Body Dysmorphic Disorder in Youth with OCD: Clinical Features and Treatment Response

What you need to know

• Body dysmorphic disorder (BDD) occurs in about 9% of youth with obsessive-compulsive disorder (OCD)
• Youth with both OCD and BDD experience greater impairment, especially in social functioning
• Standard OCD treatment may help reduce OCD symptoms but BDD symptoms often persist
• Specialized treatment addressing both OCD and BDD may be needed for youth with this comorbidity

Obsessive-Compulsive Disorder and Body Dysmorphic Disorder

Obsessive-compulsive disorder (OCD) is a mental health condition characterized by unwanted, intrusive thoughts (obsessions) and repetitive behaviors or mental acts (compulsions) performed to reduce anxiety. Body dysmorphic disorder (BDD) involves an extreme preoccupation with perceived flaws in one’s appearance, leading to significant distress and repetitive behaviors. While separate disorders, OCD and BDD share some similarities and can occur together.

This study aimed to better understand how often BDD occurs in youth with OCD, how it impacts their symptoms and functioning, and whether standard OCD treatment helps with BDD symptoms. The researchers examined 107 youth aged 7-17 who were seeking treatment for OCD.

How Common is BDD in Youth with OCD?

The study found that about 9.35% of youth with OCD also met criteria for BDD. This is much higher than rates of BDD in the general population of youth. BDD was equally common in males and females with OCD, but tended to occur more often in older youth.

Clinical Features of OCD with BDD

Youth who had both OCD and BDD showed some key differences compared to those with OCD alone:

• Greater impairment in social functioning
• Lower overall functioning and quality of life
• Higher levels of OCD symptom severity
• More difficulty regulating emotions adaptively

There was also a trend toward higher rates of other anxiety disorders, particularly social anxiety, in youth with both OCD and BDD. However, this didn’t reach statistical significance, likely due to the small sample size.

Treatment Response

All youth in the study received intensive cognitive-behavioral therapy (CBT) for OCD. The researchers found that OCD symptoms improved similarly for youth with and without BDD. However, BDD symptoms did not significantly improve with the OCD-focused treatment.

Specifically, while appearance-related anxiety decreased slightly overall, most youth with OCD and BDD continued to report clinical levels of BDD symptoms after OCD treatment. This suggests that standard OCD treatment alone may not be sufficient to address BDD symptoms in these youth.

Conclusions

• BDD is relatively common in youth seeking treatment for OCD and is associated with greater overall impairment
• Youth with both OCD and BDD may need specialized treatment that addresses both sets of symptoms
• Clinicians should screen for BDD in youth with OCD, especially older adolescents
• More research is needed on effective treatments for youth experiencing both OCD and BDD

This study highlights the importance of recognizing and addressing BDD symptoms in youth with OCD. While standard OCD treatment can help with obsessive-compulsive symptoms, additional interventions targeting body image concerns and related behaviors may be needed for optimal outcomes in youth experiencing both conditions. Parents and clinicians should be aware of the possibility of comorbid BDD in youth with OCD and consider comprehensive assessment and treatment approaches.