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Adolescent body dysmorphic disorder: Insight, executive function, and rates of ADHD and Autistic traits
Cassie H Lavell1, Ella L Oar1, Ronald M Rapee1
1Lifespan Health and Wellbeing Research Centre, Macquarie University, Sydney, Australia.
Journal of Psychiatric Research
|October 5, 2025
Summary
Adolescents with Body Dysmorphic Disorder (BDD) show poorer insight and more executive functioning difficulties, with high rates of Autism and Attention-Deficit/Hyperactivity Disorder (ADHD) traits. These factors may impact treatment for youth with BDD.
Area of Science:
- Psychiatry
- Developmental Psychology
- Clinical Psychology
Background:
- Body Dysmorphic Disorder (BDD) affects 1% of adolescents, with limited understanding of its presentation in youth.
- Current treatments for adolescent BDD have variable efficacy, suggesting a need for further research into associated factors.
- Preliminary evidence links BDD in adolescents to poor insight, executive functioning deficits, and co-occurring Autism and Attention-Deficit/Hyperactivity Disorder (ADHD).
Purpose of the Study:
- To investigate insight, executive functioning, and rates of Autism and ADHD traits in adolescents with BDD.
- To compare these factors between adolescents with BDD, those with anxiety disorders, and a non-clinical control group.
- To explore the potential impact of these factors on treatment engagement and outcomes in adolescent BDD.
Main Methods:
- A comparative study involving 26 adolescents with BDD (aged 12-17), 27 with anxiety disorders, and 25 controls.
- Assessment of insight, executive functioning (including set-shifting, response inhibition, emotional control, task initiation), and parent-reported difficulties.
- Screening for Autism traits and ADHD diagnostic criteria.
Main Results:
- Adolescents with BDD exhibited significantly poorer insight (73% poor/delusional) compared to anxious adolescents (11%).
- Parental ratings indicated greater executive functioning difficulties (shifting, emotional control, task initiation) in BDD and anxiety groups versus controls.
- The BDD group showed more emotional control difficulties than the anxiety group; 96% had Autistic traits, and 39% met ADHD criteria.
Conclusions:
- Adolescents with BDD demonstrate significantly impaired insight and executive functioning deficits, often co-occurring with Autism and ADHD.
- These findings highlight the complex clinical profile of BDD in adolescents and suggest potential targets for intervention.
- Further research is crucial to understand how insight, executive function, Autism, and ADHD influence treatment response in this population.
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