الفهرس 
Introduction and Aim of the WorkOnly 14 pages are availabe for public view
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Abstract
Body dysmorphic disorder (BDD) is one of the relatively common psychiatric disorders that affect adolescents and young adults greatly. According to American Psychiatric Association (APA), BDD includes preoccupation with one or more perceived physical flaws that are not visible to others, along with repetitive behaviors or mental acts in response to the appearance worries. The preoccupation creates clinically considerable distress or impairment in social, occupational, or other essential aspects of functioning. BDD leads to devastating negative psychosocial consequences, as well as high comorbidity and high mortality rates.
The aim of the present work was to assess body dysmorphic symptoms among university students in Alexandria. The specific objectives were to estimate the prevalence of body dysmorphic symptoms among university students, and to identify possible determinants associated with BDD.
A cross sectional design was used. The study was conducted at the Faculty of Medicine, the Faculty of Engineering, the Faculty of Commerce and the Faculty of Law affiliated to Alexandria University. The target population was first year students with a sample size of 369 students. The sample was rounded to 400 students, and with 1.5% design effect the total sample was increased to 600 students. The total sample included in the study was 636 students and a multi-stage cluster sample was used to select the students.
The data collection methods and tools included:
I- A predesigned structured self-administered questionnaire (Appendix I) that was used to collect the following data from the students: Socio-demographic data, personal hobbies, history of smoking, substance abuse and alcohol consumption, history of chronic diseases, student and family history of mental illness, and history of abuse, bullying, support and life stresses.
II- The Arabic version of the Body Dysmorphic Disorder Questionnaire (BDDQ, Appendix II) which is a brief self-reported measure used as a screening instrument for BDD.
The study revealed the following results:
Section I: characteristics of the studied sample
• The age of the students ranged from 17 to 28 years with a mean age of 18.46 ± 0.99 years. Nearly two-thirds (65.1%) of the students were in the age group 17 to less than 19 years and only 3% were in the age group 21 years or more. Males and females were equally represented (50% - 50%).
• Almost all of the students (98.8%) were Egyptians, while the remaining (1.2%) were non-Egyptians and the majority (98.3%) of the students were single, while 1.4% and 0.3% were engaged and married respectively. Regarding residence, the majority (83.2%) of the students lived in urban areas while the rest (16.8%) lived in rural areas.
• More than half (58.3%) of the students had mothers with university or post-graduate education and less than one-quarter (22.2%) of the students had mothers with high school education, followed by illiterate/can read and write that constituted 10.9%.
• Less than two-thirds (63.7%) of the students had fathers with university or post-graduate education, 18.6% had fathers with high school education and 6.9% had illiterate fathers/can read and write.
• More than two-thirds (70.8%) of the students’ mothers were housewives, 13.1% were employees, 8.8% were professionals, 2.4% had a private business, 2.2% were workers, and only 0.3% were skilled.
• More than one-third (34.3%) of the students’ fathers were professionals, 22.3% were employees and 18.7% had private business.
• Regarding the socio-economic score, 48.6% of the students had high socio-economic score, 30.5% had moderate socio-economic score, and those with low and very low socio-economic score represented 11.2% and 9.7% respectively.
• Almost three quarters of the students (72.3%) reported electronic screens as one of their hobbies and more than half of the students (55.7%) reported sports, while 34.9% reported reading. 15.8% had a hobby of drawing, 8.5% music, and 4.6% stated other different hobbies.
• More than three quarters of the studied sample (77.4%) used the internet for social media, almost half of the student (49.4%) used the internet for watching videos, about one quarter (25.9%) used it for gaming. 38.4% of the students spent 5 hours or more per day on social media.
• The majority of the students (92.5%) never smoked, 5.5% were ex-smokers, and 2% are current smokers.
• Regarding substance abuse, 57.2% used unprescribed pills, 23.8% used alcohol, and 19% used hashish.
• The majority (87.2%) of the students had no chronic diseases and 12.8% had chronic diseases. Nearly three-quarters of the students (74.1%) did not have mental illness while 25.9% of the students had mental illness. Only 10.3% sought psychiatric consultation, and less than half (41.1%) were diagnosed with depression, and equal number of students (11.8%) were diagnosed with anxiety and OCD.
• Regarding family history of mental illness, 16.8% of the studied sample had family history of mental illness, and 40.6% of them reported family history of depression, 16.2% reported anxiety, 16.2% reported OCD, and 5.4% reported schizophrenia.
• Almost one-third of the studied sample (30.7%) had history of abuse, and 87.7% of them had emotional abuse, 25.6% had physical abuse, and 16.9% had sexual abuse.
• 45.3% of the studied sample were bullied. More than half of the students (51%) were bullied in primary school, 49.7% in preparatory school, 37.2% in high school, and 14.9% in college.
• 63.7% of the students were satisfied with perceived support. Most of the students (81.1%) stated asking for support when needed, while the rest (18.9) did not ask for support when needed. More than half of the students (57.2%) experienced a recent trauma or severe stress in the past six months, while 42.8% did not have such stresses/trauma.
Section II: Prevalence of BDD symptoms among the studied sample
• The prevalence of BDD symptoms among the studied sample was 5.3%.
• The most common areas of concern were skin (36.6%), belly size (36.2%) and nose/mouth/jaw/lips (32.9%), followed by thighs size (26.4%) and hair (22.8%).
Section III: Determinants of BDD symptoms among the studied sample
• Body dysmorphic disorder symptoms were observed more among the age group 19 to less than 21 years than the younger age group 17 to less than 19 years (7.4% and 4.6% respectively). The difference was not statistically significant (p=0.2). BDD symptoms were also more common in females (8.5%) than males (2.2%) and the difference was statistically significant (p<0.001). The females were nearly 4 times more likely to have BDD than males (CI=1.768–9.611, p=0.001).
• BDD was almost equal in very low (4.8%) and high socioeconomic score (4.9%). The difference was not statistically significant (p=0.918).
• BDD symptoms were more evident in students using the internet for social media and videos (6.1% and 5.1% respectively) than gaming (3.6%). The difference was not statistically significant.
• The students who spent 5 hours or more per day on social media were 3.6 times more likely to have BDD than students who spent less than 5 hours per day.
• 5.4% of the students who had never smoked were BDD positive and 5.7% of the students who were ex-smokers were BDD positive. The difference was not statistically significant (p=1.0).
• As for substance abuse, 5.4% of the students who had abused drugs met the criteria for BDD compared to 4.8% among students who did not abuse any drugs/substance. The difference was not statistically significant (p=0.69).
• Students with history of mental illness were found to be 3.5 times more likely to have BDD symptoms than those without such history, and the difference was statistically significant (p=<0.001).
• Students with family history of mental illness were 2.9 times more likely to have BDD symptoms than those without such history, and the difference was statistically significant (p=0.004).
• Students with history of abuse were found to be 3 times more likely to have BDD symptoms than those without such history. The difference was statistically significant (p=0.002).
• Students who reported history of exposure to bullying were 10 times more likely to have BDD symptoms than those who have not been bullied. The difference was statistically significant (p=<0.001).
• Students who were not satisfied with perceive support were found to be 2.3 times more likely to have BDD symptoms and the difference was statistically significant (p=0.015).
• Students who did not ask for support when needed were found to be nearly 4.3 times more likely to have BDD symptoms than students who asked for support. The difference was statistically significant (p=<0.001).
• Students who had a recent trauma or severe stress in the past 6 months were found to be 4.6 times more likely to have BDD symptoms than those who did not. The difference was statistically significant (p=0.002).
• Based on the findings on univariate analysis, nine variables were introduced for the stepwise multiple logistic regression, four variables proved to be significant predictors of BDD symptoms which were; female gender (OR=3.011, 95% CI=1.220-7.436), time spent on social media (OR=2.926, 95% CI=1.337 - 6.403), history of exposure to bullying (OR=6.202, 95% CI=1.994 - 19.291), and not asking for support when needed (OR=3.327, 95% CI= 1.296 - 8.542).
Based on the results of the current study, the following recommendations are suggested:
• There is a pressing need to increase awareness of BDD and its impact, directed to individuals, their families, communities, and the whole population through mass media and/or social media campaigns with the goal of promoting accepting diversity in body shape/size, inclusion, and building a positive self-image
• Designing and implementing special programs for psychoeducation and positive body image in schools and universities, and altering behaviors and circumstances that may lead to BDD (as childhood neglect, abuse or bullying).
• Continuous screening of BDD among adolescents and young adults aiming at early detection and intervention.
• Follow-up is a must in the treatment of individuals with BDD to reduce the risk of relapse, comorbidity and disability. It also reduces the rate of hospitalization
• Further studies are needed, to study BDD; its determinants, risk factors, its protective factors, and different treatment approaches.
Conclusion
In the light of the current study findings, the following can be concluded:
• According to the BDDQ results, body dysmorphic symptoms showed a prevalence of 5.3% among university students in Alexandria, and they were more common among females, and the most commonly reported body part of concern was skin.
• On investigating different variables by univariate analysis, nine variables were significantly associated with BDD. These variables were: female gender, time spent on social media, student history of mental illness, family history of mental illness, history of abuse, history of exposure to bullying, satisfaction with perceived support, not asking for support when needed, and the presence of recent trauma/severe stress in the past 6 months.
• Logistic regression analysis revealed that four variables proved to be significant predictors of BDD symptoms which were; female gender, time spent on social media, history of exposure to bullying, and not asking for support when needed.
Recommendations
I- For Ministry of health and general population:
• Policy and decision makers should be aware of the importance of mental health in general and mental illness including BDD to be able to plan the suitable strategies for prevention of mental illness in schools and universities at all levels.
• Raising awareness about BDD and its impact, directed to individuals, their families, communities, and the whole population through mass media and/or social media large-scale campaigns with the aim of educating the people about the disorder and its symptoms. Another goal is promoting accepting diversity in body shape/size, and building a positive self-image.
II- For schools and universities:
• Mental health should be addressed as an important public health topic. Social and emotional well-being should be focused on.
• Counseling and preventive mental health services should be supported in schools and universities, including: managing high-risk behaviours as substance abuse, and encouraging life skills training that reinforce self-esteem and resilience to social pressures.
• Developing and implementing tailored health education programs in schools and universities directed towards improving self-esteem, building a positive body image, accepting diversity and altering behaviors and circumstances that may lead to BDD.
• Implementing anti-bullying programs with the aim of reducing bullying and victimization by raising awareness to the role a group plays in maintaining bullying, promoting strategies to support victims and promoting empathy towards them.
• Developing guiding and advising services in schools by training teachers, social workers and school doctors, and encouraging them to be available during their office hours, to offer the students the help they need.
• Continuous screening of BDD among adolescents and young adults aiming at early detection and intervention.
• Follow-up is a must in the treatment of individuals with BDD to reduce the risk of relapse, comorbidity and disability. It also reduces the rate of hospitalization.
III- For the researchers:
• Further studies with large sample size representing the schools and universities should be conducted, to study BDD; its determinants, risk factors, its protective factors, and different treatment approaches.
• Intervention approaches require more research and testing regarding their efficacy and the best combinations possible.
• In Egypt, there is lack of research regarding BDD that need to addressed, in addition to designing multifaceted interventions targeting special groups of adolescents in schools and universities to spread knowledge and awareness about the disorder.