Body Dysmorphic Disorders

身体畸形障碍
  • 文章类型: Journal Article
    身体畸形障碍(BDD)是中东国家未充分开发的精神疾病,特别是在有皮肤病学问题的患者中,外观改变可能会增加BDD的风险。我们从2022年7月至9月在约旦大学医院的普通皮肤科和美容诊所对患者进行了研究,并将其与健康对照进行了比较。根据国际疾病分类(ICD-10)标准,由训练有素的皮肤科医生评估患有皮肤病的患者。所有参与者都完成了病态关注问卷(DCQ),感知压力量表,患者健康问卷-2,一般焦虑症评估工具-2。我们使用四个DCQ截止值:9、11、14和17来评估BDD患病率,并将效应大小报告为比值比(OR)。我们的研究涉及1500名参与者,平均年龄为29.3(±14.8)岁,男女比例为3.15:1。在9、11、14和17DCQ截止时间,BDD患病率为78.2%,54.2%,26.5%,和11.7%,分别。在11截止时,有皮肤病学问题的患者比对照组更有可能出现临床BDD症状(OR:1.26;95%CI1.01-1.58;p<0.05)。相反,在截止时间9(OR:2.26;95%CI1.28-3.97;p<0.05)和11(OR:1.50;95%CI1.03-2.20;p<0.05)时,有美容问题的患者比对照组更容易发生临床BDD.我们的逻辑回归显示,较高的DCQ评分与焦虑升高之间存在一致的关联,抑郁症,感知到与皮肤病相关的污名,并降低生活质量(p<0.05)。总之,有皮肤病问题的患者和寻求整容手术的患者有发生BDD的重大风险,由于相关的心理困扰和无效的咨询,需要皮肤科医生进行主动筛查和转诊以进行专门护理。为医疗保健专业人员提供专门的培训,以建立综合护理方法来满足BDD患者的需求,应该是未来研究项目的重点。
    Body Dysmorphic Disorder (BDD) is an underexplored psychiatric condition in Middle Eastern countries, particularly in patients with dermatologic concerns, where alterations in appearance may elevate the risk of BDD. We studied patients at Jordan University Hospital\'s general dermatology and cosmetic clinics from July to September 2022, comparing them to healthy controls. Patients with dermatologic conditions were evaluated per the International Classification of Diseases (ICD-10) criteria by trained dermatologists. All participants completed the Dysmorphic Concerns Questionnaire (DCQ), Perceived Stress Scale, Patient Health Questionnaire-2, General Anxiety Disorder Assessment tool-2. We assessed BDD prevalence using four DCQ cutoffs: 9, 11, 14, and 17, reporting effect sizes as odds ratios (OR). Our study involved 1500 participants, with an average age of 29.3 (± 14.8) years and a female-to-male ratio of 3.15-to-1. At the 9, 11, 14, and 17 DCQ cutoffs, BDD prevalence was 78.2%, 54.2%, 26.5%, and 11.7%, respectively. Patients with dermatologic concerns were more likely to exhibit clinical BDD symptoms than controls at the 11-cutoff (OR: 1.26; 95% CI 1.01-1.58; p < 0.05). Conversely, those with cosmetic concerns were more prone to clinical BDD than controls at cutoffs 9 (OR: 2.26; 95% CI 1.28-3.97; p < 0.05) and 11 (OR: 1.50; 95% CI 1.03-2.20; p < 0.05). Our logistic regression revealed consistent associations between higher DCQ scores and elevated anxiety, depression, perceived skin disease-related stigma, and reduced quality of life (p < 0.05). In conclusion, patients with dermatologic issues and those seeking cosmetic procedures are at significant risk of developing BDD, necessitating proactive screening and referrals for specialized care by dermatologists due to the associated psychological distress and unproductive consultations. Providing specialized training for healthcare professionals to establish an integrated care approach to address the needs of patients with BDD should be the focus of future research projects.
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  • 文章类型: Journal Article
    以身体为中心症状的精神障碍,比如躯体,吃,和身体畸形障碍,在心理治疗中存在困难,因为心理痛苦表现在身体上,而不是口头表达。本研究说明了对检测这些疾病治疗中的特征性变化表现敏感的单例多方法调查。我们调查了一名身体畸形患者的治疗方法。计算机化的语言措施被应用于86个会议,以评估符号处理的变化;在86个会议中,对40例进行了分析,以计算专注于身体症状与人际关系的言语比例。在不同治疗阶段的9个疗程中,使用SWAP-200评估了人格变化。语言风格的衡量标准,演讲内容,性格在治疗过程中表现出明显的变化。患者表现出分裂样和分裂型人格特质,随着时间的推移而减少,随着人格高功能维度的增加。患者将他的情感体验转化为言语的能力稳步增强,将叙述的主要焦点从身体症状转移到人际关系。对身体畸形障碍的治疗的多方法评估表明,人格功能的改善伴随着从专注于身体体验到专注于人际关系的转变。
    Mental disorders with body-centered symptoms, such as somatic, eating, and body dysmorphic disorders, present difficulties in psychotherapy because psychological suffering is manifested in the body rather than expressed verbally. The present study illustrates a single case multi-method investigation sensitive to detecting characteristic change manifestations in the treatment of these disorders. We investigated a treatment of a patient with body dysmorphic disorder. Computerized linguistic measures were applied to 86 sessions to assess changes in symbolic processing; out of the 86 sessions, 40 were analyzed to calculate the proportion of speech focused on bodily symptoms versus on relationships. Changes in personality were assessed using the SWAP-200 on nine sessions from different treatment stages. Measures of linguistic style, speech content, and personality showed marked changes over the treatment. The patient manifested schizoid and schizotypal personality traits that decreased over time, along with an increase in personality high-functioning dimension. The patient\'s ability to translate his emotional experience into words steadily increased, switching the primary focus of narratives from bodily symptoms to relationships. A multimethod assessment of the treatment of body dysmorphic disorder shows that improvement in personality functioning is accompanied by a shift from a focus on bodily experiences to a focus on relationships.
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  • 文章类型: Case Reports
    背景:阴茎外伤性截肢是一种罕见的外科急症,通常是由自残引起的,事故,包皮环切术,袭击和动物袭击。这项研究旨在总结我们在罕见的自绞窄引起的慢性阴茎部分截肢病例中涉及阴茎重建的治疗经验。
    方法:一名22岁男子出现自绞窄引起的慢性阴茎部分截肢3个月,其中阴茎近端距离耻骨1厘米。重建方法包括尿道粘膜端对端吻合,阴茎海绵体和白膜的近端吻合,深背静脉吻合,背动脉,和背浅静脉.在第21天移除导管后患者顺利排尿。手术后3个月,患者的阴茎初步外观令人满意,偶尔早上勃起。阴茎远端感觉得以保留,然而,阴茎远端的勃起硬度并不令人满意。
    结论:完整的术前评估和及时的手术干预减少了残余阴茎功能的丧失。
    BACKGROUND: Traumatic amputation of the penis is a rare surgical emergency, usually caused by self-mutilation, accidents, circumcision, assault and animal attacks. This study aimed to summarize our treatment experience involving penile reconstruction in a rare case of a self-strangulation induced chronical penile partial amputation.
    METHODS: A 22-year-old man presented with self-strangulation induced chronical penile partial amputation for 3 mo where the penile proximal part was 1 cm far from the pubis. Reconstruction methods included end-to-end anastomosis of the urethral mucosa, proximal anastomosis of the corpus cavernosum and tunica albuginea of the penis, anastomosis of the deep dorsal vein, dorsal artery, and superficial dorsal vein. Patient urinated smoothly after the catheter was removed on day 21. 3 mo after the surgery, the patient\'s penile preliminary cosmetic appearance was satisfactory, with occasional morning erections. Distal penile sensation was preserved, yet erection hardness of the distal penis was not satisfactory.
    CONCLUSIONS: Complete preoperative assessment and prompt surgical intervention decreases loss of residual penile functions.
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  • 文章类型: Case Reports
    身体畸形障碍(BDD)是一种精神疾病,目前被归类为精神疾病诊断和统计手册中“强迫性和相关疾病”(OCRD)章节的一部分,第5版(DSM-5)和ICD-11。这不是疾病焦虑症/疑病(IAD/HC)的情况,如在DSM-5和ICD-11的“躯体症状和相关疾病”一章中分类,名称为HC,在OCRD章节中,它与BDD一起分类。在这篇文章中,我们的目的是描述一名年轻成年葡萄牙男子的BDD和IAD/HC合并症病例。然后,我们旨在根据DSM-5和ICD-11中的当前分类来回顾这些诊断,特别强调IAD/HC的不同分类,即,将其纳入OCRD的相关性。
    Body dysmorphic disorder (BDD) is a mental illness currently classified as part of the \"Obsessive-Compulsive and Related Disorders\" (OCRD) chapter in both the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) and in the ICD-11. This is not the case for illness anxiety disorder/hypochondriasis (IAD/HC), as IAD is classified in the chapter \"Somatic Symptom and Related Disorders\" in DSM-5, and in ICD-11, under the name HC, it is classified along with BDD in the OCRD chapter.In this article, we aim to describe a case of comorbid BDD and IAD/HC in a young adult Portuguese man. We then aim to review these diagnoses in light of their current classification in DSM-5 and ICD-11, with a particular emphasis in the divergent classification of IAD/HC, namely, the pertinence of its inclusion in the OCRD.
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  • 文章类型: Case Reports
    认知行为疗法是一种有效的治疗身体畸形障碍(BDD),但许多患者没有得到适当的治疗,由于几个治疗障碍和社会心理护理结构。低门槛干预措施,包括那些来自电子心理健康领域的人,可以改善获得心理治疗的机会。除了互联网管理的治疗,电话治疗可以减少治疗障碍,特别是在COVID-19大流行期间。本文介绍了在2020年夏季应用于身体畸形障碍患者的相同治疗(12周的电话认知行为疗法以及工作簿)的4例病例报告。完成治疗的三名患者在临床上减轻了身体畸形和抑郁症状,并提高了洞察力。一名患者没有完成电话治疗,因为她的症状恶化,她需要更深入的治疗.这些发现鼓励未来研究电话治疗BDD的功效和有效性及其在阶梯式护理模式中的作用。
    Cognitive behavioral therapy is an effective treatment for body dysmorphic disorder (BDD), but many patients do not receive appropriate treatment due to several treatment barriers and psychosocial care structures. Low-threshold interventions, including those from the field of e-mental health, could improve access to psychotherapy. In addition to internet-administered therapy, telephone-administered therapy may reduce treatment barriers, especially during the COVID-19 pandemic. This article presents four case reports of the same treatment (12 weeks of telephone-administered cognitive behavioral therapy accompanied by a workbook) applied to patients with body dysmorphic disorder during the summer of 2020. Three patients who completed the treatment had clinically relevant reductions in body dysmorphic and depressive symptoms and improved insight. One patient did not complete the telephone-administered therapy because her symptoms worsened, and she needed a more intensive form of treatment. These findings encourage future studies on the efficacy and effectiveness of telephone-administered treatment for BDD and its role in stepped-care models.
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  • 文章类型: Case Reports
    精神分裂症是最令人衰弱的精神疾病之一,影响全球约1%的人。其原因和管理都控制得很差。精神分裂症患者经常经历身体形象的改变。它的必然结果,如人格解体,感觉像是真正的折磨。在精神健康障碍管理的生物心理社会模型中,很少有工具能有效地管理去人格化综合征,而精神科医生往往忽视去人格化综合征,他们主要关注消除幻觉和其他阳性症状。精神运动,生物心理社会模型中一个鲜为人知的分支,仍然试图在心理和身体疗法之间找到一个位置。为期6个月,我们对喀麦隆杜阿拉Laquintinie医院精神科治疗的2例精神分裂症患者进行了前瞻性病例研究.在这些患者中,精神运动疗法的联合对人格解体的问题提供了令人满意的反应,也被称为碎片焦虑。
    Schizophrenia is one of the most debilitating psychiatric disorders affecting around 1% of people worldwide. Its causes and management are quite poorly controlled. Patients with schizophrenia often experience an alteration in their body image. Its corollaries such as depersonalization are felt like real torture. In the biopsychosocial model of the management of mental health disorders, very few tools are effective in the management of depersonalization syndrome which is often overlooked by psychiatrists who mainly focus on erasing hallucinations and other positive symptoms. Psychomotricity, a poorly known branch of the biopsychosocial model, is still trying to find a place between psychological and body therapies. For a period of 6 months, we conducted a prospective case-study on two patients living with schizophrenia and treated in the Psychiatry Department of Laquintinie Hospital in Douala in Cameroon. In those patients, the association of psychomotor therapies provided a satisfactory response to a problem of depersonalization, also known as fragmentation anxiety.
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  • 文章类型: Case Reports
    硅酮栓塞综合征(SES)是注射硅酮凝胶和液体硅酮后的众所周知的并发症。很少,男性使用生理盐溶液或液体硅胶注入阴囊的皮下组织,阴茎,上生殖器或腹股沟区。那些人,他们称自己为“硅氧烷工人”,想要更大的阴茎和阴囊,穿衣服时也可见。在上述区域注射液体硅酮可导致肺部和肝脏中的液体硅酮栓塞,有时最终通过右心衰竭导致死亡,如在本案中。尸检显示生殖器区域皮下组织中的“青蛙产卵”状空泡,肺和肝脏中的液体硅酮栓塞。此外,毒理学分析揭示了不同的液体有机硅。较小的低聚物被转运到肺和肝脏,较大的在注射部位显示出局部富集。在腹部脂肪中检测不到检获的聚二甲基硅氧烷(PDMS),血液或尿液,可能是由于脂肪组织的低灌注,血液和尿液的水性特征或最后一次注射和死亡之间的时间跨度。
    Silicone embolism syndrome (SES) is a well known complication after injection of silicone gel as well as liquid silicone. Rarely, men use physiologic salt solution or liquid silicone injected into the subcutaneous tissue of the scrotum, the penis, the upper genital or the inguinal region. Those men, who call themselves \"siliconers\", want to get a larger penis and scrotum, also visible when wearing clothes. Injections of liquid silicone in the mentioned regions can lead to liquid silicone embolism in the lungs and also the liver, sometimes eventually leading to death via right heart failure as in the present case. Autopsy revealed \"frog spawn\"-like vacuoles in the subcutaneous tissue of the genital region and liquid silicone embolism in lungs and liver. Additionally, toxicological analyses revealed different liquid silicones. Smaller oligomers were transported into lung and liver, larger ones showed local enrichment at the injection site. The seized Polydimethylsiloxane (PDMS) could not be detected in abdominal fat, blood or urine, potentially due to low perfusion of fat tissue, the aqueous character of blood and urine or the time span between last injection and death.
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  • 文章类型: Case Reports
    We report the case of an adolescent with hypohidrotic ectodermal dysplasia, who had obsessive-compulsive disorder and was later diagnosed with body dysmorphic disorder (BDD). BDD is a highly distressing, adolescent-onset disorder that may lead to social isolation, the development of comorbid mental health disorders and suicidality. Patients typically lack insight into their BDD and frequently present to dermatologists for medical treatment. In this paper, we address the challenges faced when working with patients with BDD.
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  • 文章类型: Case Reports
    我们的病例报告是在患有双相情感障碍(BPD)的青少年中使用电惊厥治疗(ECT),物质使用障碍(SUD)和合并症身体畸形障碍(BDD)。在我们的案例中,在第一阶段没有考虑ECT,但是我们遇到了药物治疗不合规和治疗抵抗。ECT后身体畸形症状完全消失,这与文献一致。ECT是在治疗抗性病例中具有低副作用的治疗。此外,这将有助于增加临床医生对ECT的知识和经验,并为儿童和青少年精神病诊所的ECT提供条件。
    Our case report is on the use of electroconvulsive treatment (ECT) in an adolescent with Bipolar Disorder (BPD), Substance Use Disorder (SUD) and comorbid Body Dysmorphic Disorder (BDD). In our case, ECT was not considered at the first stage, but we encountered medication noncompliance and treatment resistance. Symptoms of body dysmorphic disorder completely disappeared after ECT, which is consistent with the literature. ECT is a treatment with a low side effect profile in treatment-resistant cases. In addition, it will be useful to increase the knowledge and experience of clinicians on ECT and to provide conditions for ECT in child and adolescent psychiatric clinics.
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  • 文章类型: Case Reports
    BACKGROUND: This case report aims to present a 37-year-old women striving to shape her body like a Barbie doll of which she has been fascinated since childhood. She could hardly tolerate any deviation from this beauty ideal. She has been admitted to the psychosomatic ward due to an eating disorder.
    METHODS: The ICD-10 and DSM-5 criteria were established for axis I disorders and the German version of the SCID II interview (for DSM-4) was applied for axis II disorders. Additionally, the \"modified Yale-Brown Obsessive Compulsive Scale for body dysmorphic disorder\" was carried out.
    RESULTS: The diagnosis of dysmorphophobia (ICD-10: F45.21) or body dysmorphic disorder (DSM-5: 300.7) and bulimia nervosa (ICD-10: F50.2; DSM-5: 307.51) was confirmed. The patient fulfilled criteria of an avoidant, depressive and histrionic personality disorder. Psychopharmacological treatment with Fluoxetine was started and the patient participated in an intensive inpatient psychosomatic program. The body image, self-concept and the sense of shame were therapeutic key topics.
    CONCLUSIONS: The present case report focuses on body dysmorphic disorder as a distinctive entity with high prevalence. Diagnostic criteria of different classification systems were contrasted and comorbidity with eating disorders was discussed. In clinical praxis, body dysmorphic disorder remains underdiagnosed, especially when cooccurring with an eating disorder. However, the correct diagnosis could be relevant for therapy planning.
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