Epidemiology of Body Dysmorphic Disorder and Appearance Preoccupation in Youth: Prevalence, Comorbidity and Psychosocial Impairment

Objective: Little is known about how common and impairing body dysmorphic disorder (BDD) is in the general population of youth. We evaluated the prevalence, comorbidity, and psychosocial impairment associated with BDD and more broadly defined appearance preoccupation in young people. Method: Data were drawn from the 2017 Mental Health of Children and Young People in England survey. BDD and psychiatric comorbidity were assessed in individuals 5 to 19 years of age (N = 7,654) according to DSM-5 criteria, using a clinician-rated standardized diagnostic assessment. Psychosocial impairment was measured with a quantitative scale and was indexed by reported self-harm and suicide attempts, as well as service use, assessed using structured interviews. Results: The point prevalence of BDD was 1.0% (95% CI = 0.8%-1.3%). BDD was significantly more common among adolescents than children (1.9 vs 0.1%; OR = 22.5, p < .001), and among female than male participants (1.8% vs 0.3%; OR = 7.3, p < .001). Approximately 70% of young people with BDD had psychiatric comorbidity, most commonly internalizing disorders. BDD was associated with self- and parent-reported psychosocial impairment, self-harm and suicide attempts, and service utilization. Appearance preoccupation was more common than full-syndrome BDD, but showed similar age and sex effects, patterns of comorbidity, and associated impairment. Conclusion: BDD and appearance preoccupation are relatively common, especially among adolescent girls, and are associated with substantial cooccurring psychopathology, impairment, and risk. Improved screening is needed to increase detection and diagnosis of BDD, and to facilitate access to evidence-based treatment. Plain language summary: This study aimed to determine the prevalence, comorbidity, and psychosocial impairment associated with body dysmorphic disorder (BDD) and more broadly defined appearance preoccupation in young people. Data from an epidemiological survey of 7,654 youth aged 5 to19 years in England indicated that BDD affects approximately 1% of children and adolescents. BDD was significantly more common in adolescents compared to children and in females compared to males. Both BDD and broader appearance preoccupation were linked with high rates of psychiatric comorbidity and significant psychosocial impairment, indicating a need for better screening and access to treatment. Study preregistration information: The epidemiology of body dysmorphic disorder the youth: prevalence, comorbidity and psychosocial impact; https://osf.io/; g83jy.