| 1. |
- Krebs, Georgina, et al.
(författare)
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The association between body dysmorphic symptoms and suicidality among adolescents and young adults : a genetically informative study
- 2022
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Ingår i: Psychological Medicine. - : Cambridge University Press. - 0033-2917 .- 1469-8978. ; 52:7, s. 1268-1276
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Previous research indicates that body dysmorphic disorder (BDD) is associated with risk of suicidality. However, studies have relied on small and/or specialist samples and largely focussed on adults, despite these difficulties commonly emerging in youth. Furthermore, the aetiology of the relationship remains unknown.METHODS: Two independent twin samples were identified through the Child and Adolescent Twin Study in Sweden, at ages 18 (N = 6027) and 24 (N = 3454). Participants completed a self-report measure of BDD symptom severity. Young people and parents completed items assessing suicidal ideation/behaviours. Logistic regression models tested the association of suicidality outcomes with: (a) probable BDD, classified using an empirically derived cut-off; and (b) continuous scores of BDD symptoms. Bivariate genetic models examined the aetiology of the association between BDD symptoms and suicidality at both ages.RESULTS: Suicidal ideation and behaviours were common among those with probable BDD at both ages. BDD symptoms, measured continuously, were linked with all aspects of suicidality, and associations generally remained significant after adjusting for depressive and anxiety symptoms. Genetic factors accounted for most of the covariance between BDD symptoms and suicidality (72.9 and 77.7% at ages 18 and 24, respectively), but with significant non-shared environmental influences (27.1 and 22.3% at ages 18 and 24, respectively).CONCLUSIONS: BDD symptoms are associated with a substantial risk of suicidal ideation and behaviours in late adolescence and early adulthood. This relationship is largely explained by common genetic liability, but non-shared environmental effects are also significant and could provide opportunities for prevention among those at high-risk.
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| 2. |
- Krebs, Georgina, et al.
(författare)
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The association between body dysmorphic symptoms and suicidality among adolescents and young adults : a genetically-informative study
- 2020
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Ingår i: Behavior Genetics. - : Springer. - 0001-8244 .- 1573-3297. ; 50:6, s. 462-462
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Previous research indicates that body dysmorphic disorder (BDD) is associated with risk of suicidality. However, studies have relied on small and/or specialist samples and largely focused on adults, despite these difficulties commonly emerging in youth. Furthermore, the aetiology of the relationship remains unknown.Two independent twin samples were identified through the Child and Adolescent Twin Study in Sweden, at ages 18 (N = 6027) and 24 (N = 3454). Participants completed a self-report measure of BDD symptom severity. Young people and parents completed items assessing suicidal ideation and suicide attempts. Logistic regression models tested the association between continuous scores of BDD symptoms and suicidality outcomes. Bivariate genetic models examined the aetiology of the association between BDD symptoms and a suicidality composite at both ages.BDD symptoms were positively associated with suicidal ideation and suicide attempts at age 18 and 24. These associations generally remained significant after adjusting for depressive and anxiety symptoms. Genetic factors accounted for most of the covariance between BDD symptoms and suicidality (74.1% and 79.4% at ages 18 and 24, respectively), but with significant non-shared environmental influences (25.9% and 20.6% at ages 18 and 24, respectively).BDD symptoms are associated with substantial risk of suicidal ideation and behaviours in late adolescence and early adulthood. This relationship is largely explained by common genetic liability, but non-shared environmental effects are also significant and could provide opportunities for prevention among those at high-risk.
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| 3. |
- Mataix-Cols, David, et al.
(författare)
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All-Cause and Cause-Specific Mortality Among Individuals With Hypochondriasis
- 2024
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Ingår i: JAMA psychiatry. - : American Medical Association (AMA). - 2168-6238 .- 2168-622X. ; 81:3, s. 284-291
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Tidskriftsartikel (refereegranskat)abstract
- IMPORTANCE: Hypochondriasis, also known as health anxiety disorder, is a prevalent, yet underdiagnosed psychiatric disorder characterized by persistent preoccupation about having serious and progressive physical disorders. The risk of mortality among individuals with hypochondriasis is unknown.OBJECTIVE: To investigate all-cause and cause-specific mortality among a large cohort of individuals with hypochondriasis.DESIGN, SETTING, AND PARTICIPANTS: This Swedish nationwide matched-cohort study included 4129 individuals with a validated International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) diagnosis of hypochondriasis assigned between January 1, 1997, and December 31, 2020, and 41 290 demographically matched individuals without hypochondriasis. Individuals with diagnoses of dysmorphophobia (body dysmorphic disorder) assigned during the same period were excluded from the cohort. Statistical analyses were conducted between May 5 and September 27, 2023. EXPOSURE: Validated ICD-10 diagnoses of hypochondriasis in the National Patient Register.MAIN OUTCOME AND MEASURES: All-cause and cause-specific mortality in the Cause of Death Register. Covariates included birth year, sex, county of residence, country of birth (Sweden vs abroad), latest recorded education, civil status, family income, and lifetime psychiatric comorbidities. Stratified Cox proportional hazards regression models were used to estimate the hazard ratios (HRs) and 95% CIs of all-cause and cause-specific mortality.RESULTS: Of the 4129 individuals with hypochondriasis (2342 women [56.7%]; median age at first diagnosis, 34.5 years [IQR, 26.3-46.1 years]) and 41 290 demographically matched individuals without hypochondriasis (23 420 women [56.7%]; median age at matching, 34.5 years [IQR, 26.4-46.2 years]) in the study, 268 individuals with hypochondriasis and 1761 individuals without hypochondriasis died during the study period, corresponding to crude mortality rates of 8.5 and 5.5 per 1000 person-years, respectively. In models adjusted for sociodemographic variables, an increased rate of all-cause mortality was observed among individuals with hypochondriasis compared with individuals without hypochondriasis (HR, 1.69; 95% CI, 1.47-1.93). An increased rate was observed for both natural (HR, 1.60; 95% CI, 1.38-1.85) and unnatural (HR, 2.43; 95% CI, 1.61-3.68) causes of death. Most deaths from unnatural causes were attributed to suicide (HR, 4.14; 95% CI, 2.44-7.03). The results were generally robust to additional adjustment for lifetime psychiatric disorders.CONCLUSIONS AND RELEVANCE: This cohort study suggests that individuals with hypochondriasis have an increased risk of death from both natural and unnatural causes, particularly suicide, compared with individuals from the general population without hypochondriasis. Improved detection and access to evidence-based care should be prioritized.
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| 4. |
- Rautio, Daniel, et al.
(författare)
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Body-Focused Repetitive Behavior Disorders in Children and Adolescents : Clinical Characteristics and Treatment Outcomes in a Naturalistic Setting
- 2024
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Ingår i: Behavior Therapy. - 0005-7894 .- 1878-1888. ; 55:2, s. 376-390
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Tidskriftsartikel (refereegranskat)abstract
- Body-focused repetitive behavior disorders, including trichotillomania (hair-pulling disorder) and excoriation (skin picking) disorder, typically emerge in early adolescence, but little is known about the clinical characteristics and treatment outcomes of these disorders in young people, particularly in real-world clinical settings. Participants were 63 children and adolescents (51 girls; age range 9–17) with a diagnosis of trichotillomania (n = 33) and/or skin-picking disorder (n = 33) attending a specialist outpatient clinic in Stockholm, Sweden. Demographic and clinical characteristics were gathered at the initial assessment. Of the 63 assessed youths, 56 received manual-based behavior therapy mainly focusing on habit reversal training, which was combined with medication when deemed appropriate. The mean clinician-reported trichotillomania and skin-picking disorder symptom severity at baseline (n = 63) was in the moderate range. We observed high rates of psychiatric comorbidity (63.5%) and use of psychiatric medication (54.8%). For the 56 individuals undertaking treatment at the clinic, mixed-effects regression models showed a significant decrease in symptom severity from baseline to posttreatment, with gains maintained up to the 12-month follow-up. Substantial and durable improvements were also seen on self-reported symptoms, self-reported depression, and global functioning. Specialist care should be made more widely available to improve the prognosis and quality of life of young people with trichotillomania and skin-picking disorder.
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| 5. |
- Rautio, Daniel
(författare)
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Clinical characteristics and treatment outcomes in body dysmorphic disorder
- 2024
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Body dysmorphic disorder (BDD) is an early onset mental disorder characterized by a preoccupation with perceived flaws in physical appearance. Research on the presentation of the disorder is sparse, especially on young people with BDD. Furthermore, the availability of cognitive-behavior therapy (CBT) for the disorder is generally low, despite being recommended in treatment guidelines. The overall aim of this thesis was to further describe the clinical characteristics of BDD and to promote the dissemination of CBT among youth with BDD. In Study 1, 600 individuals with an ICD-10 diagnosis of hypochondriasis or dysmorphophobia (i.e., BDD) (300 each) were randomly selected from the Swedish National Patient Register. Eighty-four medical files of individuals with hypochondriasis and 122 files of individuals with dysmorphophobia were received and used for analyses. Two independent raters assessed the validity and reliability of the diagnosis by performing an evaluation of the clinical charts. The inter-rater agreement regarding the presence or absence of a diagnosis was high for both disorders (95.2% for hypochondriasis and 92.6% for dysmorphophobia), and 80% of the hypochondriasis files and 91% of the dysmorphophobia files were considered ‘true positive’ cases. These results confirmed that the Swedish ICD-10 codes for hypochondriasis and dysmorphophobia are sufficiently valid and reliable to be used in register-based studies. Following up on Study 1, Study 2 was a Swedish nationwide matched-cohort study of 2,833 individuals with an ICD-10 diagnosis of BDD, each matched with 10 unaffected individuals from the general population. During the study period, 466 (16.45%) individuals with BDD and 1,071 (3.78%) unexposed controls from the general population had at least one record of intentional self-harm. In adjusted models, an elevated risk of intentional self-harm was observed among individuals with BDD (IRR=3.37 [95% CI, 3.02-3.76]). Additionally, a total of 17 (0.60%) individuals with BDD and 27 (0.10%) individuals from the general population died by suicide (HR=3.47 [95% CI, 1.76-6.85]). In sum, individuals with BDD showed an increased risk of self-harm and death by suicide, compared to individuals without BDD. In Studies 3 and 4 the aims were to explore the characteristics of a large cohort of adolescents with BDD, to evaluate the multimodal treatment outcomes of this cohort, and to examine potential predictors of treatment response. In our sample, we observed high rates of psychiatric comorbidity (71.5%), self-harm (52.1%), suicide attempts (11.0%), desire for cosmetic procedures (53.7%), and school dropout (32.4%). After receiving multimodal treatment consisting of CBT and medication when deemed necessary, 79% of the participants were classified as treatment responders and 59% as full or partial remitters. Encouragingly, BDD symptoms continued to improve up to one year after the end of the treatment. BDD symptom severity was identified as a predictor of treatment outcomes at post-treatment, but no consistent predictors were found at the one-year follow-up. The conclusion of these studies was that, while BDD in young people can be a serious and disabling disorder, often accompanied with substantial functional impairment and risky behaviors, multimodal treatment is effective in both the short- and the long-term when provided flexibly within a specialist setting. Finally, in Study 5, we transferred the treatment protocol evaluated in Study 4 to an online version. The treatment was considered both credible and satisfactory and was associated with a large reduction in BDD symptoms. At the a priori primary endpoint (3-months follow-up), 74% of the participants were classified as responders and 63% as full or partial remitters, and the results continued to improve up to the 12-month follow-up. Furthermore, the average therapist support time was 8 minutes per participant and week. Nonetheless, risky behaviors typical of this patient group should be carefully monitored during treatment. CBT delivered in an online format with minimal therapist support is a feasible, potentially efficacious, and durable treatment for adolescents with BDD. To summarize, this thesis concludes that BDD can be a severe and impairing mental disorder with several risks, including an elevated risk of intentional self-harm and death by suicide. It further suggests that face-to-face CBT for young people with BDD can be successfully implemented in specialist outpatient settings. To further increase treatment availability, CBT may also be delivered remotely, which has the potential to improve access to evidence-based treatment for youth with BDD.
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| 6. |
- Rautio, Daniel, et al.
(författare)
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Intentional self-harm and death by suicide in body dysmorphic disorder : A nationwide cohort study
- 2024
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Ingår i: Biological Psychiatry. - : Elsevier. - 0006-3223 .- 1873-2402.
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: Body dysmorphic disorder (BDD) is thought to be associated with considerable suicide risk. This nationwide cohort study quantified the risks of intentional self-harm - including non-suicidal self-injuries and suicide attempts - and death by suicide in BDD.METHODS: Individuals with a validated ICD-10 diagnosis of BDD in the Swedish National Patient Register, registered between January 1, 1997 and December 31, 2020, were matched with 10 unexposed individuals from the general population on birth year, sex, and county of residence. Conditional Poisson regression models estimated incidence rate ratios (IRR) and 95% confidence intervals (CIs) for intentional self-harm and stratified Cox proportional hazards models estimated hazard ratios (HRs) and 95% CIs for death by suicide. Models adjusted for sociodemographic variables and lifetime psychiatric comorbidities.RESULTS: Among 2,833 individuals with BDD and 28,330 unexposed matched individuals, 466 (16.45%) and 1,071 (3.78%) had at least one record of intentional self-harm during the study period, respectively (IRR=3.37; 95% CI, 3.02-3.76). In the BDD cohort, about two thirds (n=314; 67%) had their first recorded self-harm event before their first BDD diagnosis. A total of 17 (0.60%) individuals with BDD and 27 (0.10%) unexposed individuals died by suicide (HR=3.47; 95% CI, 1.76-6.85). All results remained robust to additional adjustment for lifetime psychiatric comorbidities. A higher proportion of individuals with BDD who died by suicide had at least one previous record of intentional self-harm, compared to unexposed individuals (52.94% vs. 22.22%; p=0.0363).CONCLUSIONS: BDD was associated with a three-fold increased risk of intentional self-harm and death by suicide.
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| 7. |
- Rautio, Daniel, et al.
(författare)
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Therapist-guided, Internet-delivered cognitive behaviour therapy for adolescents with body dysmorphic disorder : A feasibility trial with long-term follow-up
- 2023
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Ingår i: Internet Interventions. - 2214-7829. ; 34
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Tidskriftsartikel (refereegranskat)abstract
- Body dysmorphic disorder (BDD) is a prevalent and impairing psychiatric condition that typically debuts in adolescence and is associated with risky behaviours. The disorder can be effectively treated with cognitive behaviour therapy (CBT). However, CBT for BDD is seldom available primarily due to a shortage of trained therapists. Internet-delivered CBT (ICBT) can be a way to increase treatment availability. The aim of this feasibility trial was to evaluate the feasibility, safety, and preliminary efficacy of a CBT protocol for adolescents with BDD, adapted to be delivered over the Internet with minimal therapist support. A total of 20 participants (12–17-year-olds) meeting criteria for BDD were recruited nationally to a specialist outpatient clinic in Stockholm, Sweden. One participant withdrew consent and their data could not be analysed. Nineteen participants were offered 12 modules of therapist-guided ICBT for BDD and were followed up to 12 months post-treatment. Preliminary efficacy was measured at the a priori primary endpoint (3-month follow-up) and at the 12-month follow-up with the clinician-rated Yale-Brown Obsessive Compulsive Scale Modified for BDD for Adolescents. The treatment was rated as both credible and satisfactory and was associated with a large and statistically significant reduction in BDD symptom severity (d = 2.94). The proportion of participants classified as responders at the primary endpoint was 73.7%, and the proportion of full or partial remitters was 63.2%. The average therapist support time was 8 min per participant per week. Treatment gains continued to accrue up to the 12-month follow-up. Two participants attempted suicide and another two reported non-suicidal self-injuries during the study period. ICBT with minimal therapist support is a feasible, potentially efficacious, and durable treatment for adolescents with BDD. Risky behaviours typical of this patient group should be carefully monitored during treatment.
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