Adolescent body dysmorphic disorder: Insight, executive function, and rates of ADHD and Autistic traits

Body dysmorphic disorder (BDD) affects approximately 1 % of adolescents. Little is known about the disorder in youth and many young people do not respond to current treatments. The limited research to date suggests poor insight, executive functioning differences, and an increased likelihood of co-occurring Autism and attention-deficit/hyperactivity disorder (ADHD) may be associated with BDD in adolescents. In the current study, 26 adolescents with BDD aged 12 to 17 were compared to a clinical control group of 27 adolescents with anxiety disorders and 25 adolescents without mental disorders on insight, executive functioning, and rates of ADHD and Autism traits. Adolescents with BDD had significantly poorer insight compared to anxious adolescents, with 73 % of the BDD sample having poor or delusional insight compared to 11 % of the anxious sample. Although the three groups performed similarly on set-shifting and response inhibition tasks, adolescents with BDD and anxiety disorders were rated by their parents as having significantly more difficulties with shifting, emotional control, task initiation, and overall executive functioning compared to the non-clinical control group. Adolescents with BDD were also rated as having significantly more difficulties with emotional control than adolescents with anxiety disorders. Most (96 %) of the BDD sample had Autistic traits and 39 % met criteria for ADHD. Further research is needed to understand the impact of insight, executive function and co-occurring Autism and ADHD on treatment engagement and outcomes in adolescents with BDD.