Body Dysmorphic Disorder in Dermatology: a Systematic Review
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Body Dysmorphic Disorder in Dermatology: a Systematic Review Isabella Herbst 1,2
& Gregor B. E. Jemec
1,2
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract
Body Dysmorphic Disorder (BDD) is a psychiatric diagnosis of an impairing condition in which the patient is preoccupied with a slight or perceived defect in their appearance. BDD patients have a higher rate of psychiatric comorbidities than the background population which include obsessive-compulsive disorder (OCD), depression, anxiety and suicide. It causes distress and affects the patient’s quality of life. It is previously found that the prevalence of patients that suffers from BDD is higher among dermatology patients than in the background population. To create an overview of the original literature that exist on topic: BDD in dermatology. A systematic review was conducted by two reviewers. PubMed was searched using a predefined search string created in collaboration between the authors and a bibliographic fellow on 18th of August 2018 and again in January 2020. 45 articles were obtained and after exclusion 5 relevant articles remained. Dermatology patients have a higher incidence of BDD than the background population. BDD patients are significantly younger and it has been suggested that BDD develops during adolescence but is diagnosed with a delay of several years because patients seek out health care professionals among non-mental health specialists. BDD does not appear associated with the setting, i.e. cosmetic vs general dermatology, but BDD patients have a lower quality of life and are more commonly unemployed or on sick leave. It is often difficult to treat, and a combination of the dermatologic treatment and the psychiatric treatment may be necessary in the context of visible skin pathology. Keywords JCDA-D-20-00113 . Body dysmorphic disorder . Body dysmorphia . BDD . Psychiatry . Dermatology . Body image . Quality of life
* Isabella Herbst [email protected] Gregor B. E. Jemec [email protected]
1
Department of Dermatology, Zealand University Hospital, Sygehusvej 10, 4000 Roskilde, Denmark
2
Health Sciences Faculty, University of Copenhagen, Copenhagen, Denmark
Psychiatric Quarterly
The skin is a communicative organ and plays a vital role in socializing to many species including humans. Skin disorders are generally visible disorders, and, even if located in socially non-exposed skin, they are noticed by the patients either because they are visible or due to the symptoms they cause. Skin disease is furthermore often associated with anxiety disorders and depression, and possibly through these also with suicidality [1–4]. If the face is involved, skin disease can be cosmetically disfiguring which may lead to the feeling of social exclusion and, more generally, not being similar to others. Resilience is therefore an important coping mechanism [5, 6]. In many cultures skin diseases are furthermore perceived as stigma. It may therefore be speculated that the simple fact that skin disease is visible has a strong
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