported BDD symptoms among a student sample. • Disgust propensity predicted greater BDD-related concerns during an in-vivo behavioral task. • A clinical BDD group reported greater Disgust propensity relative to healthy controls. • Findings were significant after accounting for co-occurring depression and anxiety. Abstract Disgust is a universal emotion that has received recent empirical attention for its potential role in various forms of psychopathology. We conducted two studies using varying methods to explore the relationship between disgust propensity, a construct related to obsessive-compulsive symptomatology, and symptoms of body dysmorphic disorder (BDD). Study 1 found a significant and unique (i.e., above and beyond co-occurring depression and anxiety) relationship between higher disgust propensity and more severe BDD symptoms, as measured by a standardized self-report and via an in-vivo task aimed at eliciting BDD-related concerns (N = 200). In Study 2, a clinical sample of individuals with BDD (N = 50) reported higher disgust propensity compared to mentally healthy controls (N = 36). This finding remained significant when controlling for depression and anxiety. Findings are the first to our knowledge to demonstrate a relationship between disgust propensity and BDD symptoms and provide directions for future research exploring the role of disgust in BDD. [ABSTRACT FROM AUTHOR]

This study aimed to extend the cognitive-behavioral model of Body Dysmorphic Disorder (BDD) by exploring the role of insecure attachment and self-ambivalence on the relationship between two specific cognitive factors, namely appearance orientation (seeing the self as an aesthetic object) and appearance evaluation (negative appraisal of internal body image), on levels of BDD severity. A convenience sample of 304 Australian residents (72.4% females) completed online self-report measures; 53% reported clinical or subclinical levels of BDD. Attachment anxiety and self-ambivalence were both associated with BDD severity, as were both cognitive factors. The direct effect of attachment anxiety was no longer significant after controlling for self-ambivalence, appearance orientation and evaluation. However, significant specific indirect effects were found suggesting that individuals who report greater levels of insecure attachment and self-ambivalence exhibit greater appearance orientation and negative appearance evaluation which, in turn, results in higher levels of BDD. The indirect effect through self-ambivalence was strongest suggesting a central role of self in the relationship between attachment anxiety and BDD severity. The current research demonstrates the importance of attachment anxiety and self-ambivalence in the context of BDD and implicates their potential role in treatment; however, further clinical studies are needed. • Appearance-related cognitions were replicated as correlates with BBD severity. • Insecure attachment is related to appearance-related cognitions and BDD severity. • Self-ambivalence plays a central role in BDD severity. • Insecure attachment and self-ambivalence explain BDD severity beyond appearance-related cognitions. [ABSTRACT FROM AUTHOR]

Abstract: This study aimed to explore the manifestation of body dysmorphic disorder symptoms in a sample of people with eating disorders and to investigate possible associations between body dysmorphia and alexithymia. Forty patients currently seeking treatment for an eating disorder completed a battery of six measures assessing alexithymia, mood, eating behaviours, weight-related body image, body dysmorphia and non-weight related body image. Significant moderate positive correlations (Pearson''s r) between selected variables were found, suggesting that participants with high levels of dysmorphic concern (imagined ugliness) have more difficulty with the affective elements of alexithymia, that is, identifying and describing feelings. When depression, eating attitudes, and weight-related body image concerns were controlled for, significant moderate positive correlations between this alexithymia factor and dysmorphic concerns remained present. An independent-samples t-test between eating-disordered participants with and without symptoms of body dysmorphic disorder (BDD) revealed significant group differences in difficulties identifying feelings. This pattern of results was replicated when the groups were identified on the basis of dysmorphic concerns, as opposed to BDD symptoms. This study highlights the associations between alexithymia and body dysmorphia that have not previously been demonstrated. [Copyright &y& Elsevier]

Summary: Body dysmorphic disorder (BDD) is a disabling preoccupation with a slight or an imagined defect in appearance. It is recognised in some patients who present to the plastic surgeon requesting multiple cosmetic procedures. Very rarely, BDD patients may wish for amputation of a healthy limb and may even mutilate themselves deliberately in order to necessitate amputation. These patients pose a diagnostic challenge as BDD is uncommon and they are often uncooperative whilst appearing mentally sound. Furthermore, they raise difficult ethical and legal issues for the surgeon. Although there is some guidance for the management of BDD patients seeking elective amputation, there is currently none for the management of those who present in the emergency setting. Illustrated by the case of a man who, having failed to find a complicit surgeon, attempted self-amputation of the hand, we review the relevant ethical, legal and management issues with advice by the British Medical Association and General Medical Council. [Copyright &y& Elsevier]

Abstract: Existing research argues that the muscular male body ideal, often promoted in the media, is associated with male body dissatisfaction and increasingly problematic attempts to attain unrealistic body shape by young males. The present study sought to examine the influence of “lad magazines”, a highly popular media sector over the last decade, and also the role of dating, or relationship, status, on the association between internalization of appearance ideals and drive for muscularity. One hundred and Sixty-one males between the ages of 18 and 36 from a UK university completed measures of exposure to lad magazines, eating disturbance, sociocultural attitudes towards appearance, and drive for muscularity. Internalization of appearance ideals was found to be a possible mediator of the relationship between lad magazine exposure and both drive for muscularity and eating disturbance. These effects were significantly stronger among non-dating males, suggesting that, especially for single men, preoccupation with attaining the ideal male body may be enhanced by the use of media that promote traditional masculine ideals. [Copyright &y& Elsevier]