ارتباط کیفیت زندگی و ناتوانی عملکردی در افراد مبتلا به اختلال بدریخت انگاری

Body dysmorphic disorder (BDD) is a chronic mental illness characterized by low quality of life and functional disability across multiple domains. Despite the clinical importance of understanding impairment in BDD, there has been little research examining the factors that contribute to these constructs. The present study was designed to examine sociodemographic and clinical correlates of quality of life and disability (work, social, and family) in a sample of individuals with moderately severe BDD symptoms. Method Participants completed an internet survey with questions about demographics, BDD phenomenology, treatment, and impairment. Only participants who completed all study measures and received a score ≥ 16 on the 10-item Yale-Brown Obsessive Compulsive Scale, Modified for BDD (BDD-YBOCS), indicating the presence of clinical BDD symptoms, were included in the analysis (n = 256). Multivariate regression with backwards variable selection was used to identify significant predictors of quality of life and functional disability, assessed with the Quality of Life Enjoyment and Satisfaction Scale-Short Form (QLESQ-SF) and the Sheehan Disability Scale (SDS), respectively. Results BDD symptom severity was inversely associated with quality of life and directly associated with disability in all domains. After controlling statistically for BDD symptom severity, sociodemographic and clinical factors such as age, gender, ethnicity, marital status, insurance, body parts of concern, depression symptoms, and anxiety symptoms were significantly associated with impairment. Conclusion Results suggest a multidimensional nature of quality of life and functional disability and underscore the importance of developing holistic treatment strategies to address impairment in BDD. Body dysmorphic disorder (BDD) is a debilitating mental disorder characterized by an excessive and distressing preoccupation with a slight or imagined defect in physical appearance.1 BDD is relatively common in the general population2, 3 and 4 as well as in inpatient settings.5, 6 and 7 It presents with low rates of remission8 and high rates of psychiatric comorbidity.9 Further, individuals with BDD exhibit high rates of suicidal ideation, suicide attempts, and completed suicide.3 and 10 BDD patients exhibit chronically high levels of impairment across domains of functioning.11, 12 and 13 A substantial portion of individuals with BDD (36%–39%) are unable to work due to their mental illness and many (17%–23%) receive disability insurance.14 and 15 Individuals with BDD also suffer from significant social impairment.14 and 16 Perhaps unsurprisingly, given the high levels of comorbidity and impairment associated with the disorder, individuals with BDD also report extremely low quality of life. Indeed, BDD patients report mental health-related quality of life significantly below both community samples and individuals with a range of other mental disorders, including depression, dysthymia, social phobia, panic disorder, and post-traumatic stress disorder (PTSD).11 and 12 Despite the decrements in functioning and quality of life associated with BDD, little is known about the correlates of disability and quality of life for individuals with this disorder. Although BDD symptom severity is associated with quality of life and functional disability,12, 13 and 15 it accounts for only a small portion of the variance in these constructs.12 Additionally, there is little11 or no14 difference in quality of life or functional disability between individuals who have received treatment for BDD and those who have not. These studies suggest that the low levels of functioning and quality of life observed in individuals with BDD might be related to factors other than BDD symptom severity and that standard BDD treatments are failing to address these additional factors. Initial studies examining quality of life and functional disability in BDD have provided preliminary evidence that factors such as gender, education, social support, and comorbidity may be relevant to our understanding of impairment in BDD.15 and 17 However, no study has systematically examined the composite impact of these factors on disability and quality of life for individuals with BDD. The present study sought to address this gap in the literature by identifying sociodemographic and clinical correlates of low quality of life and functional disability while controlling statistically for BDD symptom severity.

Quality of life is increasingly being recognized as a highly relevant treatment outcome and is currently one of the three criteria used to assess interventions for mental illness, along with efficacy and safety.35 In addition, improvements in quality of life and functioning have the potential to improve patients' treatment adherence and long-term treatment outcome as well as to reduce the economic impact of mental disorders.51 and 52 For these reasons, quality of life and functional impairment should be aggressively targeted in treatments for mental illness, including BDD. This objective will be aided by a comprehensive understanding of the sociodemographic and clinical factors that contribute to impairment beyond symptom severity. The findings from this study suggest that the experience of BDD may differ across age, gender, and ethnic groups. Therefore, clinicians should be sensitive to the meaning of BDD concerns in each patient's particular age, gender, and cultural context, and should discuss these issues with the patient in treatment. In addition the present findings suggest that clinicians treating individuals with BDD should monitor and target BDD patients' depressive symptoms as well as body concerns. Ultimately, a step-wise approach that is developed based on individual patient's current functioning is recommended. For example, if a patient is currently unemployed due to BDD, the patient could begin volunteering as a first step and then move towards part-time employment with the ultimate goal of a full-time job. Future research on impairment in BDD should prospectively examine the variables identified in this study as correlates of quality of life and functional disability in order to determine the temporal relationship between these variables. Furthermore, researchers should examine possible mediators of the association between these variables, including potential common pathways by which these variables influence quality of life and functional disability. Other factors that may impact these variables, such as genetic makeup, cognitions, and personality characteristics, should also be examined. Finally, treatment studies are needed to assess the longitudinal impact of different treatment approaches on impairment in BDD.