What is the ratio of BDD?
1:1 male to female
What is the presentation of BDD?
- Similar in females and males
- Men tend to focus on muscles defects and bodybuilding
- Women are more likely to have co-morbid eating disorder
What is the onset of BDD?
- 16 years (range: adolescence through 20s)
- High percentage of suicide attempts (21% - 27.5%)
- More impairment than depression, diabetes, heart attack
What are some of the more prevalent actions of BDD?
- People keep it a secret.
- The statistics are so vast from study to study.
- Much higher in psychiatric population.
What are some concerns of BDD?
-Suicidal behavior
- The text discusses one man who thought his skin was too loose, so he tried to
staple it with a staple gun - Another woman was preoccupied with her skin and her face shape. She filed her teeth to alter the appearance of her jawline.
- Another woman couldn’t afford liposuction, so she used a knife to cut her thighs open and squeeze out the fat.
- These are reactions to what they believe are horrible and disgusting features of their bodies…
What are the assessments used for BDD?
- Clinical Interview
- Collateral Information
- Structured Assessments
What are the treatments of BDD?
- Medication: block 5-HT reuptake (clomipramine, fluvoxamine)
- Psychological: ERP
- Therapy produces better and longer lasting outcomes compared to medication alone
What is a cross cultural consideration of BDD?
- Japanese variant of social anxiety disorder.
- Patient believes they have horrendous breath or body odor, will embarrass themselves, have an odd apprearance > avoid social interaction
- Patients with BDD in the U.S> may be considered to have severe social anxiety in Japan and Korea
What are the surgery statistics of BDD?
- 76.4% sought medical treatment
- Dermatology(45.2%)
- Plastic surgery (23.2%)
- People with BDD are often not satisfied with surgery
- 81% are dissatisfied
What is Body Integrity Identity Disorder?
- Disorder in which the person does not identify with a part of their body, causing significant and obsessive emotional distress, and often a strong desire to amputate a healthy appendage, become paralyzed, or remove/disable whatever is bothering them.
- Some of these patients will mutilate themselves if requests from surgeons for an amputation or for the transection of their spinal cord is denied.
What are some neurological underpinnings of BIID?
- Reduced cortical thickness in the areas of the parietal lobe and a reduced cortical surface areas of the somatosensory cortices and anterior insular cortex.
- Right-sided cortical abnormalities are associated with a strong desire for left-sided limbs for amputation.
What are some of the the motivations for those with BIID?
- Restoring true identity as an amputee
- Feeling sexually attracted or aroused
- body sculpting/aesthetics
- feeling satisfied inside
What is the treatment of BIID?
- Psychotherapy
- Medication – SSRI
- Fluoxetine
- Deep Brain Stimulation
- Elective Amputation…?
What is Hoarding Disorder?
- The acquisition of, and failure to discard, a large number of possessions
- Living spaces so cluttered that they cannot be used as intended
- Significant distress or impairment due to clutter
What is Hoarding?
- Excessively acquiring items that are not needed or for which there’s no space
- Persistent difficulty throwing out or parting with your things, regardless of actual value
- Feeling a need to save these items, and being upset by the thought of discarding them
- Building up of clutter to the point where rooms become unusable
- Having a tendency toward indecisiveness, perfectionism, avoidance, procrastination, and problems with planning and organizination.
What are some of the reasons for hoarding?
- Emotional attachments
- Sentimental
- Instrumental/useful
- Intrinsic/beautiful
What are some social problems and functions with hoarding?
- Strained relationships with family, friends,
landlords, neighbors - Work problems
- Interference with major personal or career goals
- 6% have been fired because of hoarding
- Legal/financial problems
- Credit card debt
- High expenses – buying, storage unit fees
- Property damage - loss of investment
- Eviction, divorce, bankruptcy
What are the stages of hoarding?
- Minimal clutter
- Mild clutter
- Moderate clutter
- Severe clutter
- Extreme clutter.
What is the DSM specifier with excessive acquisition?
With excessive acquisition: If difficulty discarding possessions is accompanied by excessive acquisition of items that are not needed or for which there is no available space.
What is the DSM specifier with good or fair insight?
With good or fair insight: The individual recognizes that hoarding-related beliefs and behaviors (pertaining to difficulty discarding items, clutter, or excessive acquisition) are problematic.
What is the DSM specifier with poor insight?
With poor insight: The individual is mostly convinced that hoarding-related beliefs and behaviors (pertaining to difficulty discarding items, clutter, or excessive acquisition) are not problematic despite evidence to the contrary.
What is the DSM specifier with absent insight/delusional beliefs?
With absent insight/delusional beliefs: The individual is completely convinced that hoarding-related beliefs and behaviors (pertaining to difficulty discarding items, clutter, or excessive acquisition) are not problematic despite evidence to the contrary.
What are some co morbidities of hoarding?
- Major depressive disorder- most common
- Body dysmorphic disorder
- Social anxiety disorder,
- OCD
- Substance Use Disorders
