BODY DYSMORPHIC DISORDER IN
ADULT ORTHODONTIC PATIENTS
INDIAN DENTAL ACADEMY
Leader in continuing dental education
www.ind...
INTRODUCTION
Body image plays an important role for patients
seeking orthodontic treatment. It affects how patients
feel a...
Dysmorphophobia
Dysmorphophobia was originally described as “the sudden
onset and subsequent persistence of an idea of def...
BODY DYSMORPHIC DISORDER
is defined by the fourth edition of the Diagnostic and Statistical Manual
of Mental Disorders (DS...
DIAGNOSTIC CRITERIA
☻The person is preoccupied with a defect in appearance.
Either the defect is imagined or, if there is ...
PREVALENCE OF BDD
The prevalence of BDD is unknown. Underdiagnosis and
underrepresentation are likely because patients are...
ONSET OF BDD
The onset of BDD is commonly during adolescence,
and early childhood experiences and psychological
vulnerabil...
BDD IS ASSOCIATED WITH..
BDD is often present with
◙depressive disorders (a lifetime prevalence of 83 %),
◙social phobias ...
Methods of assessment
►Brown Assessment of Beliefs Scale (BABS)
►BDD modification of the Yale-Brown obsessive compulsive
s...
TREATMENT MODALITIES
MEDICATION
ANTIDEPRESSANTS-SSRI E.G. CHLOMIPRAMINE AND
FLUOXETINE

PSYCHOTHERAPY
BEHAVIOURAL THER...
AIM OF THE PRESENT STUDY
To interview adults attending new patient clinics in the
Orthodontic Department of the Eastman De...
SUBJECTS AND METHODS
Two groups of adults were recruited for structured
interviews.
•The patient group comprised 40 consec...
ASSESSMENT
The BDD-YBOCS interview was used to access BDD. The
measure consists of initial questions to establish whether ...
RATING
Scores for the full BDD interview ranged from 3 to 9
•3 indicating no diagnosis of BDD,
•4-5 mild BDD,
•6-7 moderat...
RESULTS
From the 40 patients, 3 (2 women, 1 man; 7.5%) were
diagnosed with BDD. One was severely affected (BDDYBOCS score ...
PATIENT GROUP
A diagnosis of BDD was made in 3 patients – 2 women
and 1 man. The 3 BDD patients were concerned about
facia...
General public group
In the general public group, 2 women diagnosed with
BDD, and both were excessively concerned about we...
Comparison of the groups
It appears that BDD is more common in the patient group,
and this certainly warrants further inve...
BDD in Orthodontics
There has been little research on the impact of BDD in
orthodontic or orthognathic patients. It is kno...
IDENTIFYING THE POTENTIAL BADRISK PATIENT
A few carefully chosen questions during the initial consultation• Are you happy ...
KEY TO TREATMENT PLANNING
The key is to take a full history and ensure that you are fully
aware of the patient’s expectati...
CONCLUSION
BDD occurs in adult orthodontic patients and in members of
the general public. This study suggests that BDD mig...
REFERENCES
•Psychological assessment of patients requesting orthognathic surgery and the relevance
of BODY DYSMORPHIC DISO...
Thank
You

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Body dysmorphic disorder in adult orthodontic patients /certified fixed orthodontic courses by Indian dental academy

  1. 1. BODY DYSMORPHIC DISORDER IN ADULT ORTHODONTIC PATIENTS INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com
  2. 2. INTRODUCTION Body image plays an important role for patients seeking orthodontic treatment. It affects how patients feel about their physical appearance and, in extreme cases, can lead to subjective fears of ugliness. When there is a physical defect that, although within normal limits, seems far more noticeable to the patient, this may be diagnosed as body dysmorphic disorder (BDD). www.indiandentalacademy.com
  3. 3. Dysmorphophobia Dysmorphophobia was originally described as “the sudden onset and subsequent persistence of an idea of deformity; the individual fears he has become, or may become, deformed and feels tremendous anxiety of such an awareness.” www.indiandentalacademy.com
  4. 4. BODY DYSMORPHIC DISORDER is defined by the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV; American Psychiatric Association, 1994) as- “A preoccupation with some imagined defect in physical appearance or a gross exaggeration of a slight physical anomaly.” www.indiandentalacademy.com
  5. 5. DIAGNOSTIC CRITERIA ☻The person is preoccupied with a defect in appearance. Either the defect is imagined or, if there is a defect, the person’s concern is excessive. ☻The preoccupation causes significant distress in social, occupational, and other important areas of functioning. ☻The preoccupation is not better accounted for by another mental disorder – e.g., anorexia nervosa. www.indiandentalacademy.com
  6. 6. PREVALENCE OF BDD The prevalence of BDD is unknown. Underdiagnosis and underrepresentation are likely because patients are secretive about their symptoms and do not always seek professional treatment. However, it is estimated that up to 1% of the population in the United States suffers from BDD. There is also uncertainly about sex differences. Biby found a higher prevalence in women, but Hollander et al noted a higher prevalence in men. Phillips et al discovered equal rates among the sexes. www.indiandentalacademy.com
  7. 7. ONSET OF BDD The onset of BDD is commonly during adolescence, and early childhood experiences and psychological vulnerabilities might have an impact on symptoms, In addition, many suffers are unmarried, unemployed, and socially isolated. www.indiandentalacademy.com
  8. 8. BDD IS ASSOCIATED WITH.. BDD is often present with ◙depressive disorders (a lifetime prevalence of 83 %), ◙social phobias (35% lifetime prevalence), and ◙obsessive-compulsive disorder (29 % lifetime prevalence). ◙also in conjunction with substance abuse. www.indiandentalacademy.com
  9. 9. Methods of assessment ►Brown Assessment of Beliefs Scale (BABS) ►BDD modification of the Yale-Brown obsessive compulsive scale (YBOCS) ►Body Dysmorphic Disorder Examination (BDDE). www.indiandentalacademy.com
  10. 10. TREATMENT MODALITIES MEDICATION ANTIDEPRESSANTS-SSRI E.G. CHLOMIPRAMINE AND FLUOXETINE PSYCHOTHERAPY BEHAVIOURAL THERAPY SURGERY www.indiandentalacademy.com
  11. 11. AIM OF THE PRESENT STUDY To interview adults attending new patient clinics in the Orthodontic Department of the Eastman Dental Hospital in London for the first time to establish the prevalence of BDD in this population. In addition these findings were compared with those from a group of adult nonpatients. www.indiandentalacademy.com
  12. 12. SUBJECTS AND METHODS Two groups of adults were recruited for structured interviews. •The patient group comprised 40 consecutive adults (16 men, 24 women; > 18 years of age) attending new patient clinics for the first time. •The general public group comprised 40 men and 30 women, who were members of the general public. The members of this group were recruited from a large company with employees of all social groups and ages (range, 18-65 years). www.indiandentalacademy.com
  13. 13. ASSESSMENT The BDD-YBOCS interview was used to access BDD. The measure consists of initial questions to establish whether a diagnosis of BDD is appropriate, according to the 3 diagnostic criteria. If no diagnosis was made initially, the interview was terminated. If a positive diagnosis was made with the initial component of the interview, the rest of the semistructured interview (12 items) was undertaken to establish the severity and types of symptoms during the previous week. www.indiandentalacademy.com
  14. 14. RATING Scores for the full BDD interview ranged from 3 to 9 •3 indicating no diagnosis of BDD, •4-5 mild BDD, •6-7 moderate BDD, and •9 severe BDD. www.indiandentalacademy.com
  15. 15. RESULTS From the 40 patients, 3 (2 women, 1 man; 7.5%) were diagnosed with BDD. One was severely affected (BDDYBOCS score = 9), 1 was moderate (BDD-YBOCS score = 5). These 3 patients were concerned about dental or facial features. The severely affected patient was referred to the liaison psychiatrist, who confirmed the diagnosis, thus validating the interview process www.indiandentalacademy.com
  16. 16. PATIENT GROUP A diagnosis of BDD was made in 3 patients – 2 women and 1 man. The 3 BDD patients were concerned about facial profile, teeth, chin, smiling, talking, and laughing. These factors had an impact on their abilities to work, socialize, meet friends, and, therefore, reduced their abilities to function normally in society. www.indiandentalacademy.com
  17. 17. General public group In the general public group, 2 women diagnosed with BDD, and both were excessively concerned about weight. Neither had dental or facial concerns. Their concerns regarding perceived weight problems had impacted their day-to-day living. www.indiandentalacademy.com
  18. 18. Comparison of the groups It appears that BDD is more common in the patient group, and this certainly warrants further investigation in larger epidemiological studies. Although there was no difference in the age distribution of the groups, there were differences in ethnicity, and this might have had some influence on the findings . Because of the small numbers involved, these data were not amendable to statistical analysis but warrant further investigation about ethnic differences. www.indiandentalacademy.com
  19. 19. BDD in Orthodontics There has been little research on the impact of BDD in orthodontic or orthognathic patients. It is known to significantly affect quality of life and is associated with depression and obsessive-compulsive disorder. It is therefore important to determine the patients’ concerns and whether they have previously received treatment. It is essential to elicit when the concerns started and what impact they are having on their lives. www.indiandentalacademy.com
  20. 20. IDENTIFYING THE POTENTIAL BADRISK PATIENT A few carefully chosen questions during the initial consultation• Are you happy your appearance? • Is there anything that you would like to change about your appearance and, if so, what? • Is there anything that you avoid because of the way that you look? • Have you sought help before? • What do you expect to achieve from your treatment? www.indiandentalacademy.com
  21. 21. KEY TO TREATMENT PLANNING The key is to take a full history and ensure that you are fully aware of the patient’s expectations and whether they are within the realms of reality. If there is any uncertainty, referral should be made to a psychiatrist or clinical psychologist for a thorough psychological analysis. www.indiandentalacademy.com
  22. 22. CONCLUSION BDD occurs in adult orthodontic patients and in members of the general public. This study suggests that BDD might be more common in a referred than a nonreferred population; this clearly requires further investigation. BDD occurs often enough in adult orthodontic patients that all clinicians should be aware of its features. This study should make clinicians ask a few well-chosen questions at the start of each new consultation to help identify the potential bad-risk patient. www.indiandentalacademy.com
  23. 23. REFERENCES •Psychological assessment of patients requesting orthognathic surgery and the relevance of BODY DYSMORPHIC DISORDER, S.J. Cunningham, C. Feinmann, BJO, VOL25, NO.4,1998,293-298 •The Brown Assessment of Beliefs Scale: Reliability and Validity,Jane L. Eisen, Katharine A. Phillips, Lee Baer, Douglas A. Beer, Katherine D. Atala, and Steven A. Rasmussen, Am J Psychiatry 1998; 155:102–108. •Surgical and Nonpsychiatric Medical Treatment of Patients With Body Dysmorphic Disorder,KATHARINE A. PHILLIPS, JON GRANTJ.D.,JASON SINISCALCHI, RALPH S. ALBERTINI,Psychosomatics 2001; 42:504–510 www.indiandentalacademy.com
  24. 24. Thank You For more details please visit www.indiandentalacademy.com www.indiandentalacademy.com

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