(PS9-57) Body Dysmorphic Disorder: An Enigma Reconsidered in the Hitop Taxonomy

Because Body Dysmorphic Disorder (BDD) remains an enigma that is currently overlooked in the HiTOP dimensional model of psychopathology, we reappraised these issues in an ethnically and culturally diverse sample. In a primarily Hispanic/Latino sample, we revisited our previous findings from two largely Caucasian samples, that extended the HiTOP model to include BDD as an internalizing disorder. Our previous findings supported eating disorder pathology more related to BDD’s characteristic body distortions, although it is formally diagnosed as being an obsessive-compulsive and related disorder based on its appearance preoccupations.

In this study, Confirmatory Factor Analysis (CFA) of data from the ethnically/culturally diverse sample was analyzed. Consistent with the  HiTOP  model, we tested a bifactor model to examine the hypothesis that BDD is an internalizing disorder and is more related to the eating pathology (EP) spectrum than  to the obsessive-compulsive and related disorders (OC-RD) spectrum.

Method

Sample and Procedure

190 undergraduates from a mid-sized university in the Southwest participated in an online survey.Sixty-eight percent of the sample identified as Hispanic/Latino or multi-racial a majority of the remainder idenfied as Caucasion or other. 

Measures

Spectra/Indicators         Disorder/Symptom Markers

Distress                        GAD:GAD-7; Depression: CES-D 10; PTSD: PCL-C

Fear:                             Agoraphobia: IDAS-SAD; Panic Disorder: SMPD; Social Anxiety: SOPHS

OC-RD.                       OCD: OCI-R; Trichotillomania: MGH; Excoriation: MSPS; Hoarding: SI-R

EP:                               Eating Pathology: BSQ-8B; Body Dysmorphic: DCQ; Binge Eating: BEDS-7

                                                                                     
                                                                                        Analysis and Results

In our CFA of a bifactor model all items loaded onto a single factor of General Psychopathology as well as their respective factor domains of  Distress, Fear, EP, or OC-RD and demonstrated good fit: χ²(46) = 58.162, p = .108, CFI = .989, TLI = .981, RMSEA = .037, SRMR = .035. A nested chi square difference chi sq diff) test demonstrated that BDD fit better as an indicator of EP (chi sq diff (1) = .015, p = .903) than the OC-RD indicator (chi sq diff (1) = 15.712, p < .001). We cross-validated this structure on random halves of the sample through invariance testing, which passed at a weak and strong level.

Discussion

 Our study informs both research and practice by giving BDD the broader context of an internalizing disorder in the comprehensive HiTOP model. Furthermore, it provides empirical support to suggest that the eating pathology spectrum be expanded to include body image pathology disorders such as BDD. We will further expand this research in the future to investigate our model 's invariance between all sample sfrom which data was collected. Overall, these findings suggest that BDD is a disorder that requires greater consideration to be correctly identified and appropriately treated.