Appearance Dissatisfaction and Body Dysmorphic Disorder in the Dermatology Patient

July 2024 | Volume 23 | Issue 7 | 545 | Copyright © July 2024


Published online June 24, 2024

doi:10.36849/JDD.8156

Zane Sejdiu BSa, Erin Stitzlein BAa, Evan A. Rieder MDb, Anneke Andriessen PhDc, Jennifer L. Greenberg PsyDd, Vikash S. Oza MDe, Vanessa Cutler MDf, Mercedes E. Gonzalez g, Peter Lio MDh, Elyse M. Love MDi, Joyce Park MDj, Hinke Andriessen MSck, Katharine A. Phillips MDl

aDrexel University College of Medicine, Philadelphia, PA 
bPrivate Practice. New York, NY 
cRadboud UMC Nijmegen, Andriessen Consultants, Malden, The Netherlands
dMassachusetts General Hospital and Harvard Medical School, Boston, MA
eThe Kimberly and Eric J. Waldman Department of Dermatology at the Icahn School of Medicine at Mount Sinai, New York, NY
fDepartment of Psychiatry, NYU Grossman School of Medicine. New York, NY 
gPediatric Skin Research, LLC, Miami, FL
hNorthwestern University Feinberg School of Medicine, Chicago, IL 
iThe Ronald O. Perelman Department of Dermatology, NYU Grossman School of Medicine, New York, NY 
jSkin Refinery PLLC, Spokane, WA
kPsychonomics, Cognitive Psychology, Clinical Psychology Specialist, CRO RBC Consultants, Amstelveen, The Netherlands
lWeill Cornell College of Medicine, New York, NY

Abstract

Dermatologists routinely see patients with inflammatory skin conditions and aesthetic concerns that involve substantial psychological comorbidity. However, most dermatologists do not receive formal training in this area, and many are unsure how to best help treat certain patients holistically. Body dysmorphic disorder (BDD) is a common and distressing psychiatric condition that disproportionately impacts dermatology patients, including patients living with chronic inflammatory skin conditions such as acne and atopic dermatitis. BDD is characterized by preoccupation with nonexistent or minimally noticeable flaws in physical appearance that cause clinically significant distress or impairment in functioning. Adolescent populations may be particularly vulnerable to clinically significant body image dissatisfaction, including BDD, due to the high prevalence of acne and the pervasive role of social media platforms. The rise of social media may exacerbate body image issues through repetitive exposure to idealized and often unrealistic beauty standards. Though screening questionnaires can assist dermatologists in recognizing BDD, dermatologists must collaborate with mental health providers to provide comprehensive care to vulnerable patients, including adolescents.

J Drugs Dermatol. 2024;23(7):545-550.  doi:10.36849/JDD.8156

INTRODUCTION

A recent survey of 500 United States (US) dermatologists inquired about the current state of psychological wellness evaluation of dermatology patients, as well as the extent of mental health training in dermatology.1 While 75% of the dermatologists reported routinely asking their patients about their psychological health (including mood, quality of life, and face/body image), 60% of respondents reported having no formal training about mental health in the dermatology patient. Of the respondents who reported having received some form of psychodermatologic training, 65% had obtained this training outside of residency and fellowship (ie, conferences, journal articles, continuing medical education). Given that dermatologists see patients daily who present with inflammatory conditions such as acne and eczema and aesthetic concerns with substantial psychological comorbidity, 92% of surveyed respondents agreed with the statement that dermatology education should provide some training on the psychological health of the dermatology patient. 

Body dysmorphic disorder (BDD) is an often debilitating psychiatric disorder categorized within the spectrum of obsessive-compulsive and related disorders.2 BDD is particularly prevalent among dermatology patients because the skin and hair (for example, minor or nonexistent acne, scarring, telangiectasias, perceived thinning) are the two most common body areas of concern in both females and males with BDD.3 In addition, the skin, being our outward projection to the world, plays a significant role in shaping body and face image perception.4,5 The overall prevalence of BDD in the US is 2.4%, but among dermatology patients, 
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