by Fugen Neziroglu, PhD, ABBP, ABPP; Tania Borda, PhD; Sony Khemlani-Patel, PhD; Brittany Bonasera
Published Spring 2019
When it comes to the role of trauma in obsessive-compulsive disorder (OCD) and body dysmorphic disorder (BDD), we still know very little. There is some research to suggest that individuals with these disorders are somewhat more likely to have a history of abuse than the average person. Additionally, individuals with BDD report abuse more often than is reported by individuals with OCD1.
There have also been reports in which individuals with BDD indicated that they were often teased as children2,3. However, it is plausible that individuals with BDD are more likely to recall these events due to rejection sensitivity and heightened anxiety, which are common features of the disorder. Nonetheless, being teased or bullied in childhood has been shown to be traumatic and can have long-lasting physiological, psychological, and even biological effects on victims4,5.
Previous research on social relations in children with OCD4, as well as research suggesting a link between being teased in childhood and developing BDD later on in life2,3, led us to look further into the relationship between bullying and these disorders. In order to study this relationship, we considered bullying as a form of trauma, and measured its prevalence in a group of school-aged children in Buenos Aires, Argentina.
The purpose of this study was to look at a sample of young children during their school years — when bullying is most common — to see if there was a relationship between bullying and the emergence of BDD symptoms7.
We hypothesized that:
Children with emerging BDD would be victims of bullying more so than children without any mental health diagnosis; and
Children with OCD and other clinical diagnoses would be victims of bullying, but not to the same degree as children with emerging BDD.
How the Study was Performed
We collected data from a sample of 219 children between the ages of 7 and 10 from three elementary schools in Buenos Aires, Argentina7. Children were screened for psychiatric illness using the Mini International Neuropsychiatric Interview for Children and Adolescents (MINI), which is a short interview that can diagnose the 30 most common disorders in pediatric mental health8. Additionally, children were given the Body Dysmorphic Disorder Questionnaire (BDDQ)9, which is a brief self-report measure used to screen for BDD.
Children were then grouped into one of four categories:
BDD (children with BDD features/emerging BDD symptoms)
clinical controls (children with depressive disorders, attention deficit hyperactivity disorder, oppositional defiant disorder, and anxiety disorders not otherwise specified)
healthy controls (children with no psychiatric diagnoses)
After the children were categorized, they were given the Peer Interaction in Primary School Questionnaire (PIPS)10, which is a 22-question measure designed to identify bullying and victimization experiences in elementary school children.
The results on the PIPS provided some interesting findings:
Children with BDD experienced more bullying than the healthy control group, supporting hypothesis #1.
Contrary to hypothesis #2, children with BDD did not experience more bullying than those in the clinical control group, and experienced significantly less bullying than children in the OCD group.
Children in the OCD group were more bullied than those in any other group.
An additional finding was that children in the BDD group were more likely to be bullies than children in any of the other three groups. Within the OCD, clinical control, and nonclinical control groups, children were more likely to be victims than bullies. However, children with emerging BDD were just as likely to be bullies as they were victims.
The results of this study suggest an interesting relationship between bullying, victimization, and BDD. Perhaps more broadly, the results suggest a relationship between BDD and interpersonal conflict7.
However, there were some limitations to this study that are worth noting. One limitation was that since this study only looked at children during one point in time, we cannot know what came first: the bullying or the BDD symptomology. Therefore, children who were bullied may have already had clinical symptoms before being bullied, or they may have developed symptoms as a result of the bullying — both scenarios are equally as likely. Another limitation was that the diagnoses given to the children were based upon standardized measures alone and administered briefly in the school setting. It would have been helpful to have their diagnoses confirmed from parental interviews as well, especially to highlight any characteristics that may not have been captured within the measures used to determine the diagnoses.
This study provided an interesting insight into the nature of BDD and how it impacts social functioning in children. It seems that interpersonal conflict from a young age is related to emerging BDD and is seen in the form of bullying and victimization7. Future studies on early BDD development and symptoms may use this information to help identify youth who are at risk of developing this chronic and serious disorder. Additionally, these results could help inform future interventions for school-aged children with OCD. Catching BDD early on could potentially lead to a more successful treatment outcome, and the results of this study hopefully provide researchers with the first steps to do so.
Neziroglu, F., Khemlani-Patel, S., & Yaryura-Tobias, J.A. (2006). Rates of abuse in body dysmorphic disorder and obsessive-compulsive disorder. Body Image, 3, 189–193.
Buhlmann, U., Wilhelm, S., Glaesmer, H., Mewes, R., Brähler, E., & Rief, W. (2011). Perceived appearance-related teasing in body dysmorphic disorder: A population-based survey. International Journal of Cognitive Therapy, 4(4), 342-348.
Weingarden, H., Curley, E.E., Renshaw, K.D., & Wilhelm, S. (2017). Patient-identified events implicated in the development of body dysmorphic disorder. Body Image, 21, 19–25.
Newman, M. L., Holden, G.W., & Delville, Y. (2005). Isolation and the stress of being bullied. Journal of Adolescence, 28, 343-357.
Carney, J. V. (2008). Perceptions of bullying and associated trauma during adolescence. Professional School Counseling, 11(3), 179–188.
Borda, T., Feinstein, B. A., Neziroglu, F., Veccia, T., & Perez-Rivera, R. (2013). Are children with obsessive-compulsive disorder at risk for problematic peer relationships? Journal of Obsessive-Compulsive and Related Disorders, 2(4), 359-365.
Neziroglu, F.,Borda, T., Khemlani-Patel, S., & Bonasera, B. (2018). Prevalence of Bullying in a Pediatric Sample of Body Dysmorphic Disorder. Comprehensive Psychiatry 18, 12-16.
Sheehan, DV, Lecrubier, Y, Sheehan, KH, Amorim, P, Janavs, J, Weiller, E, Dunbar, GC. (1998). The Mini-International Neuropsychiatric Interview (M.I.N.I): The development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. The Journal of Clinical Psychiatry 1998; 59(20): 22-33.
Phillips, KA. The Broken Mirror: Understanding and treating body dysmorphic disorder. New York, NY: Oxford University Press; 2005.Tarshis, TP, Huffman, LC. Psychometric properties of the peer interactions in primary school (PIPS) questionnaire. Journal of Developmental and Behavioral Pediatrics 2007; 28: 125–132.