Category: Obsessive Compulsive and Related Disorders


Patient-Reported Triggering Events in the Development of Body Dysmorphic Disorder

Friday, November 17
1:45 PM - 3:15 PM
Location: Sapphire Ballroom K & L, Level 4, Sapphire Level

Keywords: Body Dysmorphic Disorder | Risk / Vulnerability Factors
Presentation Type: Symposium

Researchers have proposed a diathesis-stress model of development for body dysmorphic disorder (BDD), yet little is known about the stressors that may trigger BDD. Several studies have examined retrospective rates of childhood bullying and abuse, using top-down methods (e.g., compared rates of bullying/abuse across BDD and control groups). However, using exclusively top-down methods constrains the data collected to those researchers hypothesize a priori. This study builds on existing research via a patient-centered, bottom up approach to identify potential stressors in BDD development.  Participants (N = 165) were recruited through BDD organization websites, completed measures online, and met BDD criteria on the self-report BDD Questionnaire. A subsample completed phone assessments to validate diagnoses.  Participants were asked (yes/no) if they recall a specific experience or event that may be the origin of their appearance concerns. If yes, they were asked to describe this event. Two researchers independently coded responses, and inter-rater reliability was strong across categories (κs = .69 – 1.00). Over one-third (37.6%) attributed BDD development to a specific triggering event. Bullying incidents (47.4%) and situations that emphasized cultural messages of beauty (26.3%) were described most often. Compared to top-down research, fewer participants attributed BDD development to abuse (8.4%).  Most individuals who endorsed a triggering event described only one event (72.6%), as opposed to multiple events. Most events (62.8%) involved ongoing incidents (e.g., repeated bullying), rather than one-time events. Most events were interpersonal (80%) and occurred in grade school or middle school. Finally, a MANOVA with follow-up univariate tests showed that those who attributed BDD to bullying had worse psychosocial correlates (depression, disability, quality of life, social support) compared to those who attributed BDD to another type of event (F[4, 56] = 3.31, p = .02, η2 = .19).  This study complements top-down research via a patient-centered approach. Results are highly consistent with prior research, lending confidence to current CBT models of BDD development. 

Hilary Weingarden

Clinical research fellow
Massachusetts General Hospital/Harvard Medical School


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Patient-Reported Triggering Events in the Development of Body Dysmorphic Disorder

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