An empirically derived recommendation for the classification of body dysmorphic disorder: Findings from structural equation modeling

Abstract

Body dysmorphic disorder (BDD), together with its subtype muscle dysmorphia (MD), has been relocated from the Somatoform Disorders category in the DSM-IV to the newly created Obsessive-Compulsive and Related Disorders category in the DSM-5. Both categorizations have been criticized, and an empirically derived classification of BDD is lacking. A community sample of N = 736 participants completed an online survey assessing different psychopathologies. Using a structural equation modeling approach, six theoretically derived models, which differed in their allocation of BDD symptoms to various factors (i.e. general psychopathology, somatoform, obsessive-compulsive and related disorders, affective, body image, and BDD model) were tested in the full sample and in a restricted sample (n = 465) which indicated primary concerns other than shape and weight. Furthermore, measurement invariance across gender was examined. Of the six models, only the body image model showed a good fit (CFI = 0.972, RMSEA = 0.049, SRMR = 0.027, TLI = 0.959), and yielded better AIC and BIC indices than the competing models. Analyses in the restricted sample replicated these findings. Analyses of measurement invariance of the body image model showed partial metric invariance across gender. The findings suggest that a body image model provides the best fit for the classification of BDD and MD. This is in line with previous studies showing strong similarities between eating disorders and BDD, including MD. Measurement invariance across gender indicates a comparable presentation and comorbid structure of BDD in males and females, which also corresponds to the equal prevalence rates of BDD across gender.

Prevalence and Correlates of Hair Pulling Disorder and Skin Picking Disorder in an Acute Psychiatric Sample

“…Similarly, evidence suggests that neuroticism is more strongly associated with symptoms of OCD, hoarding disorder, and BDD than with symptoms of HPD and SPD (Keuthen et al, 2015; Watson et al, 2018). Finally, factor analytic studies have consistently shown that self-reported HPD and SPD symptoms load on a shared underlying “grooming” factor in both clinical and nonclinical samples (Hartmann et al, 2020; Maraz et al, 2017), and this grooming factor has been shown to have relatively limited association with negative emotionality (Snorrason et al, 2021, 2022).…”

A smartphone app for the prevention and early intervention of body dysmorphic disorder: Development and evaluation of the content, usability, and aesthetics

“…Prospectively, we should also examine potential additional effects of exposure and response prevention exercises in this subclinical target group. In accordance with the suggested body image disorders spectrum ( Hartmann et al, 2020 ), we may add examples of weight-based concerns to the exercises in order to test whether individuals at risk of an eating disorder can also benefit from AINA. In general, future studies should examine differential effects of the modules and strategies in dismantling designs.…”

Going deeper into eating and body image pathology in males: Prevalence of muscle dysmorphia and eating disorders in a university representative sample

“…It proposed reconceptualising MD within the spectrum of ED from a transdiagnostic perspective (Murray et al, 2013) or grouping MD and ED together under the category of "body image disorders" (Cooper et al, 2020). This proposal has been empirically validated by Hartmann et al (2020).…”