Debilitating Body Image Disorder Often Begins In Teens; Likely To Be Missed

ance, with those at the extreme end - 18 percent - having dropped out of school. One middle school student had missed more than 100 days of the previous school year because of BDD.

All subjects had associated compulsive behaviors - most often camouflaging the perceived defect with clothes, makeup, or a hat or repeatedly checking mirrors and other reflective surfaces. One patient asked, "Mom, do you think the gap between my front teeth has gotten any wider?" up to 30 times a day.

About half of 19 subjects treated with serotonin reuptake inhibitors experienced a decrease in preoccupation, distress and compulsive behavior and reported improved functioning, researchers found. Subjects responded to the antidepressants after four to 16 weeks of treatment. Many were able to resume normal activities with peers and improve school attendance. Other psychiatric treatments, undertaken by 55 percent of the participants, were generally ineffective, and 36 percent of subjects who received surgical treatment for their perceived flaws had no improvement in symptoms.

Diagnosis of BDD in young people often requires inquiries about specific BDD symptoms because young people are often too embarrassed to divulge them, say the researchers. For example, it may be worthwhile for parents and medical personnel to ask "Is there some aspect of your appearance that you're really unhappy about?" Concerns about appearance are not sufficient for diagnosis unless they cause significant distress or impairment in functioning. "The problem is that adolescence is when this usually begins and it's not being picked up... people see it and trivialize it," said Phillips. "This is not just a phase."

Larger studies on children and adolescents with BDD, including treatment studies with control groups, now need to be done, say researchers. Studies that use a commun

Contact: Kristen Lans
Brown University

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