DYSMORPHIA: HETEROGENEOUS RISK FACTORS, CLINICAL AND DYNAMIC CHARACTERISTICS
Authors: Frolova *Veronica , Medvedev Vladimir , Gushanskaya Ekaterina 
Published: February 2025

Abstract

Background
The results of recent studies suggest that dysmorphia (DM) is a nosologically nonspecific syndrome (Medvedev 2016; Medvedev 2019). Patients with DM are often met among the clients of plastic surgeons and cosmetologists (Fletcher 2021;Wever, Wever and Constantian 2020). Given the above, it is considered important to study risk factors and clinical and dynamic characteristics of different types of DM in this category of patients.
The aim of the study was to investigate risk factors of DM and stereotypes of its dynamics in plastic surgeons and cosmetologists patients.

Method
Study used psychpathological method. Study sample consisted of 309 patients (78.6% female, aged 18-75) who have applied to a cosmetology or plastic surgery clinic with complaints about objectively unconfirmed "defects" of appearance.

Results
91,3% of patients fulfilled the ICD-10 criteria for dysmorphophobia nondelusonal (F45.2); 8,7% - the ICD-10 criteria for dysmorphophobia delusional (F22.88). Our findings indicate that the manifestation of DM can occur at any age period from 11 years to 70 years and DM isn’ t continuously persistent in 74.7% of patients - a phasic course in 41.7%, recurrent course in 33%. Chronic course was diagnosed in 25.3% of patients.No significant correlations were found between risk factors for DM and the stereotype of DM dynamics. The manifestation of overvalued DM most often occurred between 10-11 years (p&lt;0.0001), with subsequent age peaks at 23-26 (p&lt;0.0001), 31-33 (p&lt;0.0001) and 55-56 (p&lt;0.005) years. The periods of hormonal crises (puberty, involution) and retirement turned out to be a significant risk factors. Affective DM manifested between 23-26 years (p&lt;0.0001), with age peaks at 39-40 (p=0.0023) and 49-50 (p&lt;0.005) years. Risk factors significantly correlated with affective DM were related to the generative cycle and endocrine changes, as well as factors considered by the patients as subjectively significant stress (conflict, sexual problems, threat/loss of financial stability, loss of job or loved one).Hypochondriac DM most often began at the age of 31-33 (p&lt;0.0001), with a maximum frequency of exacerbations at the age of 49-50 (p&lt;0.005) and 63-66 (p&lt;0.005). The risk factors for hypochondriac DM were real somatic disorder as well as the death of a spouse or relative. Manifestation of Obsessive-Compulsive DM was predominantly between 23-26 years (p&lt;0.0001) with a peak at 39-40 (p&lt;0.0001) years. Significant risk factors: pregnancy and postpartum. Delusional DM most often manifested at the age of 23-26 (p&lt;0.0001) with peaks at 49-50 (p&lt;0.005), 63-66 (p&lt;0.0001), and over 70 (p=0.0017) years. Risk factors were pathological puberty and a situation of interpersonal conflict.

Conclusion
The obtained data allow to conduct targeted diagnostic search, preventive psychotherapeutic and early psychopharmacological treatment of persons with identified clinical manifestations and risk factors of DM.

References
1.Medvedev,V. 2016. 'Dysmorphic disorders: clinical and nosological heterogeneity.' Neurology, neuropsychiatry, psychosomatics 8, no.1:49-55.
2.Medvedev, V. 2019. 'Dysmorphophobia in patients of plastic surgery clinics.' KOSMETIK international 2:90-94.
3.Fletcher, L. 2021. ‘Development of a multiphasic, cryptic screening protocol for body dysmorphic disorder in cosmetic dermatology.' Journal of Cosmetic Dermatology 20:1254–1262.
4.Wever, C., Wever, A., Constantian, M. 'Psychiatric disorders in facial plastic surgery.' Facial Plastic Surgery Clinics of North America 28, no.4:451-460.