Journal article review
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JOURNAL ARTICLE REVIEW INSTRUCTIONS
You are to review a psychology journal article. The article to review is on D2L. The review should not be longer or shorter than 3 double-spaced typed pages (5 Pages for graduate students). Use 1 inch margins, left right, top, and bottom. You are to use Courier or Times New Roman 12 pt font. You are to use sentences and paragraphs, outlines and bullet points are unacceptable. Journal article reviews are due on the last day of class, April 28th. Please deposit your review in the appropriate dropbox on D2L. The following points should be addressed in your review.
What was the study’s hypothesis? That is, what was the purpose of the study?
Participant information: number, gender, reason they were selected.
Materials used: includes machinery, questionnaires, etc.
Procedure: what exactly did the researchers do and have the participants do?
Results: what did the researchers find?
Discussion: according to the researchers, what is the significance of the findings?
Opinion: what is your opinion of the value of the study and the significance of the findings?
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Journal of Clinical Child & Adolescent Psychology
ISSN: 1537-4416 (Print) 1537-4424 (Online) Journal homepage: https://www.tandfonline.com/loi/hcap20
Sex Differences in the Presentation of Body
Dysmorphic Disorder in a Community Sample of
Adolescents
Sophie C. Schneider, Jonathan Mond, Cynthia M. Turner & Jennifer L. Hudson
To cite this article: Sophie C. Schneider, Jonathan Mond, Cynthia M. Turner & Jennifer L.
Hudson (2019) Sex Differences in the Presentation of Body Dysmorphic Disorder in a Community
Sample of Adolescents, Journal of Clinical Child & Adolescent Psychology, 48:3, 516-528, DOI:
10.1080/15374416.2017.1321001
To link to this article: https://doi.org/10.1080/15374416.2017.1321001
Published online: 25 May 2017.
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OBSESSIVE-COMPULSIVE AND RELATED DISORDERS
Sex Differences in the Presentation of Body
Dysmorphic Disorder in a Community Sample of
Adolescents
Sophie C. Schneider
Department of Psychology, Macquarie University
Jonathan Mond
School of Medicine, Western Sydney University and School of Health Sciences, University of
Tasmania
Cynthia M. Turner
School of Psychology, Australian Catholic University
Jennifer L. Hudson
Department of Psychology, Macquarie University
The current study sought to explore sex differences in the presentation of probable full-syndrome
and subthreshold body dysmorphic disorder (BDD) in adolescents from an Australian community
sample. Specifically, it examined sex differences in the types of BDD symptoms endorsed, body
areas of concern, and the association with elevated symptoms of comorbid disorders. In male
participants, it also compared the presenting features of those with and without muscle dysmorphia.
Of 3,149 adolescents assessed using self-report questionnaires, 162 (5.1%) reported probable BDD
(57.4% male, Mage = 14.89 years, SD = 1.33, primarily from Oceanian or European cultural
backgrounds). All participants completed measures of BDD symptoms; past mental health service
use; and symptoms of anxiety, depression, obsessive-compulsive disorder, and eating disorders.
Male participants completed additional measures of quality of life, drive for muscularity, hyper-
activity, conduct disorder, peer problems, and emotional symptoms. Controlling for demographic
variables that varied by sex, male and female participants reported similar BDD symptom severity,
rates of most elevated comorbid symptoms, and mental health service use. Concerns regarding
muscularity, breasts/nipples, and thighs differed by sex. Female participants were more likely than
male participants to report elevated generalized anxiety symptoms. In male participants, muscle
dysmorphia was not associated with greater severity across most measures. The presenting features
of BDD were broadly similar in male and female participants, and in male participants with and
without muscle dysmorphia. Future research should seek to increase mental health service use in
adolescents with BDD and to improve rates of disorder detection in clinical settings.
Body dysmorphic disorder (BDD) involves preoccupation
with perceived defects in appearance that appear minimal,
or nonexistent, to others (American Psychiatric Association,
2013). BDD typically begins in adolescence; the mean age
Correspondence should be addressed to Jennifer L. Hudson, Centre for
Emotional Health, Department of Psychology, Macquarie University,
Sydney, Australia 2109 E-mail: jennie.hudson@mq.edu.au
Journal of Clinical Child & Adolescent Psychology, 48(3), 516–528, 2019
Copyright © Society of Clinical Child & Adolescent Psychology
ISSN: 1537-4416 print/1537-4424 online
DOI: https://doi.org/10.1080/15374416.2017.1321001
http://orcid.org/0000-0002-1469-7764
http://orcid.org/0000-0002-0410-091X
http://orcid.org/0000-0001-5778-2670
https://crossmark.crossref.org/dialog/?doi=10.1080/15374416.2017.1321001&domain=pdf&date_stamp=2019-05-07
of disorder onset is 16 years, with mean subclinical symp-
tom onset at 13 years (Bjornsson et al., 2013; Marques
et al., 2011b). BDD onset prior to age 18 is reported by
66.8% of adults and is associated with increased suicidality
and comorbidity compared to those with adult onset
(Bjornsson et al., 2013). As BDD is a potentially severe
disorder that typically follows a chronic course without
appropriate mental health treatment (Phillips, Menard,
Quinn, Didie, & Stout, 2013), these difficulties are likely
to persist into adulthood. These factors highlight the need
for early detection and treatment of adolescent BDD (Fang
& Wilhelm, 2015).
A serious barrier to the early detection of BDD is under
diagnosis in routine clinical settings (Phillips & Feusner,
2010). Across four studies of adolescents and adults in psy-
chiatric settings, standard clinical interviews detected just two
of 71 (2.8%) cases of BDD subsequently identified using
BDD-focused measures (Conroy et al., 2008; Dyl, Kittler,
Phillips, & Hunt, 2006; Grant, Kim, & Crow, 2001; Veale,
Akyüz, & Hodsoll, 2015). Individuals with BDD are unlikely
to spontaneously disclose their BDD symptoms, which may
be related to feelings of embarrassment or shame, or poor
insight into their concerns (Buhlmann, 2011; Didie, Kelly, &
Phillips, 2010; Marques, Weingarden, LeBlanc, & Wilhelm,
2011). This places a responsibility on the assessing clinician
to probe for BDD and to be familiar with the symptomatol-
ogy of BDD (Phillips & Feusner, 2010).
As there may be developmental differences in the fea-
tures or impact of BDD (Phillips et al., 2006), it is important
that clinicians are aware of the presentation of BDD in
adolescents. Accordingly, several studies have provided
information about the presenting features of adolescent
BDD in clinical samples (Albertini & Phillips, 1999; Dyl
et al., 2006; Greenberg, Mothi, & Wilhelm, 2016; Mataix-
Cols et al., 2015; Phillips et al., 2006). However, it is
unclear how representative these findings are of adolescents
with BDD in the general community, as treatment seeking
for BDD may be associated with greater symptom severity,
increased comorbidity, or suicidality (Albertini & Phillips,
1999). Further, these clinical studies have involved just 126
adolescents with BDD, of whom only 24 (19.0%) were
male. As the community prevalence of adolescent BDD
appears to be similar across sex (Schneider, Turner, Mond,
& Hudson, 2016b), it is unclear whether the underrepresen-
tation of male adolescents in clinical samples may be due to
lower treatment seeking, or gender-specific barriers in
obtaining a diagnosis of BDD. Either way, existing research
on the presentation of adolescent BDD is highly limited,
and it is unclear how well female-dominated clinical sam-
ples represent adolescents in the general community, and
male BDD presentations in particular.
Sex differences in adolescent BDD should be explored,
as some features of BDD differ between male and female
individuals in adult clinical samples. Although overall BDD
severity was similar between male and female participants
(Phillips & Diaz, 1997; Phillips, Menard, & Fay, 2006),
male participants were more likely to be single and living
alone than female participants, suggesting greater interfer-
ence in romantic relationships (Phillips et al., 2006). Some
BDD symptoms appeared to differ; male individuals were
more likely to lift weights than female individuals, whereas
female individuals were more likely to try to camouflage
their appearance, pick their skin, and check the mirror
excessively (Perugi et al., 1997; Phillips & Diaz, 1997;
Phillips et al., 2006). Male individuals reported higher
rates of lifetime substance use disorders than female indivi-
duals, whereas female individuals reported higher rates of
bulimia and generalized anxiety disorder than male indivi-
duals (Perugi et al., 1997; Phillips & Diaz, 1997; Phillips
et al., 2006). Some of the body areas of concern also
differed by sex; male individuals were more likely to be
concerned about their genitals, body build, and thinning
hair, whereas female individuals were more likely to be
concerned about weight, breasts/chest, hips, buttocks,
thighs, legs, and other types of hair concerns (Perugi
et al., 1997; Phillips & Diaz, 1997; Phillips et al., 2006).
In addition to a lack of research on sex differences in
adolescent BDD, there has been little research concerning
muscle dysmorphia, a subtype of BDD that affects male
individuals almost exclusively where the individual is con-
cerned about being insufficiently muscular or having a small
body build (American Psychiatric Association, 2013). In
male adults with BDD, those with muscle dysmorphia
report poorer quality of life, greater suicidality, and higher
prevalence of substance use disorder than those without
muscle dysmorphia (Pope et al., 2005). Currently, it is
unknown whether muscle dysmorphia is associated with a
more severe BDD presentation in male adolescents. There is
also substantial debate regarding the classification of muscle
dysmorphia. Some researchers have suggested that it is a
form of BDD reflecting Western masculine body image
ideals (Kanayama & Pope, 2011), whereas others argue
that it is better understood as an eating disorder (Murray,
Griffiths, & Mond, 2016). A recent review reported that
there is insufficient evidence to support any proposed clas-
sification (Dos Santos Filho, Tirico, Stefano, Touyz, &
Claudino, 2015). Therefore, not only is it important to
determine whether muscle dysmorphia is associated with
greater BDD severity for clinical reasons, but research com-
paring the BDD presentation of male individuals with and
without muscle dysmorphia may help to inform the current
classification debate.
BDD is underdiagnosed in clinical settings, and there is
limited information available to clinicians regarding the
presentation of adolescent BDD. Further, it is unclear
whether and to what extent findings from female-dominated
SEX DIFFERENCES IN ADOLESCENT BDD 517
clinical samples represent male and female adolescents with
BDD in the general community. The aims of this study
therefore were (a) to explore potential sex differences in
the presenting features of BDD in adolescents from a com-
munity sample, and (b) to compare the presentation of BDD
in male individuals with and without muscle dysmorphia.
Consistent with Dyl et al. (2006), we chose to include
participants who screened positive both for probable full-
syndrome BDD (pBDD) and subthreshold BDD (sBDD).
Using the same sample, we have previously identified that
pBDD and sBDD are associated with higher symptoms of
depression, anxiety, and eating disorders and with higher
rates of mental health service use than those without BDD
(Schneider, et al., 2017; Schneider et al., 2016b). The pBDD
and sBDD groups were therefore combined in the current
study to identify participants with a broad range of BDD
symptom severity and to increase statistical power for key
analyses.
Based on the limited available evidence, it was hypothe-
sized that male participants would report higher levels of
interference with romantic relationships than female partici-
pants and that female participants would report higher
appearance checking than male participants. It was further
hypothesized that female participants would be more likely
than male participants to report elevated symptoms of eating
disorders and generalized anxiety disorder. Certain body
areas of concern were expected to vary by sex, with male
participants predicted to report elevated concerns about
muscularity, genitals, body build, and thinning hair and
female participants to report elevated concerns about
weight, breasts, hips, buttocks, thighs, legs, and other hair
concerns. Female participants were expected to report
higher levels of past mental health service use than male
participants. Finally, male participants with symptoms of
muscle dysmorphia were hypothesized to have poorer qual-
ity of life, a greater number of body areas of concern,
greater muscularity-related body image disturbance, and
more muscularity-driven behaviors than male participants
without muscle dysmorphia.
Participants
Details of the study design and recruitment methods have
been reported previously (Schneider et al., 2016b). Briefly,
participants were recruited from seven high schools in the
Greater Sydney area of New South Wales, Australia, that
were taking part in two existing studies of emotional health
in youth. Female adolescents were recruited from two inde-
pendent and one government girls’ school participating in a
study of the development and prevention of anxiety and
depression. This study involved annual questionnaire
assessments over a 4-year period and delivery of a
schoolwide preventative intervention for anxiety and
depression. Male adolescents were recruited from four
Catholic boys’ schools participating in a study of the utiliza-
tion of an online treatment program for anxiety. This study
involved up to 2 years of assessments, and students were
given access to an online program to treat anxiety and
depression. Data used in the current study came from the
first assessment for each student. Of 5,005 students enrolled
in eligible school grades at the time of testing, 3,149
(62.9%) consented to involvement in the larger study and
provided sufficient information for BDD group categoriza-
tion using the Body Dysmorphic Disorder Questionnaire–
Adolescent Version (BDDQ-A; Phillips, 2005). Of the 2,000
male participants, 35 (1.8%) reported pBDD and 58 (2.9%)
reported sBDD. Of the 1,149 female participants, 20 (1.7%)
reported pBDD and 49 (4.3%) reported sBDD. Participants
with pBDD and sBDD were combined, resulting in a final
sample of 162 adolescents with pBDD or sBDD (57.4%
male, Mage = 14.86, SD = 1.33, range = 12–18 years),
hereafter referred to as having BDD.
Procedure
All assessments were conducted during school hours and
were supervised by members of the research team. Students
completed questionnaires using deidentified codes, and par-
ticipants were informed that their responses were confiden-
tial unless their responses indicated serious risk of harm.
The research was approved by the Human Research Ethics
Committee of Macquarie University, references
5201300531 and 5201100886, and by the governing bodies
of each school.
All participants consented to involvement in the relevant
larger study of emotional health, of which the current study
was a part. Parents were provided with written information
about the overall study and were asked to discuss participa-
tion with their child. Students were also informed directly
about the study, typically in school assemblies or class
groups. At boys’ schools, opt-out parent consent was used,
and if parents did not opt out, students provided active
consent. At girls’ schools, opt-in parent consent was used,
and all students had the opportunity to opt out of testing
verbally. No incentives to participate were provided by the
researchers; however, some schools provided incentives to
students for the return of consent forms, regardless of the
consent status.
Measures
Male and Female Participants
The BDDQ-A (Phillips, 2005) assesses BDD criteria
according to the Fourth Edition of the the Diagnostic and
Statistical Manual of Mental Disorders (DSM-IV; American
Psychiatric Association, 1994). To screen positive for BDD,
518 SCHNEIDER ET AL.
a participant must endorse excessive concern about appear-
ance, associated distress or impairment, and report that their
concerns are not primarily due to their weight or a fear of
not being thin enough. Open text items also assess the body
areas of concern, and the nature of any interference. Time
spent thinking about appearance per day is also assessed;
thinking about appearance for at least one hour per day
indicates pBDD (Phillips, 2005), and less than one hour
was used to indicate sBDD (Schneider et al., 2017).
The Body Image Questionnaire–Child and Adolescent
Version (BIQ-C; Veale, 2009) assesses BDD symptom
severity. The questionnaire begins with a screening item to
determine if the participant has any appearance concerns. If
participants do not report any concerns, they are given a
total score of 0 and do not answer further items. Those with
appearance concerns rank up to five body areas from most
to least concerning, then answer 12 questions assessing
appearance checking, distress, avoidance, and impairment.
These items have tailored responses on a 0–8 scale, and
after reverse-scoring three items, higher scores indicate
greater symptom severity.
Although the original BIQ-C has 12 symptoms items, a
recent study conducted in our larger adolescent sample
supported using an alternate nine-item, two-factor version
of the measure (the BIQ-C-9; Schneider et al., 2016a). This
version had good internal consistency for male/female indi-
viduals (total scale Cronbach’s α = .84/.89, interference and
avoidance factor α = .71/.78, and other symptoms factor
α = .76/.84). Among BDD participants in the current study,
total scale internal consistency for male/female individuals
was α = .79/.76. However, internal consistency in the two
factors were relatively low (interference and avoidance
α = .69/.65, other symptoms α = .65/.57). For this reason,
only the BIQ-C-9 total score was utilized in the current
study.
The body areas of concern reported in the BDDQ-A and
BIQ-C-9 were coded based on body areas reported by
Phillips (2005). If the participant reported being concerned
about small body build, overall muscularity, or the muscu-
larity of a specific body area (e.g., arm muscles), the
response was coded as “muscle dysmorphia.” If they had
other or unspecified body build concerns, this was coded
as “body build.” If the concern was about overall excess
weight or weight-related concerns about a specific area
(e.g., fat legs), the response was coded as “weight.” If
the participant did not specify what was disliked about
the body area or it was not clearly related to weight or
muscularity, it was coded as the specific body area (e.g.,
nose).
The child version of the 26-item Eating Attitudes Test
(Maloney, McGuire, & Daniels, 1988) was used to measure
disordered eating attitudes and behaviors. The least proble-
matic responses (never, rarely, sometimes) are scored 0, and
the remaining responses scored as 1 (often), 2 (very often),
or 3 (always). Good internal consistency has been found in
adolescent populations (α = .86–.87; Rojo-Moreno et al.,
2011; Smolak & Levine, 1994), and a total score of 20 or
higher indicates a high probability of clinically significant
eating disorder pathology (Maloney et al., 1988). In the
current study, total scale Cronbach’s alpha values for male/
female participants were α = .78/.85.
The Spence Children’s Anxiety Scale (Spence, 1998) con-
tains 38 items assessing social anxiety, separation anxiety,
generalized anxiety, panic-agoraphobia, obsessive-compulsive
disorder, and specific phobias (limited to physical injury-
related fears). Items are scored 0 (never) to 3 (always).
The scale has good psychometric properties, with support
found for the six-factor model, acceptable internal consis-
tency (total scale α = .92, subscale α = .60–.80), conver-
gent and divergent validity, and test–retest reliability
(Spence, Barrett, & Turner, 2003). Age and sex-specific
cutoff scores have been developed from Australian com-
munity norms; a T score of 60 indicates those in the top
15.9% of scores and is used to indicate elevated anxiety
(Spence, n.d.). In the current study, Cronbach’s alpha
values for the total scale for male/female participants
were α = .92/.89, social anxiety α = .76/.60, separation
anxiety α = .77/.46, generalized anxiety α = .78/.79, panic-
agoraphobia α = .83/.85, obsessive-compulsive disorder
α = .78/.74, and specific phobias α = .57/.51.
The Short Mood and Feelings Questionnaire (Angold,
Costello, Messer, & Pickles, 1995) assesses depression symp-
toms over the past 2 weeks. The 13 items are scored from 0 (not
true) to 2 (true). The Short Mood and Feelings Questionnaire
correlates well with diagnostic measures of depression and dis-
criminates between depressed and nondepressed individuals,
with a total score greater than 7 suggesting elevated depressive
symptoms (Angold et al., 1995). It has strong internal consis-
tency (α = .84–90; Angold, Erkanli, Silberg, Eaves, & Costello,
2002; Rhew et al., 2010). In this study, internal consistency for
male/female participants was α = .90/.86.
Participants were asked to complete a small number of
questions assessing demographics and whether they had
ever received assessment or treatment for any mental
health concerns. If so, they were asked to specify what
types of professionals were seen and to briefly describe the
reasons for seeking treatment. A school-level variable, the
index of socioeducational advantage (ICSEA; Australian
Curriculum and Assessment Reporting Authority, 2013),
was used to estimate the socioeducational advantage of
each school.
Male Participants Only
The Drive for Muscularity Scale (McCreary & Sasse, 2000)
is a 15-item measure of muscularity-oriented behaviors and
body image concerns. Items are scored from 1 (never) to 6
(always), and subscales are calculated as the mean of the
items. As suggested by the authors of the measure, the item
assessing anabolic steroid use was omitted, as it was unlikely to
SEX DIFFERENCES IN ADOLESCENT BDD 519
be relevant to this sample (McCreary, 2007). Good internal
consistency has been reported in previous population-based
studies of male adolescents and young adults (α = .85–.87;
Brunet, Sabiston, Dorsch, & McCreary, 2010; McCreary,
Sasse, Saucier, & Dorsch, 2004). For male participants in the
current study, Cronbach’s alpha for the total scale was .90,
muscularity-driven body image α = .91, and muscularity-driven
behaviors α = 91.
Quality of life was assessed using the Pediatric Quality
of Life Enjoyment and Satisfaction Questionnaire (Endicott,
Nee, Yang, & Wohlberg, 2006). Life satisfaction is assessed
using 14 items covering a range of physical, emotional, and
social domains. A final item assessing total life satisfaction
is not included in the total score. Items are scored from 1
(very poor) to 5 (very good), and the total score (range =
14–70) is converted to the percentage of the maximum
possible score (range = 0–100%). The measure has good
internal consistency (α = .87–.89) and test–retest reliability
and provides unique information over and above measures
of illness severity (Endicott et al., 2006; Merry et al., 2012).
For male participants in this study, Cronbach’s α = .91.
The Strengths and Difficulties Questionnaire (Goodman,
1997) assesses emotional symptoms, conduct problems, hyper-
activity, and peer problems using 20 items scored from 0 (not
true) to 2 (certainly true), summed to form a total difficulties
score. Age and sex-specific cutoff scores have been developed
from Australian community norms that identify the top 10% of
responses (Mellor, 2005). In the current study, male internal
consistency for the total score α = .80, emotional symptoms
α = .64, conduct problems α = .68, hyperactivity α = .72, and
peer problems α = .67.
Data Analysis
Sex differences in the dependent variables were analyzed
using chi-square tests with odds ratios (ORs) or Cramer’s
V effect sizes for categorical variables, or independent
samples t tests with Cohen’s d effect sizes for continuous
variables. If a significant bivariate sex difference was
found in a dependent variable, follow-up analyses were
conducted to control for the effect of demographic vari-
ables that varied by sex. These analyses were either
logistic regressions with OR effect size for categorical
variables, or analysis of covariance with partial eta-
squared effect size for continuous variables. The Holm-
Bonferroni sequential correction was applied to control
the familywise error rate (α = .05) across each set of
analyses.
Demographic Characteristics
Table 1 presents comparisons of demographic variables
by sex. There were no significant sex differences in the
percentage of participants classified as pBDD compared
to sBDD, parent occupation, family setting, or the per-
centage of participants who spoke English as the main
language at home. However, male participants were sig-
nificantly older than female participants, and the socio-
educational advantage of their schools was lower.
Cultural background coding was condensed due to low
numbers in some categories. Asian, African, American,
and Middle Eastern backgrounds were coded as “other”
and compared to Oceanian backgrounds (e.g., Australian,
New Zealander, Melanesian, or Polynesian) or European
backgrounds. There was a significant association between
sex and parental cultural background, namely, male parti-
cipants were more likely to report that their mothers and
fathers had a European background, whereas female par-
ticipants were more likely to report “other” backgrounds,
most commonly, Asian backgrounds.
Body Dysmorphic Symptom Comparisons
Endorsement of BDDQ-A distress and interference criteria
were compared between male and female participants.
Endorsement of distress related to BDD did not vary sig-
nificantly between male (65/93 = 69.9%) and female (48/
69 = 69.6%) participants (χ2 = 0.00, p = .964, OR = 1.02),
95% confidence interval (CI) [0.52, 2.00]. Endorsement of
BDD-related avoidance also did not vary significantly
between male (57/93 = 61.3%) and female (39/
69 = 56.5%) participants (χ2 = 0.37, p = .541, OR = 1.22),
95% CI [0.65, 2.29]. Interference with socializing or dating
due to BDD was endorsed more frequently by male partici-
pants (53/93 = 57.0%) than female (23/69 = 33.3%;
χ2 = 8.90, p = .003, OR = 2.65), 95% CI [1.39, 5.06];
however, this bivariate relationship was not significant in a
secondary logistic regression controlling for age, socioedu-
cational advantage, and parent cultural background (main
effect of sex, p = .210, OR = 2.14), 95% CI [0.65, 7.03].
Interference with school or work due to BDD was reported
somewhat more frequently by male participants (22/
93 = 23.7%) than female (7/69 = 10.1%), but this relation-
ship was not significant after correction for multiple com-
parisons (χ2 = 0.37, p = .044, OR = 1.22), 95% CI [0.65,
2.29].
Descriptive statistics for the BIQ-C-9 item and total
scores are presented in Table 2. After correction for multiple
comparisons, there were no significant sex differences in
BIQ-C-9 items or the total score.
Body Areas of Concern
Female participants reported a larger number of different
body areas of concern (M = 5.7, SD = 2.9) than male
participants (M = 4.2, SD = 1.9), t(109.24) = 3.62,
p < .001, d = 0.59, 95% CI [0.29, 0.93]; however, this
difference was no longer significant in an analysis of
520 SCHNEIDER ET AL.
TABLE 1
Demographic Comparisons Between Male (n = 93) and Female (n = 69) Participants
Male Female Group Comparison
Categorical Variables n Valid % n Valid % χ2 p V
% pBDD 35 37.6 20 29.0 1.32 .205 .09
Speak English at home 77 92.8 33 84.6 1.99 .158 .13
Mother Cultural background 11.39 .003 .28
Oceanian 23 28.0 15 24.2
European 46 56.1 22 35.5 +
Othera 13 15.9 25 40.3 +
Father Cultural Background 13.57 .001 .31
Oceanian 22 29.3 22 33.8
European 47 62.7 24 36.9 +
Otherb 6 8.0 19 29.2 +
Mother Occupation 5.59 .235 .22
Not in the workforce 12 15.8 8 20.5
Manager/skilled professional 47 61.8 19 48.7
Trade/manual 0 0.0 2 5.1
Sales/clerical 9 11.8 4 10.3
Community/health 8 10.5 6 15.4
Father Occupation 4.38 .357 .20
Not in the workforce 4 5.5 3 7.9
Manager/skilled professional 42 57.5 23 60.5
Trade/manual 15 20.5 3 7.9
Sales/clerical 7 9.6 7 18.4
Community/health 5 6.8 2 5.3
Household Type 2.83 .243 .15
Two parent household 58 69.9 32 82.1
Single parent household 9 10.8 4 10.3
Step/Blended/Other household 16 19.3 3 7.7
Continuous Variables M SD M SD t p d
Age 15.1 1.3 14.5 1.3 2.97 .003 0.47
ICSEA 1046.3 40.0 1162.1 48.5 16.15 <.001 2.64
Note. Bold text indicates a significant sex difference after Holm-Bonferroni adjustment for multiple comparisons. + Adjusted residual > |
1.96|. BDD = Body dysmorphic disorder. ICSEA = Index of Community Socio-educational advantage. CI = Confidence interval. d =
Cohen’s d. V = Cramer’s V.
aOther mother cultural background for males/females: North African and Middle Eastern (3.7/0.0%), Asian (7.3/30.6%), People of the
Americas (2.4/8.1%), Sub-Saharan African (2.4/1.6%).
bOther father cultural background for males/females: North African and Middle Eastern (2.7/3.1%), Asian (4.0/23.1%), People of the
Americas (1.3/1.5%), Sub-Saharan African (0.0/1.5%).
TABLE 2
BIQ-C-9 Item and Total Score Comparisons Between Male (n = 93) and Female (n = 69) Participants
Male Female t-Test Analyses
Item (Original Scale Numbering) M SD M SD t p d [95% CI]
3. Frequency of Checking Appearance 3.8 2.1 3.8 2.2 0.06 .950 0.01 [−0.32, 0.34]
4. Feeling That Feature Is Ugly/Not Right 4.3 1.8 4.2 1.9 0.29 .772 0.05 [−0.28, 0.38]
5. Amount of Distress 3.7 1.7 4.0 1.9 −0.86 .393 −0.14 [−0.47, 0.19]
6. Related Avoidance of Places or Activities 2.7 2.0 2.5 2.1 0.53 .601 0.09 [−0.24, 0.42]
7. How Much Feature Is on the Mind 4.8 1.7 4.5 1.7 1.26 .208 0.21 [−0.12, 0.54]
8. Effect on Romantic Relationships 3.9 2.3 3.7 2.6 0.35 .729 0.06 [−0.27, 0.39]
10. Interference With School Work 1.3 1.6 0.9 1.3 1.38 .170 0.23 [−0.10, 0.56]
11. Interference With Social Life 3.3 2.1 2.6 2.1 1.99 .049 0.34 [0.00, 0.67]
12. Appearance as Most Important Characteristic 4.2 1.9 3.9 1.8 1.65 .101 0.19 [−0.15, 0.52]
Nine-Item Total Score 30.6 12.4 28.1 12.3 1.20 .232 0.20 [−0.13, 0.52]
Note: There were no significant analyses after Holm-Bonferroni correction for multiple comparisons. BIQ-C-9 = Body Image Questionnaire–Child and
Adolescent Version, nine items; d = Cohen’s d; CI = confidence interval.
SEX DIFFERENCES IN ADOLESCENT BDD 521
covariance controlling for age, ICSEA, and parent cultural
background (main effect of sex, p = .094, η2p= .022). Prior
studies have found that male and female individuals differ in
the nature of their concerns about hair, for example, thin-
ning hair, excess hair, or hair style. In the current study,
however, there was insufficient data to confidently code all
responses according to the type of hair concern. Hence, a
single hair concern variable was used. Table 3 shows sex
differences in the body areas of concern that were endorsed
by at least 10% of male or female participants. Significant
bivariate sex differences were observed for seven of 20
body areas analyzed. Sex differences in concerns about
muscularity, breasts/nipples, and thighs remained significant
in logistic regressions controlling for age, ICSEA, and par-
ent cultural background, whereas differences in concern
about chest, stomach, eyes, and teeth were no longer
significant.
Comorbid Symptom Severity
The percentage of participants with elevated levels of anxi-
ety, depression and eating disorders, by sex, is shown in
Table 4. The only significant sex difference was that female
participants were more likely to report elevated generalized
anxiety symptoms than male participants.
Past Mental Health Service use
Information about past mental health service use was provided
by 131 participants (80.9%). Past mental health service use
was more common in male (33/93 = 35.5%) than in female (5/
38 = 13.2%) participants (χ2 = 6.53, p = .011, OR = 3.63), 95%
CI [1.29, 10.19]. However, this effect was no longer significant
in the follow-up logistic regression analysis (main effect of
sex, p = .595, OR = 1.51), 95% CI [0.33, 6.87].
Of the 33 male and five female participants who had
accessed mental health services, the most common profes-
sionals consulted were school counsellors (male n = 20, female
n = 3), psychologists (male n = 15, female n = 1), and
psychiatrists (male n = 4, female n = 1). Information about
the reasons for service use was disclosed by 26 male and five
female participants, the most common of these being depres-
sion/sadness (male n = 10, female n = 1), anxiety (male n = 6,
female n = 2), and family problems (male n = 5, female n = 1).
No participant reported BDD or appearance concerns as a
reason for seeking mental health services.
Comparison of Male Participants With and Without
Muscle Dysmorphia
Of the 93 male participants with pBDD or sBDD, 41
(44.1%) reported at least one body area of concern related
TABLE 3
Body Areas of Concern Comparisons Between Male (n = 93) and Female (n = 69) Participants
Male Female Chi-Square Bivariate Analysis Logistic Regressiona
Area n % n % χ2 p OR [95% CI] p OR [95% CI]
Skin 57 61.3 48 69.6 1.19 .275 1.44 [0.75, 2.80] — —
Hair 33 35.5 25 36.2 0.01 .922 1.03 [0.54, 1.98] — —
Nose 24 25.8 26 37.7 2.62 .106 1.74 [0.89, 3.41] — —
Muscularity 41 44.1 3 4.3 31.62 < .001 17.35 [5.08, 59.19] < .001 24.28 [4.26, 138.31]
Stomach 10 10.8 28 40.6 19.63 < .001 5.67 [2.51, 12.78] .77 3.71 [0.87, 15.83]
Breasts/Nipples 1 1.1 31 44.9 48.06 < .001 75.05 [9.89, 569.67] < .001 121.44 [9.65, 1528.59]
Legs 18 19.4 13 18.8 0.01 .934 1.03 [0.47, 2.28] — —
Face—Other 14 15.1 13 18.8 0.41 .522 1.31 [0.57, 3.00] — —
Height 14 15.1 13 18.8 0.41 .522 1.31 [0.57, 3.00] — —
Weight 12 12.9 15 21.7 2.23 .136 1.88 [0.82, 4.32] — —
Thighs 1 1.1 22 31.9 30.86 < .001 43.06 [5.63, 329.40] .005 31.68 [2.84, 353.54]
Lips/Mouth 8 8.6 13 18.8 3.68 .055 2.47 [0.96, 6.33] — —
Chest 19 20.4 1 1.4 13.19 < .001 17.46 [2.28, 133.96] .018 28.48 [1.80, 451.77]
Arms 13 14.0 6 8.7 1.07 .301 1.71 [0.61, 4.74] — —
Eyes 4 4.3 12 17.4 7.63 .006 4.68 [1.44, 15.24] .567 1.99 [0.19, 20.72]
Body Build 11 11.8 4 5.8 1.72 .190 2.17 [0.66, 7.16] — —
Teeth 4 4.3 10 14.5 5.21 .022 3.77 [1.13, 12.59] — —
Hips 0 0.0 11 15.9 15.91 < .001
Hands 3 3.2 7 10.1 3.27 .070 3.39 [0.84, 13.61] — —
Eyebrows 2 2.2 8 11.6 6.10 .014 5.967 [1.23, 29.06] — —
Note: Bold text indicates a significant sex difference after Holm-Bonferroni adjustment for multiple comparisons. Cells with dashes indicate that the value
was not calculated as the bivariate relationship was not significant. The empty cells for hips indicate that the value could not be estimated, as the value of the
outcome variable was 0 for all cases in a group for one or more predictor variables. OR = odds ratio, presented relative to the category with the lowest
frequency; CI = confidence interval.
aLogistic regressions controlling for participant age, school socioeducational advantage, and parent cultural background.
522 SCHNEIDER ET AL.
to muscularity or small body build. Supporting the concep-
tualization of muscle dysmorphia as a primarily male pre-
sentation, such concerns were reported by just 4.3% of
female participants. Table 5 compares male participants
with and without muscularity concerns on a range of study
variables. As predicted, male participants with muscularity
concerns reported significantly higher muscularity-related
body image scores on the Drive for Muscularity Scale,
and a greater number of different body areas of concern,
than those who did not report these concerns. However,
there was no difference in quality of life or muscularity-
related behaviors. There were no significant differences
between groups with respect to BDD symptom severity,
endorsement of BDD criteria, or rates of elevated comorbid
symptoms, or with respect to past mental health service use;
with muscle dysmorphia (13/41 = 31.7%) without muscle
dysmorphia (20/52 = 38.5%), χ2(1, N = 93) = 0.46, p = .499,
OR = 1.35, 95% CI [0.57, 3.19]. There were no differences
between groups on any of the demographic variables
assessed (details available from the corresponding author),
so supplementary analyses were not required.
Although information about the presentation of adolescent
BDD is vital for the early detection of the disorder, few
studies have examined the presentation of BDD symptoms
in adolescents, and there is little known about potential sex
differences. The current study found that in adolescents with
pBDD or sBDD recruited from the general community,
there were few sex differences in the presenting features
of BDD. Male and female participants were similar in the
types of BDD symptoms endorsed; the association with
elevated depression, anxiety, and eating disorder symptoms;
many body areas of concern; and rates of past mental health
service use. However, there were sex differences in some
body areas of concern, and female participants were more
likely than male participants to report elevated symptoms of
generalized anxiety disorder. Despite findings that muscle
dysmorphia is associated with greater severity in adult male
participants (Pope et al., 2005), muscle dysmorphia was not
associated with a more severe BDD presentation in the
present study.
Summary of Main Findings
Overall, there were few sex differences in the presentation
of BDD, or in associated features. Contrary to hypotheses,
female participants did not report higher levels of BDD-
related appearance checking. Although male participants did
report greater levels of social interference related to BDD,
this was not significant after correcting for multiple compar-
isons. There were no sex differences in endorsement of
specific BDD symptoms, or in the overall severity of BDD
symptoms. This is broadly consistent with adult studies,
which have found few sex differences in the core symptoms
of BDD (Perugi et al., 1997; Phillips & Diaz, 1997; Phillips
et al., 2006).
As reported in clinical samples of adolescents (Albertini
& Phillips, 1999; Phillips et al., 2006) and adults (Phillips,
Menard, Fay, & Weisberg, 2005), the most common body
areas of concern in the current study sample were skin, hair,
and facial features. There was mixed support for the
hypothesized sex differences in the body areas of concern.
As predicted, male participants were significantly more
likely to report muscularity concerns than female partici-
pants, and female participants were more likely to report
TABLE 4
Comparison of Percentage of Participants With Elevated or High-Risk Comorbid Symptoms Between Male (n = 93) and Female (n = 69)
Participants
Male Female Chi-Square Bivariate Analysis Logistic Regressiona
Symptom Measure n % n % χ2 p OR [95% CI] p OR [95% CI]
Depression 57 61.3 49 71.0 1.66 .198 1.55 [0.79, 3.01] — —
Total Anxiety 38 40.9 31 44.9 0.27 .605 1.18 [0.63, 2.22] — —
Panic/Agoraphobia 36 38.7 28 40.6 0.06 .810 1.08 [0.57, 2.04] — —
Separation Anxiety 29 31.2 17 24.6 0.84 .361 1.38 [0.69, 2.80] — —
Social Anxiety 56 60.2 39 56.5 0.22 .637 1.16 [0.62, 2.19] — —
Specific Phobia (Physical Injury) 40 43.0 19 27.5 4.10 .043 1.98 [1.02, 3.88] — —
Obsessive-Compulsive Disorder 35 37.6 21 30.4 0.91 .341 1.37 [0.71, 2.68] — —
Generalized Anxiety 34 36.6 42 60.9 9.40 .003 2.70 [1.42. 5.13] .032 3.75 [1.12, 12.58]
Eating Disorder 4 5.1 6 9.4 0.97 .325 1.91 [0.52, 7.1] — —
Note: Bold text indicates a significant sex difference after Holm-Bonferroni adjustment for multiple comparisons. Cells with dashes indicate that the value
was not calculated as bivariate relationship was not significant. OR = odds ratio, presented relative to the category with the lowest frequency; CI = confidence
interval.
aLogistic regression controlling for participant age, school socioeducational advantage, and parent cultural background.
SEX DIFFERENCES IN ADOLESCENT BDD 523
concerns about breasts/nipples and thighs than male partici-
pants. However, other hypothesized sex differences were
not significant, or could not be properly assessed due to
the coding system or low numbers for some comparisons.
Female participants were significantly more likely than
male participants to report elevated symptoms of general-
ized anxiety disorder, though other symptoms comparisons
did not differ by sex. Elevated comorbid symptoms were
common in male and female participants, particularly
depression, social anxiety, and generalized anxiety. They
occurred at a higher rate than is expected in the general
adolescent population (Schmeelk-Cone, Pisani, Petrova, &
Wyman, 2012; Spence, n.d.), which is consistent with the
high comorbidity of these disorders with BDD in clinical
samples (Albertini & Phillips, 1999; Mataix-Cols et al.,
2015; Phillips et al., 2006). Elevated levels of eating dis-
order pathology were less common in the current study, and
comorbidity with eating disorders is relatively low in ado-
lescents with BDD in clinical samples (0.0%–16.7%;
Albertini & Phillips, 1999; Greenberg et al., 2016; Mataix-
Cols et al., 2015; Phillips et al., 2006). However, these
studies are likely to have underestimated eating disorder
comorbidity as they typically only assessed anorexia ner-
vosa and bulimia nervosa, which may be less common in
those with BDD compared to binge eating disorder and “not
otherwise specified” eating disorders (Phillips et al., 2006).
Unexpectedly, past mental health service use was more
common in male (35.1%) than in female (13.2%) partici-
pants, though this difference was not significant when demo-
graphic variables were controlled for. Service use appears to
be lower than in other disorders; data from a national survey
of 6,310 Australian children and adolescents showed 57.1%
of those with mild depression and 40.2% with mild anxiety
accessed mental health services in the past 12 months alone
(Lawrence et al., 2015). Further, none of the current study
participants who had used mental health services reported
that their appearance concerns were a reason for seeking
these services. Although this latter finding should not be
taken as a proxy for poor BDD disclosure as we do not
know whether their BDD symptoms were present at the
TABLE 5
Comparisons of Outcomes Between Male Participants With (n = 41) and Without (n = 52) Muscle Dysmorphia
With Muscle Dysmorphia Without Muscle Dysmorphia
Continuous Variables M SD M SD t p d [95% CI]
BIQ-C-9 Item Total 31.9 9.1 29.3 15.0 0.94 .349 0.21 [−0.23, 0.64]
Drive for Muscularity Total Score 3.6 1.0 3.0 1.1 2.62 .011 0.56 [0.13, 1.00]
Drive for Muscularity Body Image 4.7 1.2 3.9 1.4 3.07 .003 0.66 [0.22, 1.10]
Drive for Muscularity Behaviors 2.5 1.4 2.1 1.3 1.24 .218 0.27 [−0.16, 0.70]
Quality of Life 59.1 18.2 61.3 20.4 −0.47 .640 0.11 [−0.58, 0.36]
No. of Body Areas of Concern 5.1 1.5 3.6 1.9 4.28 < .001 0.88 [0.44, 1.30]
Categorical Variables n % n % χ2 p OR [95% CI]
BDDQ-A 3a. Distress 31 75.6 34 65.4 1.14 .286 1.64 [0.66, 4.09]
BDDQ-A 3b. Interference With Socializing or Dating 18 43.9 35 67.3 5.12 .024 2.63 [1.13, 6.13]
BDDQ-A 3c. Interference With School or Work 11 26.8 11 21.2 0.41 .523 1.37 [0.52, 3.57]
BDDQ-A 3d. Avoidance due to BDD 25 61.0 32 61.5 0.00 .956 1.02 [0.44, 2.37]
Elevated Depression 27 65.9 30 57.7 0.64 .422 1.41 [0.61, 3.30]
Elevated Total Anxiety 18 43.9 20 38.5 0.28 .596 1.25 [0.55, 2.88]
Elevated Panic/Agoraphobia 14 34.1 22 42.3 0.64 .422 1.41 [0.61, 3.30]
Elevated Separation Anxiety 12 29.3 17 32.7 0.13 .723 1.17 [0.48, 2.85]
Elevated Social Anxiety 26 63.4 30 57.7 0.31 .576 1.27 [0.55, 2.95]
Elevated Physical Injury Fears 17 41.5 23 44.2 0.07 .789 1.12 [0.49, 2.56]
Elevated Obsessive-Compulsive Disorder 15 36.6 20 38.5 0.03 .853 1.08 [0.46, 2.52]
Elevated Generalized Anxiety 17 41.5 17 32.7 0.76 .383 1.45 [0.62, 3.41]
Elevated Eating Disorder 1 2.6 3 7.7 1.05 .305 3.17 [0.32, 31.86]
Elevated Total Difficulties 16 39.0 16 30.8 0.69 .405 1.44 [0.61, 3.41]
Elevated Emotional Symptoms 19 43.6 21 40.4 0.33 .565 1.28 [0.56. 2.91]
Elevated Peer Problems 16 39.0 18 34.6 0.19 .661 1.21 [0.52, 2.82]
Elevated Conduct Problems 12 29.3 12 23.1 0.46 .498 1.38 [0.54, 3.50]
Elevated Hyperactivity 12 29.3 9 17.3 1.88 .171 1.98 [0.74. 5.29]
Note: Bold text indicates a significant muscle dysmorphia group difference after Holm-Bonferroni adjustment for multiple comparisons. BIQ-C-9 = Body
Image Questionnaire–Child and Adolescent Version, nine Items. d = Cohen’s d; CI = confidence interval; BIQ-C-9 = Body Image Questionnaire–Child and
Adolescent Version, nine items; OR = odds ratio, presented relative to the category with the lowest frequency; BDDQ-A = Body Dysmorphic Disorder
Questionnaire–Adolescent Version.
524 SCHNEIDER ET AL.
time of service use, it is consistent with reports that indivi-
duals with BDD typically present for other concerns, such as
mood or anxiety disorders (Veale et al., 2015). Of note, the
majority of young people who had accessed services had
done so via school counsellors, underscoring the importance
of educating school personnel about BDD.
Finally, many (44.1%) male participants reported con-
cerns relating to muscularity or small body build, indicative
of the muscle dysmorphia subtype of BDD (American
Psychiatric Association, 2013). As predicted, male partici-
pants with muscle dysmorphia reported higher muscularity-
related body image concern, and were concerned about a
higher number of different body areas, than those without
muscle dysmorphia. However, contrary to findings in adults
(Pope et al., 2005), we found no difference in the quality of
life of male participants with and without muscle dysmor-
phia, nor in the severity of BDD and comorbid symptoms.
However, it is important to note that suicidality, substance
use, and exercise behaviors were not assessed in the current
study, which may be important correlates of muscle dys-
morphia (Pope et al., 2005). The similarity in most present-
ing features of male participants with and without muscle
dysmorphia provides support for the current conceptualiza-
tion of muscle dysmorphia as a subtype of BDD.
Limitations and Future Directions
The study began prior to the release of the Fifth Edition of
the DSM (DSM-5), which expanded BDD criteria to include
repetitive behaviors or mental acts, and clarified exclusion
criteria regarding eating disorders (American Psychiatric
Association, 2013). Although adult prevalence estimates
are similar when using DSM-IV and DSM-5 criteria
(Schieber, Kollei, De Zwaan, & Martin, 2015), this is yet
to be established in adolescent samples. The use of self-
report screening questionnaires may result in false positives
(Brohede, Wingren, Wijma, & Wijma, 2013), for example,
if the appearance concerns are realistic or due to another
disorder. The study primarily involved participants with
sBDD, so it is unclear whether the lack of sex differences
observed in this sample is representative of youth with more
severe BDD presentations. The BDDQ-A item excluding
individuals with primary weight concern is intended to
preclude eating disorders being incorrectly labeled as BDD
(Phillips, 2005). However, 42.3% of adult female partici-
pants and 11.1% of adult male participants with BDD report
a lifetime history of an eating disorder (Phillips et al., 2006),
and weight concerns are common in adolescents with BDD
(Albertini & Phillips, 1999; Phillips et al., 2006). This
exclusion criterion may therefore result in the underestima-
tion of BDD prevalence where weight concerns are the
primary feature of concern, and underestimation of the
comorbidity between eating disorders and BDD. Future
studies should explore ways to combine self-report ques-
tionnaire assessment of BDD and eating disorders to
overcome these limitations. These studies should also assess
a wider range of clinically relevant outcomes, such as sui-
cidality and substance use, as well as administering all
measures to male and female individuals. As insight may
be particularly poor in adolescents with BDD (Phillips et al.,
2006), multi-informant methods should be considered when
assessing BDD in adolescents.
The schools recruited were a convenience sample of
seven single-sex schools. The schools varied in the type of
governing body, level of socioeducational advantage, and
parental cultural background. Although school socioeduca-
tional advantage and parental cultural background were
controlled for in follow-up analyses of significant bivariate
relationships, it is unknown whether other school factors
may influence BDD symptom presentation. Given that the
presentation of BDD in adults may be affected by factors
such as culture and sexual identity (Boroughs, Krawczyk, &
Thompson, 2010), future studies should explore the poten-
tial impact of a range of demographic variables on BDD and
involve a wider and more representative range of partici-
pants, including those from coeducational schools and lower
socioeducational advantage backgrounds.
The BIQ-C-9 subscales of interference and avoidance
and other symptoms, devised in our whole sample in a
previous study (Schneider et al., 2016a), had poorer than
anticipated internal consistency. Hence, the psychometric
properties of the BIQ-C-9 subscales and those of alternative
measures (e.g. Veale et al., 2014) should be evaluated in
future research. Although male participants with and with-
out muscle dysmorphia were similar across many measures,
further research is needed to examine the criteria and con-
ceptualization of muscle dysmorphia, particularly in relation
to eating disorders (Phillipou, Blomeley, & Castle, 2015).
Implications for Research, Policy, and Practice
The study findings indicate that core BDD symptoms are
highly similar in male and female adolescents with pBDD
and sBDD recruited from a community setting. They were
also very similar in male adolescents with and without mus-
cle dysmorphia concerns. This is an encouraging finding, as it
indicates that clinicians can be trained to recognize the same
types of BDD symptoms regardless of sex or muscularity
concerns. In the sample as a whole, distress and avoidance
were the most highly endorsed criteria on the BDDQ-A, and
for BIQ-C-9 symptoms, mean scores were highest for items
relating to preoccupation about appearance, negative evalua-
tion of features, and the importance of appearance for self-
evaluation. The most common body areas of concern related
to the skin and hair, though there were some sex differences
in concern about other body areas.
Elevated symptoms of depression and anxiety were
reported by a majority of participants, and female partici-
pants were significantly more likely to report elevated gen-
eralized anxiety disorder symptoms than male. Although
SEX DIFFERENCES IN ADOLESCENT BDD 525
comorbid anxiety and depression is frequently reported in
clinical samples of adolescents with BDD (Albertini &
Phillips, 1999; Mataix-Cols et al., 2015; Phillips et al.,
2006), this study indicates that BDD is closely associated
with anxiety and depression in a nonclinical sample as well.
Mental health service use was relatively low in the current
study, especially compared to reported service use rates in
other adolescent disorders (Lawrence et al., 2015). This is
consistent with the low rates of treatment seeking reported
in adult BDD studies (Buhlmann, 2011; Marques et al.,
2011a). Further research is needed to determine specific
service use barriers in adolescent BDD and to understand
why male individuals are underrepresented in specialist
BDD settings (Albertini & Phillips, 1999; Mataix-Cols
et al., 2015; Phillips et al., 2006).
The underdiagnosis of BDD in routine clinical practice is a
serious concern, and the results of the current study indicate
that school counsellors and psychologists may have a key
role in improving BDD detection. However, the majority of
adolescents with pBDD and sBDD in our sample had never
accessed a mental health service. Improving the detection and
early intervention for BDD will thus require a broader
approach, whereby adolescents and their parents are educated
about the nature of BDD symptoms and encouraged to seek
appropriate mental health treatment. Efforts to combat the
shame associated with BDD may be particularly valuable, as
this is commonly reported as a reason for not disclosing BDD
(Marques et al., 2011).
In conclusion, the presentation of BDD is similar
between male and female adolescents in a community
sample. This includes the types of BDD symptoms
endorsed, many of the body areas of concern, and the
close association with anxiety and depression. In male
adolescents, muscle dysmorphia was not associated with
greater BDD severity or poorer quality of life. Public
education about BDD and improved detection of BDD by
clinicians is greatly needed in order to improve early
detection of this serious disorder.
We thank the students and staff of each school, and Laura
Clark (PhD), Keila Brockveld (PhD), and Danielle Einstein
(PhD) from the Centre for Emotional Health, Department of
Psychology, Macquarie University, Sydney, Australia, for
their assistance with data collection.
Please contact the corresponding author for requests
regarding access to data.
The research was supported by (a) Macquarie University
Research Excellence Scholarship awarded to Sophie
Schneider; (b) Australian Research Council grants
LP130100576, FT120100217; (c) beyondblue National
Priority Driven Research funding; and (d) a Sponsored
Research Project grant from Macquarie University and one
participant school awarded to Jennifer Hudson. These fund-
ing sources had no involvement in the study design, data
collection, analysis or interpretation, and writing of the
report. Schools were given a copy of the completed manu-
script prior to submission to check that details of school
involvement were accurately reported.
ORCID
Sophie C. Schneider http://orcid.org/0000-0002-1469-
7764
Jonathan Mond http://orcid.org/0000-0002-0410-091X
Jennifer L. Hudson http://orcid.org/0000-0001-5778-
2670
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- Abstract
- References
INTRODUCTION
THE CURRENT STUDY
METHOD
Participants
Procedure
Measures
Male and Female Participants
Male Participants Only
Data Analysis
RESULTS
Demographic Characteristics
Body Dysmorphic Symptom Comparisons
Body Areas of Concern
Comorbid Symptom Severity
Past Mental Health Service use
Comparison of Male Participants With and Without Muscle Dysmorphia
DISCUSSION
Summary of Main Findings
Limitations and Future Directions
Implications for Research, Policy, and Practice
ACKNOWLEDGMENTS
FUNDING