Characteristics and 12-month outcomes of clinically-referred children and young people at risk of body dysmorphic disorder

Body Dysmorphic Disorder (BDD) is impairing yet often under-detected in children and young people (CYP). This paper aims to describe the characteristics and 12-month outcomes of clinically referred CYP based on their likelihood of having BDD. This paper investigated 307 CYP aged 11–17 years from the STandardised DIagnostic Assessment (STADIA) trial for CYP with emotional difficulties referred to Child and Adolescent Mental Health Services (CAMHS). CYP and/or their parents completed the Development and Wellbeing Assessment (DAWBA) to assess the likelihood of meeting diagnostic criteria for emotional disorders, including BDD. Baseline and 12-month follow-up measures were collected from self- and/or parent- reports and healthcare records. Overall, 6.2% (95% confidence interval 3.8%, 9.5%) of referred CYP had probable BDD according to the DAWBA; however, no CYP received a BDD diagnosis from CAMHS clinicians. CYP with probable BDD were predominantly female (84%), white (89%) and came from diverse socio-economic backgrounds. Nearly three quarters (74%) of them scored very high for comorbid depression and generalised anxiety disorder, but only 47% had their referral accepted by CAMHS by 12 months. At baseline, 50% reported self-harm thoughts and 33% reported self-harm behaviours, with 42% reporting self-harm behaviours at 12 months. BDD is relatively common among CYP with emotional difficulties referred to CAMHS, but may be overlooked. CYP with probable BDD often meet criteria for depressive or anxiety disorders and exhibit high levels of self-harm thoughts and behaviours. Despite this, referral acceptance to CAMHS was no higher for CYP with probable BDD, highlighting the need to raise awareness about BDD among referrers and clinicians.