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，具有极其负面的后果。最值得注意的是，BDD患者的失业程度、社交功能障碍、共病性重度抑郁症和自杀倾向似乎高于大多数其他心理障碍，包括强迫症（OCD）等相关障碍。总之，这些结果给个人带来了巨大的心理和经济成本，也给社会带来了巨大的经济成本，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。目前的研究通过测试羞耻感作为BDD患者、健康个体和强迫症患者更严重后果的中心风险因素来解决这一差距。临床轶事认为羞耻感是BDD的核心破坏性情绪，更广泛的情绪研究将羞耻感与BDD患者的每一种负面结果联系起来。然而，没有科学研究调查过BDD患者与健康个体或相关疾病（如强迫症）患者的羞耻感程度，也没有研究调查过羞耻感与BDD严重后果之间的关系。目的1是对一般羞耻感进行第一次实证评估，将其作为BDD与健康对照组和OCD参与者中更严重的结果（即社会和职业障碍、抑郁、自杀）的核心、强有力的风险因素。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。尤其是，身体羞耻感似乎是BDD的核心，几乎是普遍存在的。因此，除了BDD中身体羞耻感的更普遍的经历之外，一般羞耻感升高的个体在BDD中最严重的负面结果的风险最大。因此，目的2是评估总体羞耻感是否比身体羞耻感对BDD中记录的负面结果有更强的风险因素。参与者将通过发布在在线BDD、OCD或非心理健康相关论坛、支持小组和诊所网站上的广告招募到三个组（BDD、OCD比较、健康对照组）。参与者将通过一个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的严重避免和损害，主要感兴趣的群体（例如，30%可能足不出户）。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，也不会让人感到羞耻。为了与NIMH战略目标2.3保持一致，本项目的总体目标是将羞耻感确定为BDD（一种高度关注公共卫生的疾病）中严重且代价高昂的后果的可扩展且强大的风险因素。这一信息有可能为BDD治疗提供新的目标，并将BDD患者目前所经历的痛苦和昂贵的后果降到最低。

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.