Personality disorders and traits in patients with body dysmorphic disorder

Individuals with body dysmorphic disorder (BDD) have been postulated to have schizoid, narcissistic, and obsessional personality traits and to be sensitive, introverted, perfectionistic, and insecure. However, data on personality traits and disorders in BDD are limited. This study assessed 148 subjects with BDD, 26 of whom participated in a fluvoxamine treatment study; 74 subjects were assessed for personality disorders with the Structured Clinical Interview for DSMIII-R Personality Disorders (SCID-II), 100 subjects completed the NEO-Five Factor Inventory (NEO-FFI), and 51 subjects completed the Rathus Assertiveness Scale. Forty-two subjects (57%) had one or more personality disorders, with avoidant personality disorder (43%) being most common, followed by dependent (15%), obsessive-compulsive (14%), and paranoid (14%) personality disorders. On the NEO-FFI, the mean scores were in the very high range for neuroticism, the low range for extraversion and conscientiousness, the low-average range for agreeableness, and the average range for openness to experience. On the Rathus Assertiveness Scale, the mean score was -17.1 +/- 32.0 for women and -17.0 +/- 32.3 for men. Among fluvoxamine responders, the number of personality disorders significantly decreased between the study baseline and endpoint. These findings suggest that the rate of personality disorders in BDD is relatively high, with avoidant personality disorder being most common. The high neuroticism scores and low extraversion scores are consistent with this finding.     

Body Dysmorphic Disorder: A Review of the Current Knowledge

Body Dysmorphic Disorder (BDD) is an excessive preoccupation with an imagined, or real, slight defect in normal physical appearance. The disorder, which usually begins during adolescence, tends to be chronic, and probably is much more common than is usually thought. This review presents an overview of the available scientific literature of BDD. It provides information about historical aspects, epidemiology, clinical features, aetiology, and instruments for assessing BDD. The relationship of BDD with other psychiatric disorders such as depression, obsessive-compulsive disorders, anxiety disorders, schizophrenia, eating disorders and personality disorders is discussed. Aetiological theories, including psychological and neurobiological explanations, are reviewed. Finally, psychopharmacological and psychotherapeutic treatment approaches are presented with special regard to treatment with serotonin-reuptake inhibitors, behavioural therapy and cognitive-behavioural therapy.     

Body dysmorphic disorder and depression: phenomenological and psychotherapeutic aspects: a report of five cases

Body dysmorphic disorder (BDD) is a hard-to-treat disorder that often coincides with depression and suicidal tendency. We investigate the correlations between depression and BDD in an idiographic study of 5 patients receiving treatment in the psychiatric ward of a general hospital in 2008. Among these patients we found common triggering factors - mainly separation - that were associated with humiliation, childhood stresses, worries in regard to attractiveness and masculinity, and personality structures showing dependent-avoidant, self-insecure and sensitive traits, as described by Kretschmer. It transpired that their BDD had developed out of a self-aggravating cycle of shame, controlling actions, alienation and self-disempowerment. After a certain period their self-disempowerment then gradually transforms into a depressive cycle of despair, increased withdrawal, inward-directed anger and self-depreciation. These correlations indicate that the depressive symptomatology among these patients can be better classified as adjustment disorder in regard to their BDD than as independent major depression. Finally, we present dance/movement therapy as a promising additional psychotherapeutic approach that can complement the recognized therapy forms (serotonin re-uptake inhibitors and cognitive behavioral therapy).     

Schizotypy, emotional-behavioural problems and personality disorder traits in a non-clinical adolescent population

The main goal of the present study was to examine the relationship between the schizotypy dimensions, emotional-behavioural problems and personality disorder traits in non-clinical general adolescent population. A total of 1455 participants (M=15.9years; S.D.=1.2) were administered the Oviedo Schizotypy Assessment Questionnaire (ESQUIZO-Q), the Strengths and Difficulties Questionnaire (SDQ) and the Personality Diagnostic Questionnaire-4+ (PDQ-4+). Correlation analyses revealed significant associations between the schizotypy and emotional-behavioural problems self-reported by adolescents. Participants with high scores in schizotypy dimensions, reported higher rates of affective and behavioural problems than those with low scores. Also, schizotypy dimensions and personality disorder traits were closely related in adolescent population. These data indicate, as occurs in clinical samples, the high overlap between schizotypy and personality disorder traits. Affective dysregulation and behavioural problems are present at the subclinical level in non-clinical adolescent population. These results have implications for the integration of schizotypy studies within the paradigms of developmental psychology and dimensional models of personality.     

Comorbid personality impairment in body dysmorphic disorder

Personality impairment was evaluated in 17 body dysmorphic disorder (BDD) patients undergoing a treatment study of clomipramine versus desipramine. Semistructured interviews were administered using both categorical (Structured Clinical Interview for DSM [SCID II]) and dimensional (Dimensional Assessment of Personality Impairment [DAPI]) methods. Personality measures were also correlated with a range of clinical variables (severity of BDD and depressive symptoms, age, duration of illness, and response to treatment). A secondary aim of the study was to provide preliminary validation for the DAPI. Consistent with previous studies, BDD patients showed considerable personality pathology. By SCID II, patients met criteria for a mean of 2.53 personality disorder diagnoses; 87% of patients met criteria for at least 1 diagnosis and 53% for more than 1. Cluster C diagnoses were the most common. Mean scores for the DAPI were 2.63 (3 = mild impairment) to 6.41 (7 = severe impairment), averaging 5.26 (5 = moderate). With regard to the DAPI, the results provided preliminary evidence of good reliability and validity. Moreover, both personality measures were highly intercorrelated. Although SCID II diagnoses correlated with baseline depression (Hamilton Rating Scale for Depression [HRSD]) scores, there were few other significant correlations between personality and other clinical variables. Of note, however, treatment responders demonstrated less personality impairment than nonresponders. The finding that personality measures were highly intercorrelated but, on the whole, not well correlated with other clinical measures supports the distinct and dissociable nature of personality phenomena in BDD. Despite the small sample size, these results suggest that personality impairment appears to be significant factor in BDD and may even play a role in treatment response.     

Childhood adversity and adult personality

OBJECTIVES: To explore how recalled childhood adversity affects trait measures of personality in three age cohorts of an Australian adult population and to examine the effects of particular adversities on adult personality traits. METHOD: A total of 7485 randomly selected subjects in the age bands of 20-24, 40-44 and 60-64 years were interviewed at the outset of a longitudinal community study of psychological health in the Canberra region of Australia. In the initial interview, subjects answered 17 questions about domestic adversity and three questions on positive aspects of upbringing to age 16 years. Personality traits were measured by Eysenck Personality Questionnaire, Behavioural Activation and Inhibition Scales, Positive and Negative Affect Scales and a measure of dissocial behaviours. RESULTS: Higher levels of childhood adversity substantially increase the risk of high neuroticism (OR = 2.6) and negative affect (OR = 2.6), less for behavioural inhibition (OR = 1.7) and for dissocial behaviour (OR = 1.7). No significant effect is seen for extraversion, psychoticism or behavioural activation. Age and gender had little effect on the pattern of risk. Maternal depression has significant and substantial independent effects on measures of neuroticism and negative affect as well as most other measures of personality. CONCLUSION: Childhood domestic adversity has substantial associations with clinically important aspects of personality: neuroticism and negative affect. Only small effects are seen on behavioural inhibition and dissocial behaviour, and no significant effect on extraversion and behavioural activation. These unexpected findings contradict clinical belief. Maternal psychological ill-health is pre-eminent among adversities predicting later disadvantageous traits, even for those traits that had only the slightest association with childhood adversity. Consequences of childhood adversity prevail throughout the lifespan in men and women equally. The study underlines the importance of childhood domestic adversity and especially maternal psychological ill-health as a target for preventive intervention for psychological difficulties at all ages.     

Dysmorphic concern symptoms and personality disorders: a clinical investigation in patients seeking cosmetic surgery

Body dysmorphic disorder (BDD) is a somatoform disorder characterized by an excessive concern with an imagined or slight defect in appearance. BDD has been particularly studied in cosmetic surgery settings. The object of the present study is to investigate the relationship between personality disorders and dysmorphic symptoms in a group of 66 patients seeking cosmetic surgery. Assessment instruments included the following: a semistructured interview for demographic and clinical characteristics; the Structured Clinical Interview for DSM-IV, the Hamilton Depression and Anxiety Rating Scales, and the Body Dysmorphic Disorder Yale - Brown Obsessive--Compulsive Scale (BDD - YBOCS). A multiple regression analysis was performed using the BDD - YBOCS score as a continuous dependent variable. The severity of dysmorphic symptoms (BDD - YBOCS score) was significantly related to two factors: the number of diagnostic criteria for schizotypal and paranoid personality disorders. The results suggest that the presence of a psychopathological reaction to imagined defects in appearance in subjects pursuing a surgical correction is associated with the severity of schizotypal and paranoid personality disorders. Preoperative assessment could help to define the clinical profile of patients in cosmetic surgery settings.     

The role of mood and personality in the perception of emotions represented by music

Neuroimaging studies investigating the processing of emotions have traditionally considered variance between subjects as statistical noise. However, according to behavioural studies, individual differences in emotional processing appear to be an inherent part of the process itself. Temporary mood states as well as stable personality traits have been shown to influence the processing of emotions, causing trait- and mood-congruent biases. The primary aim of this study was to explore how listeners’ personality and mood are reflected in their evaluations of discrete emotions represented by music. A related aim was to investigate the role of personality in music preferences. An experiment was carried out where 67 participants evaluated 50 music excerpts in terms of perceived emotions (anger, fear, happiness, sadness, and tenderness) and preference. Current mood was associated with mood-congruent biases in the evaluation of emotions represented by music, but extraversion moderated the degree of mood-congruence. Personality traits were strongly connected with preference ratings, and the correlations reflected the trait-congruent patterns obtained in prior studies investigating self-referential emotional processing. Implications for future behavioural and neuroimaging studies on music and emotions are raised.     

Predictors of remission from body dysmorphic disorder: a prospective study

In the first naturalistic, prospective study of the course of body dysmorphic disorder (BDD), we examined predictors of remission in 161 subjects over 1 year of follow-up. Data were obtained on clinical characteristics at the intake interview and weekly BDD symptom severity over 1 year using the Longitudinal Interval Follow-Up Evaluation. More severe BDD at intake, longer BDD duration, and the presence of a comorbid personality disorder predicted a lower likelihood of partial or full remission from BDD. BDD remission was not predicted by gender; race/ethnicity; socioeconomic status; being an adult versus an adolescent; age of BDD onset; delusionality of BDD symptoms; or the presence at intake of major depression, a substance use disorder, social phobia, obsessive compulsive disorder, or an eating disorder. Receipt of mental health treatment or nonmental health treatment (e.g., surgery, dermatologic treatment) during the follow-up year also did not predict remission from BDD.     

Holistic versus detailed visual processing in body dysmorphic disorder: Testing the inversion,composite and global precedence effects

Individuals with Body Dysmorphic Disorder (BDD) are preoccupied with perceived defects in their appearance that are not visible to others. An excessive focus and processing of details has been proposed as a possible mechanism underlying this distorted self-image in BDD. The nature and extent of visuoperceptual abnormalities in BDD however require further investigation; specifically, it remains unclear whether feature-based processing in BDD is a result of a failure of holistic perceptual processes. The present study evaluated whether BDD is associated with an impairment in global processing. Twenty-five individuals with a primary diagnosis of BDD (15 unmedicated, 10 medicated) and 25 matched healthy controls were administered three robust behavioural tasks that test holistic encoding, namely the face inversion, the composite and the navon tasks. Overall, individuals in the BDD and control groups performed similarly in all aspects of holistic processing tested. Our findings suggest that the excessive focus on specific aspects of appearance in BDD may not be explained by impairments in the global encoding of visual information. Implications of these results and suggestions for future research on visual processing in BDD are discussed.