Body dysmorphic disorder in Lebanese dermatology patients: prevalence and correlates of depression, anxiety, stress, and trauma in a multitraumatized population.

Background: Body dysmorphic disorder (BDD) is a psychiatric condition marked by an intense preoccupation with perceived flaws in physical appearance that are minimal or unobservable to others. Given Lebanon's prolonged exposure to cumulative traumatic stress, the country represents a uniquely vulnerable setting in which to explore the interplay between psychological distress and BDD.Objectives: This study aims to: (1) investigate the prevalence of BDD among patients attending dermatology clinics in Lebanon; (2) examine the association between BDD and depression, anxiety, stress, and trauma in a multitraumatized society; and (3) explore the insight of patients with BDD regarding their perceived flaws.Method: We screened for BDD in Lebanese dermatology clinics using the Arabic Body Dysmorphic Disorder Questionnaire (ABDDQ) and examined its association with depression, anxiety, and stress using the 21-Item Depression, Anxiety, and Stress Scale (DASS-21). Trauma exposure was assessed using Criterion A of the PTSD Checklist for DSM-5 (PCL-5).Results: BDD was diagnosed in 7.6% of 472 participants in cosmetic and dermatology clinics combined. Participants with BDD were found to have significantly higher scores for anxiety (p < .001), depression (p < .001), stress (p < .001), and post-traumatic stress disorder (PTSD) symptoms (p < .001) on bivariate analysis. BDD was significantly associated with younger age, being single, student status, and trauma exposure. Higher BDD symptom severity correlated with greater psychological distress and lower insight (p < .001).Conclusion: This study reveals a 7.6% prevalence of BDD among Lebanese dermatology patients, closely linked to psychological distress, trauma, and poor insight, emphasizing the need for mental health screening and culturally appropriate diagnostic tools in dermatological care.