High Prevalence of Body Dysmorphic Disorder Observed in Patients With Acne

A stressed woman examining her skin in the mirror

A high prevalence of body dysmorphic disorder (BDD) was observed in patients with acne vulgaris at various dermatology centers in Spain, according to study data published in the Journal of the European Academy of Dermatology and Venereology.

Investigators conducted a cross-sectional study at 11 dermatology clinics in Spain. The study enrolled patients age 16 to 30 years who had been diagnosed with acne by a dermatologist. Patients attended a single medical visit at which clinical and sociodemographic variables were captured. Acne severity was assessed with the Leeds Revised Acne Grading system; patients with moderate or severe visible lesions were excluded from analyses. The Body Dysmorphic Disorder Questionnaire (BDDQ) was used to identify possible patients with BDD.

The final analysis cohort comprised 245 patients with acne, of whom 202 (63.7%) were women. Of these patients, 43 (17.6%) screened positive for BDD, for a prevalence of 10.6% (95% CI, 7.6-13.6%) in the total cohort. A greater percentage of patients who screened BDD-positive were women (80%). Non-inflammatory lesions were more commonly observed in the BDD-positive group compared with the BDD-negative group (56% vs 30%; P =.002). Most patients in the BDD-positive group reported worrying about just one body part (86%). Primary areas of preoccupation were the face (95%), back (16.3%), bust (2.3%), and chest (2.3%). Patients who screened positive for BDD spent an average of 122 minutes per day preoccupied by their appearance. The most frequently endorsed compulsive behaviors in the BDD group were mirror checking (90.7%), camouflaging (79.1%), and using makeup (72.1%).

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These data align with prior studies suggesting a significant prevalence of BDD in patients with acne vulgaris. However, present results may be limited by the cross-sectional design; patient experiences could have been influenced by treatment received prior to data collection. Even so, investigators endorsed screening for BDD in patients with acne to “reduce the progression of psychosocial deterioration and the development of comorbid disorders.”

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Marron SE, Miranda-Sivelo A, Tomas-Aragones L, et al. Body dysmorphic disorder in patients with acne: a multicentre study [published online September 13, 2019]. J Eur Acad Dermatol Venereol. doi:10.1111/jdv.15954