Body dysmorphic disorder in adolescents: family history, parental distress, rearing, and accommodation

Objective: The family environment of adolescents with body dysmorphic disorder (BDD) is under researched. The current study aimed to investigate family psychiatric history, as well as parental distress, rearing practices, accommodation of appearance concerns, and appearance messages in a clinical sample of adolescents with BDD. Method: Twenty-six adolescents (12–17 years) with BDD were compared to 27 adolescents with anxiety disorders and 25 adolescents without mental disorders. Adolescents and their primary caregivers completed self-report measures and participated in a discussion task that was independently coded for parental rearing styles. Results: Parents of adolescents with BDD reported experiencing significantly more emotional distress than parents in the non-clinical group (p =.003, d = 1.02). The majority (92%) of parents in the BDD group reported accommodating their child’s appearance concerns and reported performing significantly more frequent appearance accommodations than parents of anxious adolescents (p <.001, d = 1.40) and the non-clinical group (p <.001, d = 1.83). An independent observer rated parents of adolescents with BDD (p =.002, d = 1.19) and anxiety disorders (p =.008, d = 0.87) as more critical than parents in the non-clinical group during a body-image related discussion, but parents of adolescents with BDD were not rated as more critical in other discussion scenarios. There were no significant differences in parental warmth, overprotection, or appearance messages between parents in the BDD group and comparison groups. Conclusions: Results of the study can inform cognitive–behavioral models of adolescent BDD as well as family-based treatment approaches.