Body Dysmorphic Disorder 245
Risk and Prognostic Factors 
Environmental. Body dysmorphic disorder has been as sociated with high rates of child-
hood neglect and abuse. 
Genetic and physiological. The prevalence of body dysmor phic disorder is elevated in
first-degree relatives of individuals with  obsessive-compulsi ve disorder (OCD).
Culture-Related Diagnostic Issues 
Body dysmorphic disorder has be en reported internationally. It appears that the disorder
may have more similarities th an differences across races and cultures but that cultural
values and preferences may influence symptom content to some degree. Taijin kyofusho,
included in the traditional Japanese diagnost ic system, has a subtype similar to body dys-
morphic disorder: shubo-kyofu  (“the phobia of a deformed body”). 
Gender-Related Diagnostic Issues 
Females and males appear to have more similariti es than differences in terms of most clin-
ical features— for example, di sliked body areas, types of repetitive behaviors, symptom
severity, suicidality, comorbidity, illness course, and receipt of cosmetic procedures for
body dysmorphic disorder. However, males ar e more likely to have genital preoccupa-
tions, and females are more likely to have a comorbid eating disord er. Muscle dysmorphia
occurs almost exclusively in males. 
Suicide Risk
Rates of suicidal ideation and suicide attemp ts are high in both adults and children/ado-
lescents with body dysmorphic disorder. Furthe rmore, risk for suicide appears high in ad-
olescents. A substantial proportion of individuals attribute suicidal ideation or suicide
attempts primarily to their appearance concerns. Individuals with body dysmorphic dis-
order have many risk factors for completed suic ide, such as high rates of suicidal ideation