پیشرفت در یک مدل شناختی رفتاری اختلال بدریخت انگاری
|کد مقاله||سال انتشار||مقاله انگلیسی||ترجمه فارسی||تعداد کلمات|
|35542||2004||13 صفحه PDF||سفارش دهید||8377 کلمه|
Publisher : Elsevier - Science Direct (الزویر - ساینس دایرکت)
Journal : Body Image, Volume 1, Issue 1, January 2004, Pages 113–125
Body dysmorphic disorder (BDD) is the most distressing and handicapping of all the body image disorders. A cognitive behavioural model of BDD is discussed which incorporates evidence from recent studies and advances in the author’s 1996 conceptual model. The model aims to understand the maintenance of symptoms in BDD, to assist in the process of engagement of therapy and to guide the strategies to use. At the core of BDD is an excessive self-focussed attention on a distorted body image, the negative appraisal of such images leading to rumination, changes in mood and the use of safety behaviours. Evidence for possible risk factors in the development of BDD is also discussed.
Body dysmorphic disorder (BDD) is characterised by a preoccupation with an imagined defect in one’s appearance or, in the case of a slight physical anomaly, the person’s concern is markedly excessive. The person must also be significantly distressed or handicapped in his or her occupational and social functioning (American Psychiatric Association, 1994). There is frequent comorbidity in BDD especially for depression, social phobia and obsessive–compulsive disorder (OCD) (Neziroglu et al., 1996 and Phillips and Diaz, 1997; Veale et al., 1996a). There is also heterogeneity in the presentation of BDD from individuals with borderline personality disorder with self-harming behaviours to others with muscle dysmorphia (Pope, Gruber, Choi, Olivardia, & Phillips, 1997), who are less handicapped. They share a common feature of a preoccupation with an imagined defect or minor physical anomaly. The most common preoccupations concern the skin, hair, nose, eyes, eyelids, mouth, lips, jaw and chin, however any part of the body may be involved and the preoccupation is frequently focussed on several body parts simultaneously (Phillips, McElroy, Keck, Pope, & Hudson, 1993). Complaints typically involve perceived or slight flaws on the face, asymmetrical or disproportionate body features, thinning hair, acne, wrinkles, scars, vascular markings and pallor, or ruddiness of complexion. Sometimes the complaint is extremely vague or amounts to no more than a general perception of ugliness. BDD is characterised by time consuming behaviours such as mirror gazing, comparing particular features to those of others, excessive camouflage, skin-picking and reassurance seeking. There is usually avoidance of social situations and of intimacy. Alternatively such situations are endured with the use of alcohol, illegal substances or safety behaviours similar to social phobia. The prevalence rate of BDD in the community is reported as 0.7% in two studies (Faravelli et al., 1997; Otto, Wilhelm, Cohen, & Harlow, 2001) with a higher prevalence of milder cases in adolescents and young adults (Bohne et al., 2002). The prevalence of BDD is about 5% in a cosmetic surgery setting (Sarwer, Wadden, Pertschuk, & Whitaker, 1998) and 12% in a dermatology clinic (Phillips, Dufresne, Wilkel, & Vittorio, 2000). Surveys of BDD patients attending a psychiatric clinic tend to show an equal sex incidence and sufferers are usually single or separated (Neziroglu & Yaryura-Tobias, 1993; Phillips & Diaz, 1997; Phillips et al., 1993 and Veale et al., 1996a). Veale et al. (1996a) found a greater preponderance of women but this may be because of a referral bias. It is also possible that, in the community, while more women are affected overall, a greater proportion experience milder symptoms.