Shame as a Risk Factor for Severe and Costly Outcomes in Body Dysmorphic Disorder

描述（由申请人提供）：身体畸形障碍（BDD）是一种严重的精神疾病，与极端负面的后果。最值得注意的是，BDD的失业程度，社会功能障碍，共病重度抑郁症和自杀倾向似乎高于大多数其他心理疾病，包括相关的疾病，如强迫症（OCD）。总之，这些结果对个人产生了巨大的心理和经济成本，对社会也产生了巨大的经济成本，使BDD成为一个严重的公共卫生问题。令人惊讶的是，与其他疾病相比，很少有研究研究可能有助于解释BDD中这些升高的负面结果的风险因素。本研究通过测试羞耻感作为BDD患者与健康个体和强迫症患者更严重结果的中心风险因素来解决这一差距。临床轶事讨论了羞耻作为BDD的核心，破坏性情绪，更广泛的情绪研究将羞耻与BDD患者中升高的每一个负面结果联系起来。然而，没有科学研究调查过BDD与健康个体或患有相关疾病的人（例如，强迫症），也没有研究研究如何羞耻与BDD的严重后果有关。目的1是对一般羞耻感进行第一次实证评估，将其作为一个核心的、强大的风险因素，导致更严重的结果（即，社会和职业损伤，抑郁症，自杀倾向）。此外，关于BDD中羞耻感的具体性质的信息具有重要的临床意义。特别是，身体羞耻感似乎是BDD的核心，几乎是普遍的。因此，除了BDD中更普遍的身体羞耻感之外，BDD中最严重的负面结果的风险最大的可能是那些具有更高的一般羞耻感的个体。因此，目的2是评估一般羞耻感是否是BDD中记录的负面结果的比身体羞耻感更强的风险因素。将通过在线BDD、OCD或非精神健康相关论坛、支持团体和诊所网站上发布的广告招募三组受试者（BDD、OCD比较、健康对照）。参与者将通过安全的在线网站提供自我报告数据。为了验证完善的自我报告筛选措施，将从每组中随机选择一个子样本，通过电话完成诊断访谈。选择基于互联网的方法是因为BDD的严重回避和损害，BDD是主要的兴趣群体（例如，30%的人可能会被关在家里）。因此，从诊所或研究实验室招募的样本可能会有偏见，结果不那么严重，也不那么令人羞愧。根据NIMH战略目标2.3，该项目的总体目标是将羞耻感确定为BDD（一种高度公共卫生关注的疾病）中严重和昂贵结果的可延展和强大的风险因素。这些信息有可能为BDD治疗提供新的靶点，并最大限度地减少BDD患者目前经历的痛苦和昂贵的后果。

DESCRIPTION (provided by applicant): Body dysmorphic disorder (BDD) is a severe mental illness associated with extremely negative consequences. Most notably, the degree of unemployment, social dysfunction, comorbid major depressive disorder, and suicidality appear higher in BDD than in most other psychological disorders, including related disorders like obsessive compulsive disorder (OCD). Together, these outcomes produce substantial psychological and economic costs to the individual, as well as significant economic costs to society, making BDD a serious public health concern. Surprisingly, scant research has studied risk factors that may help to explain these elevated negative outcomes in BDD, as compared to other disorders. The present study addresses this gap by testing shame as a central risk factor for more severe outcomes in those with BDD vs. healthy individuals and individuals with OCD. Clinical anecdotes discuss shame as a central, destructive emotion in BDD, and broader emotions research links shame to each of the negative outcomes that are elevated among those with BDD. However, no scientific research has investigated the degree of shame in BDD vs. healthy individuals or those with related disorders (e.g., OCD), nor is there research examining how shame relates to the severe outcomes in BDD. Aim 1 is to conduct the first empirical evaluation of general shame as a central, robust risk factor accounting for more severe outcomes (i.e., social and occupational impairment, depression, suicidality) in BDD vs. healthy control participants and participants with OCD. Additionally, information about the specific nature of shame within BDD has important clinical implications. In particular, body shame appears central and nearly universal to BDD. Thus, it may be that, beyond the more universal experience of body shame in BDD, it is individuals with elevated general shame who are at greatest risk for the most severe negative outcomes in BDD. Aim 2 is, thus, to evaluate whether general shame is a stronger risk factor than body shame for the negative outcomes documented within BDD. Participants will be recruited for the three groups (BDD, OCD comparison, healthy control) through advertisements posted on online BDD, OCD, or non-mental health related forums, support groups, and clinic websites. Participants will provide self-report data through a secure online website. To verify the well-established self-report screening measures, a randomly selected subsample from each group will be called to complete a diagnostic interview via phone. An Internet-based approach was chosen because of the severe avoidance and impairment in BDD, the primary group of interest (e.g., 30% may be housebound). Thus, samples recruited from clinics or research labs would likely be biased, with less severe outcomes and shame. In keeping with NIMH Strategic Objective 2.3, the overarching goal of this project is to identify shame as a malleable and robust risk factor for serious and costly outcomes in BDD, a disorder of high public health concern. This information has the potential to provide new targets for BDD treatment and to minimize the painful and costly consequences that BDD sufferers currently experience.