Body Dysmorphic Disorder patients have higher risk of personal and appearance-based rejection sensitivity

July 15, 2014

In a recent study, researchers at Rhode Island Hospital found that fear of being rejected because of one's appearance, as well as rejection sensitivity to general interpersonal situations, were significantly elevated in individuals with Body Dysmorphic Disorder (BDD). These fears, referred to as personal rejection sensitivity and appearance-based rejection sensitivity, can lead to diminished quality of life and poorer mental and overall health. BDD is a common, often severe, and under-recognized body image disorder that affects an estimated 1.7 to 2.4 percent of the population. The study is published in the current issue of the journal Body Image.

"People with BDD obsess about physical features or attributes that they believe are ugly or hideous, often spending hours looking in the mirror and taking extraordinary measures to try to correct imperfections that only they can see," said Katharine Phillips, M.D., director of the Body Dysmorphic Disorder program at Rhode Island Hospital, and senior author of the study. "So they are particularly sensitive to what they believe is rejection from others based on these or other perceived flaws."

She continued, "This study suggests that those with BDD experience an increased expectation of , often to the detriment of their overall health and quality of life."

The study found that personal rejection sensitivity was associated with more severe BDD and depressive symptoms, poorer mental health, general health, and physical and social functioning, while appearance-based rejection sensitivity was associated with more severe BDD and depressive symptoms, and poorer general health. Personal rejection sensitivity is defined as the tendency by an individual to worry that others will negatively evaluate and reject them. Clinical observations additionally suggest that personal rejection sensitivity is common in persons with BDD. A more specific type of rejection sensitivity, appearance-based rejection sensitivity, also may be a key characteristic of BDD. Appearance-based rejection sensitivity is defined as anxiety-provoking expectations of based on physical appearance

"Generally speaking, no one enjoys being rejected or feeling embarrassed," Phillips said. "But for people with BDD, feelings of being rejected by others are exacerbated, sometimes to the point where individuals are debilitated by these concerns, even if the rejection was simply perceived, not real."

BDD typically starts during early adolescence. The disorder consists of intrusive, time-consuming preoccupations about perceived defects in one's physical appearance (for example, acne, hair loss, or nose size) whereas the perceived flaws are actually minimal or even nonexistent in the eyes of others. Individuals with BDD may engage in obsessive grooming, skin picking or plastic surgery (which appears to usually be ineffective). BDD also often leads to social impairments, missed work or school and difficulty forming and maintaining meaningful relationships. It is associated with high lifetime rates of psychiatric hospitalization and suicide.

"More research is needed to help patients and their families better understand BDD and associated rejection sensitivity. Studies are also needed to help clinicians determine the best treatment to help patients who are suffering with BDD lead lives that are as productive and satisfying as possible," Phillips said.

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