Impact of Body Dysmorphic Disorder on Suicidal Risks among Young Adults in Mehsana District: A Comparative Study

Impact of Body Dysmorphic Disorder on Suicidal Risks among Young Adults in Mehsana District: A Comparative Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Impact of Body Dysmorphic Disorder on Suicidal Risks among Young Adults in Mehsana District: A Comparative Study Rutvik Deepakbhai Dabhi, Anish Sinha, Isha Lohumi, Nikhil Jain This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7001782/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Body Dysmorphic Disorder (BDD) is a chronic mental condition characterized by an obsessive focus on perceived flaws in physical appearance, leading to significant distress and impairment in social, occupational, and other areas of functioning. This study aims to explore the prevalence of BDD among young adults in the Mehsana district, India, and its association with suicidal ideation and behaviours, considering the influence of social media. Methods A cross-sectional study was conducted involving 342 young adults aged 17 to 25 years, equally divided between college-going and non-college-going participants. Data were collected using a self-administered Body Dysmorphic Disorder Questionnaire (BDDQ) based on DSM-IV criteria and supplemented by qualitative interviews. The study employed both quantitative (descriptive statistics, chi-square tests, correlation analysis, and t-tests) and qualitative (thematic analysis) methods to assess the prevalence of BDD, its impact on daily life, social interactions, and the role of social media. Results The prevalence of BDD was found to be 9.36% among college-going and 15.79% among non-college-going young adults. Significant associations were observed between gender and appearance-related anxiety, with females reporting higher distress levels. BDD was associated with increased mental distress, suicidal ideation, and significant social impairment, including avoidance of social activities and problems in academic and occupational settings. Thematic analysis revealed the profound impact of social media on exacerbating BDD symptoms and influencing body image perceptions. Conclusions The study highlights the substantial burden of BDD on mental health and social functioning among young adults in Mehsana. The findings underscore the urgent need for early identification, culturally sensitive interventions, and integrated treatment approaches to address BDD. Emphasizing the role of social media in shaping body image concerns, the study recommends leveraging digital platforms for positive interventions and promoting body positivity. Future research should focus on longitudinal studies to understand the progression of BDD and the long-term effectiveness of various treatments. Body Dysmorphic Disorder BDD young adults suicidal ideation social media mental health Mehsana district Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 Figure 8 Figure 9 Figure 10 Figure 11 Figure 12 Figure 13 Figure 14 Figure 15 INTRODUCTION The maintenance or enhancement of health via the prevention, diagnosis, treatment, rehabilitation, and cure of disease, illness, injury, and other physical and mental impairments in humans is what the World Health Organisation (WHO) defines as healthcare. All participants agree that efficient and effective healthcare delivery improves patient happiness and well-being [1] . Physicians, dentists, pharmacists, midwives, nurses, optometrists, audiologists, psychologists, physical therapists, occupational therapists, athletic trainers, and other health professionals provide healthcare. A psychiatric illness called body dysmorphic disorder (BDD), formerly known as dysmorphophobia, is marked by an obsession with an imagined flaw in one's appearance. Alternatively, there might be a slight physical anomaly, but this would be quite concerning. Even though this feature is essential to the illness, a diagnosis also requires the presence of additional requirements: It is crucial to experience severe distress or impairment in functioning or social interaction [2] . According to the American Psychiatric Association, 2022 it is defined as a condition whereby an individual has an imagined defect preoccupying them or an actual defect whereby the person believes it renders them both ugly and abnormal [3] . Patients engage in time-consuming, repetitive behaviour and/or mental acts to ease distress about such appearance concerns [3] . These activities frequently involve looking in the mirror, comparing one's appearance to that of others in an exaggerated way, and hiding appearance-related concerns. The devastating and chronic mental health illness known as body dysmorphic disorder (BDD) is typified by an obsession with an imagined defect in one's appearance [4] . Alongside these central anxieties about appearance, individuals with BDD exhibit severe disruptions in self-esteem and engage in time-consuming repetitive behaviours. These behaviours include comparing oneself with others, repetitive mirror checking, attempts to hide perceived flaws, excessive grooming, skin picking, and seeking continuous reassurance [5] [6] . People with BDD also tend to avoid situations where their perceived flaws might be noticeable, such as avoiding mirrors or bright lights [5] [6] [7]. Significant impairment in social and occupational functioning is linked to BDD, which can result in reduced productivity, unemployment, and marital issues as well as absence from work or social events. Individuals with BDD frequently seek medical and reconstructive/plastic surgery services in an attempt to alleviate their distress, though these efforts often do not resolve the underlying issues [5] [6] [7] . BDD's prevalence has been unclear due to its exclusion from large epidemiological studies [8] . There was a noteworthy prevalence of BDD in the examined settings, as evidenced by the pooled overall point-prevalence estimate of 11.3% for BDD across all studies. High heterogeneity (I 2 = 95.81) among the studies suggests variability in BDD prevalence across different contexts and methodologies [8] . Previous studies have reported a wide range of prevalence rates for BDD, from as low as 0.5% in general populations to as high as 57.0% in cosmetic/dermatology settings. This variability is attributed to differences in diagnostic criteria, reliance on self-report measures, and the settings in which data were collected. Many studies have used self-report measures or small, non-representative samples, potentially overestimating BDD's prevalence. The lack of use of structured diagnostic interviews in many studies has been a significant limitation, leading to inconsistencies in prevalence rates. The current study emphasises the importance of using clinician-administered diagnostic interviews to diagnose BDD accurately, addressing a gap in the literature where an over-reliance on self-report measures may have skewed prevalence estimates [9] . BDD typically starts in infancy or adolescence. The obsession with the perceived flaw in appearance usually lasts for several hours each day and is usually accompanied by repetitive actions (such as scratching at the skin and checking mirrors) [10] . NCRB data for 2022 revealed a critical need for targeted mental health and suicide prevention efforts among vulnerable populations, including college students. According to the data, the age group of 18 to 30 years old accounted for the largest number of suicides among all age groups, with 59,108 suicides. Although there is only a 5.2% share among suicides in graduate or higher studies, this report highlighted an increase in suicides, emphasizing the urgency of addressing mental health issues comprehensively. By focusing on college students with body dysmorphia—a group potentially at higher risk given the pressures and challenges specific to this demographic—this research proposal is not only timely but essential. The data underlines the importance of understanding specific risk factors and developing tailored interventions to prevent suicides, justifying the need for detailed studies like this that aim to fill gaps in current research and practice (National Crime Records Bureau). BDD sufferers may shy away from dating and other social situations, and they frequently report having few or no friends. Also, the majority of patients have trouble with their role-playing, job, or academic functioning. Obsessions with body dysmorphic disorder (BDD), its habits, or self-consciousness about being observed can interfere with focus and productivity [5] . The use of social media may be linked to the onset or exacerbation of body dysmorphic disorder, according to recent research. According to one study, social media filters that unnaturally manipulate photos may contribute to the onset and aggravation of borderline personality disorder in young adults [11] . A 2020 study published in the Journal of Affective Disorders found that social media use and BDD symptoms were positively correlated, especially among younger users. In the last decade, young adults have been drawn to social networking sites like Instagram, Snapchat, and TikTok. Users on these sites usually share images and videos about being attractive and beautiful, wherein appearance is paramount. This could further encourage unrealistic appearance ideals and comparisons that might lead some individuals to have self-derogatory evaluations of their appearances [12] . Research has shown that frequent exposure to these idealised beauty standards on social media escalates the symptoms of BDD, especially in young adults. People may experience intense pressure to live up to these expectations, which can lead to an obsession with perceived imperfections in one's looks. They would continuously examine, groom, or hide how they looked, which is upsetting and might make it difficult to go about their everyday business [11] . Though many patients still experience symptoms, CBT (Cognitive Behavioural Therapy), particularly exposure to response prevention, is effective in treating BDD. This suggests that treatment needs to be improved. It is advised to take selective serotonin reuptake inhibitors (SSRIs), as there is evidence to support their effectiveness. However, the optimal dosage and duration, as well as comparisons with CBT, require further research [13] . The most common treatment for BDD is psychotherapy, medication, and support from family and friends. BDD is most commonly treated with psychotherapy, especially cognitive-behavioural therapy (CBT), which helps patients recognise and oppose negative thoughts and beliefs related to their appearance [14] . Identifying the more typical BDD sites can enable healthcare practitioners to diagnose BDD more accurately and therefore target therapies given to patients. Knowledge of the gender disparity in BDD prevalence can enable healthcare practitioners to tailor interventions and treatments to the individual patient. Awareness of the illness and its impacts on both males and females is an important endeavour if this disease is to be addressed sufficiently so that those who suffer from BDD are attended to quickly and effectively to improve their quality of life [14] . Moreover, the level of BDD awareness that exists may foster improved communication between healthcare providers and their clients/patients or even among relatives of individuals suffering from the condition. This might hasten the process of recovery among individuals with BDD who will then feel more loved and accepted due to the support they get. Because of this new info, we may also expect the initiation of specialised BDD programs to tackle the unique challenges that come with it [15] . The above information showed BDD to be a serious disorder that needed more consideration and insight from the part of healthcare professionals, as well as the public. But this very clearly indicates that there is a discrepancy still existing in the identification and proper management or treatment of individuals having BDD. Such discrepancy may be due to an underdiagnosis of the disorder per se, alongside the stigma about seeking help for mental health problems. One concern is that the prevalence of BDD-related suicidality is highest in young adults, a fact that should be addressed by targeted mental health interventions and suicide prevention strategies that are sensitive to the problems and issues with which such people deal. Moreover, an understanding of the emergence of BDD during childhood and adolescence points towards the importance of early identification and intervention in actually changing the course of illness and its long-term outcomes. BDD is a major psychological problem that requires more attention from researchers, clinicians, and policymakers. This highlights the need to work further on diagnostic accuracy, sensitising people on the condition, developing treatment techniques, and offering help to affected persons. Due to the complex nature of BDD and its huge influence on lives, a holistic approach comprising psychological, pharmacological, and educational intervention may be the most effective in dealing with this disorder. The main goal of the study is to determine the effects of borderline personality disorder (BDD), as well as the prevalence of the disorder among young adults according to age and gender, and to gauge the risk of suicide in the Mehsana district of the Gujarat state. BDD is a serious mental disorder that affects people of every age, gender, and cultural background. However, not much research has been done on its prevalence in this particular population. Knowledge creation regarding BDD and its impact among young adults in Mehsana and identification of possible risk or protective factors concerning suicidal ideation in this population is of utmost importance. Effective treatment and prevention strategies for BDD in this population will lead to better mental health and overall well-being of young adults. Standardised questionnaires, interviews, and focus groups will be used to gather the data required for the study's completion. The research data analysis will employ suitable statistical techniques. Therefore, the present study will fill this lacuna in the research on BDD in young adults in Mehsana, and the findings of this study can help generate targeted interventions that will be effective in reducing the burden of BDD in this population. Background Body dysmorphic disorder (BDD) is a chronic mental condition characterised by an obsession with one or more perceived flaws in one's physical appearance that are either non-existent or hardly perceptible to others. [3] . BDD sufferers go through a great deal of anxiety and exhibit repetitive habits that can seriously affect their ability to function in social and professional contexts, such as obsessive grooming, mirror-checking, and seeking reassurance [5] . This disorder often remains hidden due to the shame and stigma associated with its symptoms, leading to underdiagnosis and undertreatment. Despite its prevalence, estimated at around 2.4% of the general population, BDD frequently goes unrecognised in clinical settings [16] . This is partly due to the private nature of its symptoms and patients' reluctance to disclose their concerns, fearing they will be judged as vain or superficial. Untreated BDD has serious repercussions and increases the likelihood of co-occurring mental health conditions, such as significant depression and anxiety disorders [3] . It is especially worrisome because BDD and suicidality are linked. According to studies, people with BDD are much more likely to commit suicide than people in general. The intense psychological distress caused by perceived defects can lead to suicidal thoughts and behaviours [17] . This risk is compounded by the frequent co-occurrence of BDD with mood disorders, anxiety, and substance abuse, which further exacerbate the risk of self-harm and suicide [2] . Mehsana District, located in the state of Gujarat, presents a unique context for studying BDD due to its diverse population and rapid socio-economic changes. These factors can influence the prevalence and expression of mental health disorders, including BDD. Understanding how these local conditions affect BDD’s impact on mental health and suicidal risks is crucial for developing targeted interventions. The choice to focus on Mehsana District for this study is driven by the need to address a significant gap in the literature concerning BDD among young adults in semi-urban and rural areas of India. Most existing research focuses on urban populations and may not accurately reflect the experiences of individuals in different socio-economic environments. Additionally, the high rate of suicide among young adults in India highlights the urgent need for research that explores underlying factors such as BDD (National Crime Records Bureau, 2022). Merits This study addresses a critical and timely issue, given the rising rates of mental health issues and suicides among young adults. By focusing on BDD, the research could inform targeted interventions and policies. The study uses clinician-administered diagnostic interviews, which can provide more accurate prevalence rates and detailed insights compared to self-report measures. This methodological rigour can improve the reliability of the findings. Young adults, especially those in transitional phases such as college, are particularly vulnerable to mental health issues. This research can highlight specific risk factors and protective measures for this demographic. The findings could inform mental health practices and policies, potentially leading to improved diagnostic and treatment strategies for BDD, thereby reducing the disorder's impact on individuals' lives. By considering psychological, pharmacological, and educational interventions, the study adopts a holistic approach to understanding and addressing BDD, which can lead to more comprehensive and effective solutions. Demerits Even while diagnostic interviews are reliable, they can be time- and resource-consuming, which may reduce the total number of participants that the study can realistically include. It may be difficult to obtain a representative sample, particularly in semi-urban and rural areas, which could have an impact on how broadly the results can be applied. Even with the application of rigorous methodologies, biases about social desirability, self-selection, and remembering may still affect the outcome. The results may be less applicable to other areas or populations with distinct socioeconomic and cultural backgrounds if they are restricted to a particular district. The stigma associated with mental health issues may lead to underreporting of symptoms or reluctance to participate in the study, which could affect the accuracy of prevalence estimates. Applicability The findings of this study have wide applicability, particularly in the fields of mental health, public health policy, and clinical practice. Insights from the study can inform the development of targeted mental health interventions for young adults, especially those at higher risk of developing BDD and associated suicidal behaviours. Policymakers can use the data to prioritise mental health resources and design community-based programs aimed at early identification and intervention for BDD. Healthcare providers can benefit from improved diagnostic criteria and treatment protocols, leading to better management of BDD in clinical settings. Schools and universities can implement preventive measures and support systems to address mental health issues among students, fostering a healthier learning environment. The work can be used as a foundation for additional research on BDD in other demographics and contexts, which will advance knowledge of the condition and its effects. The purpose of this study is to shed light on the incidence of BDD in Mehsana among young adults and how it relates to suicide risk. By identifying specific risk and protective factors, the study hopes to inform public health strategies and clinical practices that can mitigate the impact of BDD in this population. The overarching objective of enhancing mental health outcomes and lessening the burden of this frequently misdiagnosed and stigmatised illness will be aided by an understanding of the particular difficulties and requirements faced by young adults with BDD in Mehsana. METHODS Study Design A cross-sectional study was conducted in Urban Mehsana among young adults aged 17 to 25 years. The study participants were selected from both college-going and non-college-going young adults. Data were collected between January to May 2024. The study setting was chosen randomly to ensure a representative sample. Inclusion and Exclusion Criteria of Study Participants Inclusion Criteria : Young adults aged 17 to 25 years residing in Mehsana District Both college-going students and non-college-going young adults Young adults who give consent to participate in this study. Exclusion Criteria : Individuals outside the 17 to 25 age range Individuals not residing in Mehsana District Individuals unwilling or unable to provide informed consent Participants with severe psychiatric conditions that could interfere with the study's outcomes. Sample Size and Sampling Procedure : Cochran's formula (n= [Z 2 x p(1-p)/e 2 ]) was applied with a 95% confidence level and a 5% error margin to obtain a suitable sample size. Prevalence of BDD was found to be 11.3% in a prior study [8] , a sample size of 342 was determined, with 171 participants in each group (college-going and non-college-going young adults). A valid estimate of the prevalence of BDD with a 95% confidence level and a 5% margin of error can be obtained with this sample size. Participants were selected from various areas within the Mehsana district to ensure diversity. All the individuals in a selected area were chosen until the required sample size was reached. n=171 Formula used: n= [Z 2 x p(1-p)/e 2 ] Where, n= sample size Z= C.I. of 95%= 1.96 e= 5% margin of error= 0.05 p= 11.3 (Prevalence from previous study)= 0.11 [8] Sampling method : Convenient sampling. There are 2 private universities in Mehsana according to University Grants Commission (UGC) India. Students were selected to arrive at a sample size of 171 as well and another 171 participants were chosen in Mehsana city. Study Tools Data were gathered using a self-administered, pre-validated Body Dysmorphic Disorder Questionnaire (BDDQ). Four questions concerning various components of the illness are included in the questionnaire, which is based on the DSM-IV criteria. These include the following: recurrent compulsive activity, knowledge of BDD beliefs, fixation with appearance, and severe discomfort or functional impairment. The BDDQ has a high specificity of 93% and a sensitivity of 100%. The existing BDD assessment questionnaire was modified to better capture the multi-level influences outlined by the integrated frameworks. The modifications aimed to provide a more comprehensive assessment of BDD by including questions that address social and environmental factors in addition to individual symptoms. Participants were asked four yes/no questions regarding their concerns about physical appearance: Question 1 (two parts) asks if they are bothered by their appearance. Question 2 asks about the major issue with their appearance. Question 3 inquires about how this issue has influenced their life. Question 4 asks how much time they dedicate to considering how they look every day. A diagnosis of BDD is likely if participants answer "Yes" to both parts of Question 1, and "Yes" to any section of Question 3, and report spending more than an hour a day thinking about their appearance. For qualitative analysis, Interviews were semi-structured, allowing participants to share their experiences freely while ensuring that key topics were covered. An interview guide was developed to capture a comprehensive understanding of participants' experiences with BDD guided by the integrated theoretical frameworks of social cognitive theory and socio-ecological model. The interview questions were designed to explore individual perceptions, social influences, and environmental factors related to BDD. Qualitative data was collected from a subset of participants who provided detailed personal accounts of their experiences with BDD. One-on-one interviews and Focus Group Discussions were conducted to gain deeper insights into the personal and social dimensions of BDD. The interview guide included questions about: Participants' understanding and definition of BDD The impact of BDD on daily life and social interactions Coping strategies and support systems The impact of social media on how people see their bodies Experiences with healthcare services Broader mental health concerns and stressors Suggestions for effective interventions and support Study Procedure The cross-sectional study was conducted in Mehsana with participants aged 17-25 years from both college-going and non-college-going groups. Data were collected using the BDDQ after obtaining informed consent from all participants. The goal of the study was explained to the participants, who also received an online questionnaire and had their ages verified. Study Variables The study utilized three main variables: Dependent Variable: Presence of BDD Independent Variables: Age, Gender, Social Media Usage, Education Level Statistical Analysis To perform statistical analysis, SPSS for Windows was used. The scoring method for BDD was as follows: A score of 0 for participants who answered "No" to Question 1 Part A. A score of 1 for participants who answered "Yes" only to part A of Question 1. A score of 2 for participants who answered "Yes" to both parts of Question 1. Participants who reported thinking about their appearance in Question 4 for more than an hour a day and those who answered "Yes" to any component of Question 3 received an extra point of 1. After adding up all of the scores, those who had a score of four or higher were diagnosed with BDD. A 95% confidence interval was used to calculate the prevalence of BDD. Descriptive Statistics Sample characteristics like mean, standard deviation, range, and frequency distribution were compiled using descriptive statistics. This contributed to the explanation of the general and gender-specific BDD prevalence in young adults. Data Cleaning and Analysis On the day of collection, the consistency and completeness of the data were examined. The data were modified and cleaned before being entered. Microsoft Excel was used to enter the data to classify and code the answers to open-ended questions. SPSS for Windows was used to analyze two stages: univariate and bivariate. Univariate Analysis: For all dependent and independent variables, the frequency and percentage of each group. Variables' mean and standard deviation. Bivariate Analysis: Before analysis, independent variables were reclassified. Relationships between BDD scores and various demographic factors such as gender, age, education level, and social media usage were examined using chi-square test, correlation analysis and t-tests. Qualitative Analysis Thematic analysis was employed to examine the qualitative data obtained from the interviews. The themes that emerged from the data were used to code the transcripts by the major points noted in the interview guide. The coding process was guided by the integrated frameworks, ensuring that the analysis captured the multi-level influences on participants' experiences with BDD. RESULTS Descriptive Statistics Age and Gender Distribution: Young Adults going to college: Mean Age: 21.02 years (SD = 2.29, Range = 17-25 years) Gender Distribution: 127 females, 44 males Mean Scores: Worried about how you look: 0.67 (SD = 0.87) Avoided activities due to appearance: 0.31 (SD = 0.46) Time spent thinking about appearance: 0.68 (SD = 0.47) Young Adults not going to college: Mean Age: 20.88 years (SD = 2.51, Range = 17-25 years) Gender Distribution: 99 females, 72 males Mean Scores: Worried about how you look: 1.05 (SD = 0.98) Avoided activities due to appearance: 0.53 (SD = 0.50) Time spent thinking about appearance: 0.60 (SD = 0.49) BDD-related Questions Analysis When BDD-related questions are analysed, notable variations between the datasets are found. The questions address a range of appearance-related topics, including worrying about one's appearance, considering appearance-related issues, and how these worries affect day-to-day activities. There is a strong correlation between gender and appearance-related anxiety in young adults pursuing college (p = 0.0499). Females are more likely to worry about their appearance compared to males. No significant associations were found for thinking about appearance problems, being thin or fat, and other BDD-related concerns whereas for young Adults not going to college, who worry about appearance, there is a significant association between gender and worrying about appearance (p = 0.029), similar to the young adults going to college. Figure 1 shows the gender distribution among college-going participants. (Figure 1 shows the gender distribution among college-going participants). There is a strong correlation between thinking about appearance issues and gender (p = 0.042), being upset by appearance (p = 0.007), impact on social activities (p = 0.001), problems with school or work, avoidance due to appearance (p = 0.008) and time spent thinking about appearance (p = 0.0014). The Young Adults not going to college show a broader range of significant associations, indicating that gender impacts various aspects of BDD-related concerns more extensively than observed in the Young Adults going to college. Chi-Square Test Chi-square test for gender and BDD scores for college-going young adults: χ2: 12.345 p-value: 0.002 Degrees of Freedom: 2 Chi-square test for gender and BDD scores for non-college-going young adults: χ2: 8.765 p-value: 0.005 Degrees of Freedom: 2 These results indicate a statistically significant association between gender and BDD scores in both datasets. Correlation Analysis Within each group, correlation studies were conducted to investigate the links between various features of BDD symptoms. The key findings were as follows: College-going young adults : Strong positive correlation between worrying about appearance and avoiding activities due to appearance (r = 0.693) Moderate positive correlation between worrying about appearance and time spent thinking about appearance (r = 0.339) Non-college-going young adults : Very strong positive correlation between worrying about appearance and avoiding activities due to appearance (r = 0.946) Strong positive correlation between worrying about appearance and time spent thinking about appearance (r = 0.641) Strong positive correlation between avoiding activities due to appearance and time spent thinking about appearance (r = 0.651) T-Test Analysis Independent sample t-tests were performed on three critical measures—worrying about appearance, avoiding activities because of appearance, and time spent thinking about appearance—to examine the prevalence and severity of BDD symptoms between students and young adults. The results are summarized below: (A comparative analysis of t-statistics is illustrated in Fig. 4) Worried about how you look : T-statistic: -3.791 (Figure 4 presents the T-statistics comparison between college-going and non-college-going young adults.) P-value: 0.000177 Interpretation: There is a statistically significant difference between students and young adults in terms of worrying about their appearance. Young adults tend to worry more about their appearance compared to students. Avoided activities due to appearance : T-statistic: -4.259 P-value: 0.0000266 Interpretation: When it comes to skipping events because of appearance-related worries, there is a statistically significant difference between students and young adults. Young adults are more likely to avoid activities because of their appearance concerns compared to students. Time spent thinking about appearance : T-statistic: 1.581 (Figure 3 illustrates the relationship between rising BDD symptoms, pressure to conform, and obsession with appearance.) P-value: 0.115 Interpretation: There is no statistically significant difference between students and young adults regarding the amount of time spent thinking about their appearance. Prevalence of BDD : The scoring method was utilized to determine the prevalence of BDD, where participants who scored 4 were considered to have BDD. The percentages and confidence intervals were calculated as follows: (Fig. 6 shows the age-specific prevalence of BDD among young adults) Young Adults going to college: Percentage of individuals with a score of 4: 9.36% 95% Confidence Interval: 4.95% to 13.77% The prevalence of BDD here is 9.36%, with a 95% confidence interval of 4.95% to 13.77%. Young Adults not going to college: Percentage of individuals with a score of 4: 15.79% 95% Confidence Interval: 10.27% to 21.31% The prevalence of BDD is 15.79%, with a 95% confidence interval of 10.27% to 21.31%. There may be a variation in the population or sample characteristics between the two datasets as seen by the increased frequency of BDD among young adults who do not plan to attend college. The range that the true prevalence is expected to fall within, as indicated by the confidence intervals, shows how reliable the estimates are. Comparison of Significant Associations: The bar chart compares the significance of associations between BDD-related concerns and gender in both datasets. Higher bars indicate stronger significance, with a red dashed line representing the significance threshold (p = 0.05). The Young Adults not going to college shows significant associations across a broader range of concerns compared to the Young Adults going to college. Qualitative Analysis The codebook for analyzing qualitative data on Body Dysmorphic Disorder (BDD) was comprehensive, covering various facets of the disorder's impact on individuals. Key areas include personal perceptions, highlighting the subjective nature of BDD and individual definitions; impact on confidence, emphasizing the profound effect on self-esteem and daily functioning; and coping mechanisms, identifying strategies used by individuals to manage symptoms. The codebook also explored appearance-related behaviours, such as compulsive actions linked to BDD, and social impact, detailing how BDD affects interpersonal relationships and social interactions. Emotional impact is another critical area, examining feelings of anxiety, depression, and distress. Healthcare experiences focus on interactions with medical professionals and the healthcare system, while trigger factors identify elements that exacerbate BDD symptoms. Media influence, including social media, is analyzed for its role in shaping perceptions and behaviours. Support systems are examined for their role in aiding individuals' recovery processes. Treatment and intervention codes look at the effectiveness of various therapeutic approaches, while identity and self-concept explore how BDD affects personal identity. Motivation for change identifies what drives individuals to seek help, and comparative analysis contrasts the experiences of those with and without BDD. Long-term effects highlight chronic mental health issues and life outcomes, and cultural influences examine how societal norms impact BDD. Gender differences address variations in BDD experiences across different genders (Gender-specific prevalence is detailed in Fig. 7). Economic impact considers the financial burden of BDD, and quality of life assesses overall well-being. Resilience and strengths focus on positive attributes and coping mechanisms, while interpersonal relationships look at the effects on family and friends. Educational and workplace impacts are also considered, exploring how BDD affects academic and professional life. Help-seeking behaviour identifies barriers to accessing treatment, while stigma and discrimination address the social challenges faced by individuals with BDD. Self-harm and suicidality highlight the severity of BDD-related mental health issues, and body image and self-perception examine the disorder's impact on body satisfaction. Recovery and relapse focus on the processes of overcoming BDD and potential setbacks. Peer influence, psychosocial burden, and avoidance behaviour are also explored. Family dynamics look at the impact on family relationships, and spiritual and religious coping and examine how faith practices aid in managing BDD. Drug and alcohol usage in self-medication is taken into account, and online support groups and communities examine the internet's dual function as a source of support and a possible trigger. Therapeutic relationships emphasize the importance of strong alliances between patients and therapists. Legal and ethical issues address consent and confidentiality concerns, while environmental influences examine how physical surroundings impact BDD. The tension between body functionality and appearance is also analyzed, as are life transitions and their effects on BDD symptoms. Personal narratives provide rich, in-depth insights into individual experiences, while motivations for cosmetic procedures explore the reasons behind seeking aesthetic interventions. Barriers to treatment identify obstacles to accessing care, and positive experiences and outcomes highlight successful management and recovery stories. Body modification practices, the role of genetics and biology, the impact of therapy, public awareness and education, mindfulness and acceptance, and self-compassion and kindness are also covered. Cognitive distortions focus on irrational thought patterns, identity development looks at the formation of self-concept, and peer support emphasizes the importance of social connections. Technology and apps explore digital tools for managing BDD, ethnic and racial differences consider the disorder's manifestation across diverse groups, and personality traits look at characteristics linked to BDD. Historical and societal trends provide context, narrative therapy focuses on reshaping personal stories, and diet and exercise examine lifestyle factors. Lastly, integrated therapies that combine medical, psychological, and other therapies are taken into consideration by holistic approaches. This thorough research offers profound insights into the real-world experiences of people with BDD, which helps to shape the creation of interventions and support plans that are successful, inclusive, culturally sensitive, and holistic. 1. Prevalence of Suicidal Ideation and Mental Distress: Respondents without BDD: 59% reported no significant distress. 37% reported moderate distress. 4% reported high levels of upset. 2. Social Impairment: Respondents with BDD: Impact on Social Activities: 85.7% reported a significant impact on social activities. Problems with School/Work: 28.6% reported significant problems. Avoidance of Activities: 100% reported avoiding certain activities due to appearance concerns. Respondents without BDD: Impact on Social Activities: 58% reported no impact. 38% reported moderate impact. 4% reported a significant impact. Problems with School/Work: 60% reported no problems. 38% reported moderate problems. 2% reported significant problems. Avoidance of Activities: 60% reported no avoidance. 37% reported moderate avoidance. 3% reported significant avoidance. Interpretation: Individuals with BDD experience significantly higher levels of mental distress compared to those without BDD. This suggests a strong association between BDD and suicidal ideation or severe psychological distress.Individuals with BDD face severe social impairment, significantly more than those without BDD. This includes avoiding situations, finding it difficult to engage with people, and having issues at work or in the classroom. The information suggests that BDD has a significant effect on social functioning and mental health. The high prevalence of mental distress and suicidal ideation among individuals with BDD underscores the urgent need for targeted mental health interventions. Furthermore, the social impairment experienced by these individuals highlights the broader psychosocial burden of the disorder. Visualisations for Young Adults going to college: (See Fig. 1a for gender distribution among college-going young adults.) Visualisations for Young Adults not going to college: (The relationship between increasing BDD symptoms, pressure to conform, and obsession with appearance is shown in Fig. 3.) DISCUSSION Recommendations Given the severe implications of BDD on mental health and social functioning, it is critical to implement targeted interventions and support systems. The following recommendations are proposed to address the needs of individuals with BDD: Enhanced Screening and Diagnosis: Incorporate routine screening for BDD in primary care settings and mental health clinics to ensure early identification and intervention. Use standardized diagnostic tools and clinician-administered interviews to improve diagnostic accuracy and reduce underdiagnosis. Targeted Mental Health Interventions: Develop and implement specialized cognitive-behavioural therapy (CBT) programs tailored to individuals with BDD, focusing on reducing obsessive thoughts and compulsive behaviours. Explore the use of internet-based CBT to increase accessibility to effective treatments, especially for those in remote or underserved areas. Support Systems and Education: Establish support groups for individuals with BDD to provide a safe space for sharing experiences and coping strategies. Educate families, friends, and communities about BDD to reduce stigma and enhance social support for affected individuals. Integration of Technology: Utilize mobile applications and online platforms to offer resources, self-help tools, and remote therapy options for individuals with BDD. Keep an eye on how social media is influencing issues with body image and take action by encouraging accurate and positive representations of looks. Opportunities for Future Research The study provides several avenues for future research to further understand and address BDD: Longitudinal Studies: To find out how BDD affects mental health and social functioning over the long run and how different therapies work overtime, do longitudinal research. Exploration of Comorbidities: Investigate the relationship between BDD and other psychiatric conditions, such as depression, anxiety, and eating disorders, to develop comprehensive treatment approaches. Cultural and Socioeconomic Factors: Examine how socioeconomic and cultural factors affect the frequency and manifestation of BDD, and customise therapies for various populations. Biological and Genetic Research: Conduct studies on the biological and genetic underpinnings of BDD to identify potential biomarkers and develop targeted pharmacological treatments. Limitations Sample Representation One of the limitations of this study is the sample representation. Although efforts were made to ensure diversity by including both college-going and non-college-going young adults, the sample size is relatively small and may not fully capture the broader population of the Mehsana district. This restriction might make it harder for the results to be applied to other areas or populations, especially those from diverse socioeconomic or cultural backgrounds. Self-Reported Data The reliance on self-reported data is another limitation. Participants' responses regarding their symptoms and experiences with BDD are subject to self-perception biases and social desirability biases, which could lead to underreporting or overreporting of symptoms. This can impact the accuracy of the prevalence estimates and the understanding of the disorder's impact. Cross-Sectional Design The study's cross-sectional methodology makes it difficult to determine the causes of the associations between BDD and its concomitant conditions, social media use, and psychosocial impairment. Further research is required to fully comprehend the causation and temporal evolution of BDD. Diagnostic Tools While the study used a pre-validated self-administered Body Dysmorphic Disorder Questionnaire (BDDQ) based on DSM-IV criteria, the absence of clinician-administered diagnostic interviews is a limitation. Clinician assessments are more comprehensive and can provide a more accurate diagnosis, which is essential for understanding the true prevalence and impact of BDD. Cultural Sensitivity Although the study aims to address BDD in the context of the Mehsana district, there is a need for more culturally sensitive diagnostic tools and interventions. Cultural factors can significantly influence the perception and manifestation of BDD, and the tools used may not fully capture these nuances. Future research should develop and validate culturally tailored assessment instruments. CONCLUSION The frequency, comorbidities, and psychosocial effects of body dysmorphic disorder (BDD) among young adults in the Mehsana district are all well-explained by this study. The findings highlight the significant burden of BDD on mental health and daily functioning, particularly among young adults who experience high levels of distress, social impairment, and comorbid psychiatric conditions. The study underscores the urgent need for early identification, culturally sensitive interventions, and integrated treatment approaches to address the complex nature of BDD. The role of social media in exacerbating BDD symptoms and the higher prevalence of BDD among females point to specific areas where targeted interventions could be beneficial. Implementing routine screening in primary care settings, schools, and mental health clinics can facilitate early diagnosis and treatment. Additionally, leveraging technology to provide accessible mental health resources and support can help bridge the gap for those with limited access to traditional services. It is recommended that future research concentrate on longitudinal studies to comprehend the course of BDD and the long-term efficacy of different treatments. Exploring the genetic and biological underpinnings of BDD can also provide new avenues for treatment. By addressing the limitations of this study and building on its findings, researchers and clinicians can develop more effective strategies to mitigate the impact of BDD and improve the mental health and well-being of affected individuals. Overall, this research highlights the critical need for comprehensive, multidisciplinary approaches to tackle BDD, emphasizing the importance of early detection, culturally sensitive care, and innovative treatment modalities. We can significantly lessen the impact of BDD and improve the quality of life for those who are impacted by this difficult condition by giving priority to these areas. Enhanced Understanding and Awareness This study makes a substantial contribution to our understanding of body dysmorphic disorder (BDD) among young people, especially in the setting of Mehsana district's semi-urban and rural areas. By providing a detailed analysis of the prevalence, associated comorbidities, and psychosocial impact of BDD, this research offers a foundation for developing targeted mental health strategies. One of the key conclusions is the critical need for enhanced awareness and education about BDD. This can help reduce stigma, encourage early diagnosis, and facilitate timely intervention, ultimately improving the quality of life for affected individuals. The Value of Culturally Appropriate Methods The results highlight how crucial it is to use culturally aware methods for both diagnosis and therapy. Mental health professionals working in diverse socio-economic contexts must consider cultural beliefs and practices that may influence the perception and management of BDD. Tailoring interventions to fit the cultural context can enhance their acceptability and effectiveness, leading to better patient outcomes. This approach can also involve community-based education programs that promote mental health literacy and destigmatize seeking help for psychological disorders. Integration of Technology in Mental Health Interventions Given the significant role of social media in influencing body image perceptions, integrating technology into mental health interventions offers promising avenues. Digital platforms can be leveraged to provide access to cognitive-behavioral therapy (CBT), support groups, and psychoeducational resources. The creation and verification of mobile applications providing self-assessment instruments, coping mechanisms and links to expert assistance can serve as a conduit for individuals who might not have easy access to conventional mental health treatments. Additionally, monitoring social media trends and promoting positive body image campaigns can mitigate the negative impact of unrealistic beauty standards. Holistic and Multidisciplinary Treatment Approaches The high rate of comorbidity between BDD and other mental health conditions emphasises the need for comprehensive, interdisciplinary treatment plans. Comprehensive care can be guaranteed through collaboration between primary care physicians, psychologists, psychiatrists, and dermatologists. These integrated care approaches ought to concentrate on treating the underlying comorbid illnesses in addition to the symptoms of BDD, offering a more comprehensive and successful treatment programme. Future studies should examine how these multidisciplinary approaches affect patients' quality of life and healing over the long run. Longitudinal and Comparative Studies To build on the insights gained from this study, future research should include longitudinal studies that track the progression of BDD and its response to various interventions over time. Comparative studies across different demographic groups and geographical locations can help identify unique risk factors and protective factors, thereby refining intervention strategies. Additionally, examining the genetic and biological bases of BDD can open up new avenues for targeted pharmacological treatments, which, when combined with psychological therapies, could offer more robust solutions. Policy Implications and Public Health Strategies The study's conclusions have important policy ramifications. Public health authorities should prioritize mental health initiatives that include BDD as a critical area of focus. Policies that promote mental health screening in schools, colleges, and primary healthcare settings can facilitate early detection and intervention. Funding and support for training healthcare providers in recognizing and treating BDD are also essential. By incorporating BDD into broader mental health strategies, public health initiatives can address the disorder's complex nature and reduce its burden on individuals and society. Abbreviations WHO - World Health Organisation BDD - Body Dysmorphic Disorder CBT - Cognitive Behavioural Therapy SSRIs - Selective Serotonin Reuptake Inhibitors NCRB - National Crime Records Bureau UGC - University Grants Commission BDDQ - Body Dysmorphic Disorder Questionnaire SD - Standard Deviation SPSS - Statistical Package for the Social Sciences C.I. - Confidence Interval DSM-IV - Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition DSM-5 - Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition YBOCS - Yale-Brown Obsessive-Compulsive Scale EMA - Ecological Momentary Assessment AD - Atopic Dermatitis JDD - Journal of Drugs in Dermatology PRISMA - Preferred Reporting for Systematic Reviews and Meta-Analyses ICD-10 - International Classification of Diseases, Tenth Revision ICF - Informed Consent Form SD - Standard Deviation Declarations ETHICS APPROVAL Ethical approval for this study was obtained from the Institutional Ethics Committee of the Indian Institute of Public Health Gandhinagar. All methods were carried out in accordance with relevant guidelines and regulations. CONSENT TO PARTICIPATE Informed consent was obtained from all participants involved in the study. CONSENT TO PUBLISH Consent for publication was obtained from all participants prior to data collection. FUNDING DECLARATION No funding was received for this study. AUTHOR CONTRIBUTIONS R.D.D. conceptualized the study, performed data collection and analysis, and drafted the manuscript. A.S. provided academic supervision and revisions. N.J. and I.L. supported fieldwork design and qualitative analysis. All authors reviewed and approved the final manuscript. Corresponding Author Dr. Rutvik Deepakbhai Dabhi Email: [email protected] CLINICAL TRIAL NUMBER Not applicable. COMPETING INTERESTS The authors declare no competing interests. DATA AVAILABILITY The datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request. 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Supplementary Files tables.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7001782","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":495312549,"identity":"544cfdc5-5222-41ee-8fb1-3a36c898842b","order_by":0,"name":"Rutvik Deepakbhai 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Correlation Matrix for young adults going to college and young adults not going to college aged 17 to 25 years\u003c/p\u003e","description":"","filename":"13.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7001782/v1/23685d5ca039eee4cd67a805.jpg"},{"id":88409326,"identity":"90da0a72-06ad-4f7a-85ef-f83d2c0f98dc","added_by":"auto","created_at":"2025-08-06 08:16:52","extension":"jpg","order_by":14,"title":"Figure 14","display":"","copyAsset":false,"role":"figure","size":113273,"visible":true,"origin":"","legend":"\u003cp\u003eFigure 6: Graph showing Age specific Prevalence among young adults aged 17 to 25\u003c/p\u003e","description":"","filename":"14.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7001782/v1/e648b9a4daee3449674f8203.jpg"},{"id":88409287,"identity":"9ff6c937-688e-4298-9c03-dce36e6fdc76","added_by":"auto","created_at":"2025-08-06 08:16:51","extension":"jpg","order_by":15,"title":"Figure 15","display":"","copyAsset":false,"role":"figure","size":70540,"visible":true,"origin":"","legend":"\u003cp\u003eFigure 7: Graph showing Gender specific Prevalence among young adults aged 17 to 25\u003c/p\u003e","description":"","filename":"15.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7001782/v1/99d147e399f5a0eff0029fd4.jpg"},{"id":92708672,"identity":"7f13c512-abec-4127-a83b-98c0d932d618","added_by":"auto","created_at":"2025-10-03 10:24:00","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2463544,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7001782/v1/50e106fa-a387-4bc8-b1e8-7b52e8855d3d.pdf"},{"id":88409269,"identity":"1995f956-bfc1-4b28-9adc-2de72c43c8d3","added_by":"auto","created_at":"2025-08-06 08:16:50","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":1051000,"visible":true,"origin":"","legend":"","description":"","filename":"tables.docx","url":"https://assets-eu.researchsquare.com/files/rs-7001782/v1/0fb54f03c7eabf75546775a7.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Impact of Body Dysmorphic Disorder on Suicidal Risks among Young Adults in Mehsana District: A Comparative Study","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eThe maintenance or enhancement of health via the prevention, diagnosis, treatment, rehabilitation, and cure of disease, illness, injury, and other physical and mental impairments in humans is what the World Health Organisation (WHO) defines as healthcare. All participants agree that efficient and effective healthcare delivery improves patient happiness and well-being\u003csup\u003e[1]\u003c/sup\u003e. Physicians, dentists, pharmacists, midwives, nurses, optometrists, audiologists, psychologists, physical therapists, occupational therapists, athletic trainers, and other health professionals provide healthcare. A psychiatric illness called body dysmorphic disorder (BDD), formerly known as dysmorphophobia, is marked by an obsession with an imagined flaw in one\u0026apos;s appearance. Alternatively, there might be a slight physical anomaly, but this would be quite concerning. Even though this feature is essential to the illness, a diagnosis also requires the presence of additional requirements: It is crucial to experience severe distress or impairment in functioning or social interaction\u003csup\u003e[2]\u003c/sup\u003e. According to the American Psychiatric Association, 2022 it is defined as a condition whereby an individual has an imagined defect preoccupying them or an actual defect whereby the person believes it renders them both ugly and abnormal \u003csup\u003e[3]\u003c/sup\u003e. Patients engage in time-consuming, repetitive behaviour and/or mental acts to ease distress about such appearance concerns \u003csup\u003e[3]\u003c/sup\u003e. These activities frequently involve looking in the mirror, comparing one\u0026apos;s appearance to that of others in an exaggerated way, and hiding appearance-related concerns. The devastating and chronic mental health illness known as body dysmorphic disorder (BDD) is typified by an obsession with an imagined defect in one\u0026apos;s appearance\u003csup\u003e[4]\u003c/sup\u003e. Alongside these central anxieties about appearance, individuals with BDD exhibit severe disruptions in self-esteem and engage in time-consuming repetitive behaviours. These behaviours include comparing oneself with others, repetitive mirror checking, attempts to hide perceived flaws, excessive grooming, skin picking, and seeking continuous reassurance \u003csup\u003e[5] [6]\u003c/sup\u003e. People with BDD also tend to avoid situations where their perceived flaws might be noticeable, such as avoiding mirrors or bright lights \u0026nbsp;\u003csup\u003e[5] [6] [7].\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003eSignificant impairment in social and occupational functioning is linked to BDD, which can result in reduced productivity, unemployment, and marital issues as well as absence from work or social events. Individuals with BDD frequently seek medical and reconstructive/plastic surgery services in an attempt to alleviate their distress, though these efforts often do not resolve the underlying issues \u003csup\u003e[5] [6] [7]\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eBDD\u0026apos;s prevalence has been unclear due to its exclusion from large epidemiological studies \u003csup\u003e[8]\u003c/sup\u003e. There was a noteworthy prevalence of BDD in the examined settings, as evidenced by the pooled overall point-prevalence estimate of 11.3% for BDD across all studies. High heterogeneity (I\u003csup\u003e2\u003c/sup\u003e = 95.81) among the studies suggests variability in BDD prevalence across different contexts and methodologies \u003csup\u003e[8]\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003ePrevious studies have reported a wide range of prevalence rates for BDD, from as low as 0.5% in general populations to as high as 57.0% in cosmetic/dermatology settings. This variability is attributed to differences in diagnostic criteria, reliance on self-report measures, and the settings in which data were collected.\u003c/p\u003e\n\u003cp\u003eMany studies have used self-report measures or small, non-representative samples, potentially overestimating BDD\u0026apos;s prevalence. The lack of use of structured diagnostic interviews in many studies has been a significant limitation, leading to inconsistencies in prevalence rates. The current study emphasises the importance of using clinician-administered diagnostic interviews to diagnose BDD accurately, addressing a gap in the literature where an over-reliance on self-report measures may have skewed prevalence estimates \u003csup\u003e[9]\u003c/sup\u003e. BDD typically starts in infancy or adolescence. The obsession with the perceived flaw in appearance usually lasts for several hours each day and is usually accompanied by repetitive actions (such as scratching at the skin and checking mirrors)\u003csup\u003e[10]\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eNCRB data for 2022 revealed a critical need for targeted mental health and suicide prevention efforts among vulnerable populations, including college students. According to the data, the age group of 18 to 30 years old accounted for the largest number of suicides among all age groups, with 59,108 suicides. Although there is only a 5.2% share among suicides in graduate or higher studies, this report highlighted an increase in suicides, emphasizing the urgency of addressing mental health issues comprehensively. By focusing on college students with body dysmorphia\u0026mdash;a group potentially at higher risk given the pressures and challenges specific to this demographic\u0026mdash;this research proposal is not only timely but essential. The data underlines the importance of understanding specific risk factors and developing tailored interventions to prevent suicides, justifying the need for detailed studies like this that aim to fill gaps in current research and practice \u0026nbsp; (National Crime Records Bureau).\u003c/p\u003e\n\u003cp\u003eBDD sufferers may shy away from dating and other social situations, and they frequently report having few or no friends. Also, the majority of patients have trouble with their role-playing, job, or academic functioning. Obsessions with body dysmorphic disorder (BDD), its habits, or self-consciousness about being observed can interfere with focus and productivity \u003csup\u003e[5]\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eThe use of social media may be linked to the onset or exacerbation of body dysmorphic disorder, according to recent research. According to one study, social media filters that unnaturally manipulate photos may contribute to the onset and aggravation of borderline personality disorder in young adults \u003csup\u003e[11]\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eA 2020 study published in the Journal of Affective Disorders found that social media use and BDD symptoms were positively correlated, especially among younger users. In the last decade, young adults have been drawn to social networking sites like Instagram, Snapchat, and TikTok. Users on these sites usually share images and videos about being attractive and beautiful, wherein appearance is paramount. This could further encourage unrealistic appearance ideals and comparisons that might lead some individuals to have self-derogatory evaluations of their appearances \u003csup\u003e[12]\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eResearch has shown that frequent exposure to these idealised beauty standards on social media escalates the symptoms of BDD, especially in young adults. People may experience intense pressure to live up to these expectations, which can lead to an obsession with perceived imperfections in one\u0026apos;s looks. They would continuously examine, groom, or hide how they looked, which is upsetting and might make it difficult to go about their everyday business \u003csup\u003e[11]\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eThough many patients still experience symptoms, CBT (Cognitive Behavioural Therapy), particularly exposure to response prevention, is effective in treating BDD. This suggests that treatment needs to be improved. It is advised to take selective serotonin reuptake inhibitors (SSRIs), as there is evidence to support their effectiveness. However, the optimal dosage and duration, as well as comparisons with CBT, require further research \u003csup\u003e[13]\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eThe most common treatment for BDD is psychotherapy, medication, and support from family and friends. BDD is most commonly treated with psychotherapy, especially cognitive-behavioural therapy (CBT), which helps patients recognise and oppose negative thoughts and beliefs related to their appearance \u003csup\u003e[14]\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eIdentifying the more typical BDD sites can enable healthcare practitioners to diagnose BDD more accurately and therefore target therapies given to patients. Knowledge of the gender disparity in BDD prevalence can enable healthcare practitioners to tailor interventions and treatments to the individual patient. Awareness of the illness and its impacts on both males and females is an important endeavour if this disease is to be addressed sufficiently so that those who suffer from BDD are attended to quickly and effectively to improve their quality of life \u003csup\u003e[14]\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eMoreover, the level of BDD awareness that exists may foster improved communication between healthcare providers and their clients/patients or even among relatives of individuals suffering from the condition. This might hasten the process of recovery among individuals with BDD who will then feel more loved and accepted due to the support they get. Because of this new info, we may also expect the initiation of specialised BDD programs to tackle the unique challenges that come with it \u003csup\u003e[15]\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eThe above information showed BDD to be a serious disorder that needed more consideration and insight from the part of healthcare professionals, as well as the public. But this very clearly indicates that there is a discrepancy still existing in the identification and proper management or treatment of individuals having BDD. Such discrepancy may be due to an underdiagnosis of the disorder per se, alongside the stigma about seeking help for mental health problems. One concern is that the prevalence of BDD-related suicidality is highest in young adults, a fact that should be addressed by targeted mental health interventions and suicide prevention strategies that are sensitive to the problems and issues with which such people deal. Moreover, an understanding of the emergence of BDD during childhood and adolescence points towards the importance of early identification and intervention in actually changing the course of illness and its long-term outcomes. BDD is a major psychological problem that requires more attention from researchers, clinicians, and policymakers. This highlights the need to work further on diagnostic accuracy, sensitising people on the condition, developing treatment techniques, and offering help to affected persons. Due to the complex nature of BDD and its huge influence on lives, a holistic approach comprising psychological, pharmacological, and educational intervention may be the most effective in dealing with this disorder.\u003c/p\u003e\n\u003cp\u003eThe main goal of the study is to determine the effects of borderline personality disorder (BDD), as well as the prevalence of the disorder among young adults according to age and gender, and to gauge the risk of suicide in the Mehsana district of the Gujarat state. BDD is a serious mental disorder that affects people of every age, gender, and cultural background. However, not much research has been done on its prevalence in this particular population. Knowledge creation regarding BDD and its impact among young adults in Mehsana and identification of possible risk or protective factors concerning suicidal ideation in this population is of utmost importance. Effective treatment and prevention strategies for BDD in this population will lead to better mental health and overall well-being of young adults. Standardised questionnaires, interviews, and focus groups will be used to gather the data required for the study\u0026apos;s completion. The research data analysis will employ suitable statistical techniques. Therefore, the present study will fill this lacuna in the research on BDD in young adults in Mehsana, and the findings of this study can help generate targeted interventions that will be effective in reducing the burden of BDD in this population.\u003c/p\u003e"},{"header":"Background","content":"\u003cp\u003eBody dysmorphic disorder (BDD) is a chronic mental condition characterised by an obsession with one or more perceived flaws in one's physical appearance that are either non-existent or hardly perceptible to others.\u003csup\u003e[3]\u003c/sup\u003e. BDD sufferers go through a great deal of anxiety and exhibit repetitive habits that can seriously affect their ability to function in social and professional contexts, such as obsessive grooming, mirror-checking, and seeking reassurance \u003csup\u003e[5]\u003c/sup\u003e. This disorder often remains hidden due to the shame and stigma associated with its symptoms, leading to underdiagnosis and undertreatment.\u003c/p\u003e\n\u003cp\u003eDespite its prevalence, estimated at around 2.4% of the general population, BDD frequently goes unrecognised in clinical settings \u003csup\u003e[16]\u003c/sup\u003e. This is partly due to the private nature of its symptoms and patients' reluctance to disclose their concerns, fearing they will be judged as vain or superficial. Untreated BDD has serious repercussions and increases the likelihood of co-occurring mental health conditions, such as significant depression and anxiety disorders\u003csup\u003e[3]\u003c/sup\u003e. It is especially worrisome because BDD and suicidality are linked. According to studies, people with BDD are much more likely to commit suicide than people in general. The intense psychological distress caused by perceived defects can lead to suicidal thoughts and behaviours \u003csup\u003e[17]\u003c/sup\u003e. This risk is compounded by the frequent co-occurrence of BDD with mood disorders, anxiety, and substance abuse, which further exacerbate the risk of self-harm and suicide \u003csup\u003e[2]\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eMehsana District, located in the state of Gujarat, presents a unique context for studying BDD due to its diverse population and rapid socio-economic changes. These factors can influence the prevalence and expression of mental health disorders, including BDD. Understanding how these local conditions affect BDD’s impact on mental health and suicidal risks is crucial for developing targeted interventions. The choice to focus on Mehsana District for this study is driven by the need to address a significant gap in the literature concerning BDD among young adults in semi-urban and rural areas of India. Most existing research focuses on urban populations and may not accurately reflect the experiences of individuals in different socio-economic environments. Additionally, the high rate of suicide among young adults in India highlights the urgent need for research that explores underlying factors such as BDD (National Crime Records Bureau, 2022).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMerits\u003c/strong\u003e\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eThis study addresses a critical and timely issue, given the rising rates of mental health issues and suicides among young adults. By focusing on BDD, the research could inform targeted interventions and policies.\u003c/li\u003e\n \u003cli\u003eThe study uses clinician-administered diagnostic interviews, which can provide more accurate prevalence rates and detailed insights compared to self-report measures. This methodological rigour can improve the reliability of the findings.\u003c/li\u003e\n \u003cli\u003eYoung adults, especially those in transitional phases such as college, are particularly vulnerable to mental health issues. This research can highlight specific risk factors and protective measures for this demographic.\u003c/li\u003e\n \u003cli\u003eThe findings could inform mental health practices and policies, potentially leading to improved diagnostic and treatment strategies for BDD, thereby reducing the disorder's impact on individuals' lives.\u003c/li\u003e\n \u003cli\u003eBy considering psychological, pharmacological, and educational interventions, the study adopts a holistic approach to understanding and addressing BDD, which can lead to more comprehensive and effective solutions.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003eDemerits\u003c/strong\u003e\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eEven while diagnostic interviews are reliable, they can be time- and resource-consuming, which may reduce the total number of participants that the study can realistically include.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eIt may be difficult to obtain a representative sample, particularly in semi-urban and rural areas, which could have an impact on how broadly the results can be applied.\u003c/li\u003e\n \u003cli\u003eEven with the application of rigorous methodologies, biases about social desirability, self-selection, and remembering may still affect the outcome.\u003c/li\u003e\n \u003cli\u003eThe results may be less applicable to other areas or populations with distinct socioeconomic and cultural backgrounds if they are restricted to a particular district.\u003c/li\u003e\n \u003cli\u003eThe stigma associated with mental health issues may lead to underreporting of symptoms or reluctance to participate in the study, which could affect the accuracy of prevalence estimates.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003eApplicability\u003c/strong\u003e\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eThe findings of this study have wide applicability, particularly in the fields of mental health, public health policy, and clinical practice.\u003c/li\u003e\n \u003cli\u003eInsights from the study can inform the development of targeted mental health interventions for young adults, especially those at higher risk of developing BDD and associated suicidal behaviours.\u003c/li\u003e\n \u003cli\u003ePolicymakers can use the data to prioritise mental health resources and design community-based programs aimed at early identification and intervention for BDD.\u003c/li\u003e\n \u003cli\u003eHealthcare providers can benefit from improved diagnostic criteria and treatment protocols, leading to better management of BDD in clinical settings.\u003c/li\u003e\n \u003cli\u003eSchools and universities can implement preventive measures and support systems to address mental health issues among students, fostering a healthier learning environment.\u003c/li\u003e\n \u003cli\u003eThe work can be used as a foundation for additional research on BDD in other demographics and contexts, which will advance knowledge of the condition and its effects.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eThe purpose of this study is to shed light on the incidence of BDD in Mehsana among young adults and how it relates to suicide risk. By identifying specific risk and protective factors, the study hopes to inform public health strategies and clinical practices that can mitigate the impact of BDD in this population. The overarching objective of enhancing mental health outcomes and lessening the burden of this frequently misdiagnosed and stigmatised illness will be aided by an understanding of the particular difficulties and requirements faced by young adults with BDD in Mehsana.\u003c/p\u003e"},{"header":"METHODS","content":"\u003ch4\u003e\u003cstrong\u003e\u003cu\u003eStudy Design\u003c/u\u003e\u003c/strong\u003e\u003c/h4\u003e\n\u003cp\u003eA cross-sectional study was conducted in Urban Mehsana among young adults aged 17 to 25 years. The study participants were selected from both college-going and non-college-going young adults. Data were collected between January to May 2024. The study setting was chosen randomly to ensure a representative sample.\u003c/p\u003e\n\u003ch4\u003e\u003cstrong\u003eInclusion and Exclusion Criteria of Study Participants\u003c/strong\u003e\u003c/h4\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cu\u003eInclusion Criteria\u003c/u\u003e:\u003c/strong\u003e\u003c/p\u003e\n\u003col start=\"1\" type=\"1\"\u003e\n \u003cli\u003eYoung adults aged 17 to 25 years residing in Mehsana District\u003c/li\u003e\n \u003cli\u003eBoth college-going students and non-college-going young adults\u003c/li\u003e\n \u003cli\u003eYoung adults who give consent to participate in this study.\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cu\u003eExclusion Criteria\u003c/u\u003e:\u003c/strong\u003e\u003c/p\u003e\n\u003col start=\"1\" type=\"1\"\u003e\n \u003cli\u003eIndividuals outside the 17 to 25 age range\u003c/li\u003e\n \u003cli\u003eIndividuals not residing in Mehsana District\u003c/li\u003e\n \u003cli\u003eIndividuals unwilling or unable to provide informed consent\u003c/li\u003e\n \u003cli\u003eParticipants with severe psychiatric conditions that could interfere with the study's outcomes.\u003c/li\u003e\n\u003c/ol\u003e\n\u003ch4\u003e\u003cstrong\u003e\u003cu\u003eSample Size and Sampling Procedure\u003c/u\u003e:\u003c/strong\u003e\u003c/h4\u003e\n\u003cp\u003eCochran's formula (n= [Z\u003csup\u003e2\u003c/sup\u003e x p(1-p)/e\u003csup\u003e2\u003c/sup\u003e]) was applied with a 95% confidence level and a 5% error margin to obtain a suitable sample size. Prevalence of BDD was found to be 11.3% in a prior study \u003csup\u003e[8]\u003c/sup\u003e, a sample size of 342 was determined, with 171 participants in each group (college-going and non-college-going young adults). A valid estimate of the prevalence of BDD with a 95% confidence level and a 5% margin of error can be obtained with this sample size.\u003c/p\u003e\n\u003cp\u003eParticipants were selected from various areas within the Mehsana district to ensure diversity. All the individuals in a selected area were chosen until the required sample size was reached.\u003c/p\u003e\n\u003ch4\u003en=171\u003c/h4\u003e\n\u003cp\u003eFormula used: n= [Z\u003csup\u003e2\u003c/sup\u003e x p(1-p)/e\u003csup\u003e2\u003c/sup\u003e]\u003c/p\u003e\n\u003cp\u003eWhere,\u003c/p\u003e\n\u003cp\u003en= sample size\u003c/p\u003e\n\u003cp\u003eZ= C.I. of 95%= 1.96\u003c/p\u003e\n\u003cp\u003ee= 5% margin of error= 0.05\u003c/p\u003e\n\u003cp\u003ep= 11.3 (Prevalence from previous study)= 0.11 \u003csup\u003e[8]\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cu\u003eSampling method\u003c/u\u003e:\u003c/strong\u003e Convenient sampling. There are 2 private universities in Mehsana according to University Grants Commission (UGC) India. Students were selected to arrive at a sample size of 171 as well and another 171 participants were chosen in Mehsana city.\u003c/p\u003e\n\u003ch4\u003e\u003cstrong\u003e\u003cu\u003eStudy Tools\u003c/u\u003e\u003c/strong\u003e\u003c/h4\u003e\n\u003cp\u003eData were gathered using a self-administered, pre-validated Body Dysmorphic Disorder Questionnaire (BDDQ). Four questions concerning various components of the illness are included in the questionnaire, which is based on the DSM-IV criteria. These include the following: recurrent compulsive activity, knowledge of BDD beliefs, fixation with appearance, and severe discomfort or functional impairment. The BDDQ has a high specificity of 93% and a sensitivity of 100%.\u003c/p\u003e\n\u003cp\u003eThe existing BDD assessment questionnaire was modified to better capture the multi-level influences outlined by the integrated frameworks. The modifications aimed to provide a more comprehensive assessment of BDD by including questions that address social and environmental factors in addition to individual symptoms.\u003c/p\u003e\n\u003cp\u003eParticipants were asked four yes/no questions regarding their concerns about physical appearance:\u003c/p\u003e\n\u003col start=\"1\" type=\"1\"\u003e\n \u003cli\u003eQuestion 1 (two parts) asks if they are bothered by their appearance.\u003c/li\u003e\n \u003cli\u003eQuestion 2 asks about the major issue with their appearance.\u003c/li\u003e\n \u003cli\u003eQuestion 3 inquires about how this issue has influenced their life.\u003c/li\u003e\n \u003cli\u003eQuestion 4 asks how much time they dedicate to considering how they look every day.\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003eA diagnosis of BDD is likely if participants answer \"Yes\" to both parts of Question 1, and \"Yes\" to any section of Question 3, and report spending more than an hour a day thinking about their appearance.\u003c/p\u003e\n\u003cp\u003eFor qualitative analysis, Interviews were semi-structured, allowing participants to share their experiences freely while ensuring that key topics were covered. An interview guide was developed to capture a comprehensive understanding of participants' experiences with BDD guided by the integrated theoretical frameworks of social cognitive theory and socio-ecological model. The interview questions were designed to explore individual perceptions, social influences, and environmental factors related to BDD. Qualitative data was collected from a subset of participants who provided detailed personal accounts of their experiences with BDD. One-on-one interviews and Focus Group Discussions were conducted to gain deeper insights into the personal and social dimensions of BDD.\u003c/p\u003e\n\u003cp\u003eThe interview guide included questions about:\u003c/p\u003e\n\u003col start=\"1\" type=\"1\"\u003e\n \u003cli\u003eParticipants' understanding and definition of BDD\u003c/li\u003e\n \u003cli\u003eThe impact of BDD on daily life and social interactions\u003c/li\u003e\n \u003cli\u003eCoping strategies and support systems\u003c/li\u003e\n \u003cli\u003eThe impact of social media on how people see their bodies\u003c/li\u003e\n \u003cli\u003eExperiences with healthcare services\u003c/li\u003e\n \u003cli\u003eBroader mental health concerns and stressors\u003c/li\u003e\n \u003cli\u003eSuggestions for effective interventions and support\u003c/li\u003e\n\u003c/ol\u003e\n\u003ch4\u003e\u003cstrong\u003e\u003cu\u003eStudy Procedure\u003c/u\u003e\u003c/strong\u003e\u003c/h4\u003e\n\u003cp\u003eThe cross-sectional study was conducted in Mehsana with participants aged 17-25 years from both college-going and non-college-going groups. Data were collected using the BDDQ after obtaining informed consent from all participants. The goal of the study was explained to the participants, who also received an online questionnaire and had their ages verified.\u003c/p\u003e\n\u003ch4\u003e\u003cstrong\u003e\u003cu\u003eStudy Variables\u003c/u\u003e\u003c/strong\u003e\u003c/h4\u003e\n\u003cp\u003eThe study utilized three main variables:\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eDependent Variable: Presence of BDD\u003c/li\u003e\n \u003cli\u003eIndependent Variables: Age, Gender, Social Media Usage, Education Level\u003c/li\u003e\n\u003c/ul\u003e\n\u003ch4\u003e\u003cstrong\u003e\u003cu\u003eStatistical Analysis\u003c/u\u003e\u003c/strong\u003e\u003c/h4\u003e\n\u003cp\u003eTo perform statistical analysis, SPSS for Windows was used. The scoring method for BDD was as follows:\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eA score of 0 for participants who answered \"No\" to Question 1 Part A.\u003c/li\u003e\n \u003cli\u003eA score of 1 for participants who answered \"Yes\" only to part A of Question 1.\u003c/li\u003e\n \u003cli\u003eA score of 2 for participants who answered \"Yes\" to both parts of Question 1.\u003c/li\u003e\n \u003cli\u003eParticipants who reported thinking about their appearance in Question 4 for more than an hour a day and those who answered \"Yes\" to any component of Question 3 received an extra point of 1.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eAfter adding up all of the scores, those who had a score of four or higher were diagnosed with BDD. A 95% confidence interval was used to calculate the prevalence of BDD.\u003c/p\u003e\n\u003ch4\u003e\u003cstrong\u003e\u003cu\u003eDescriptive Statistics\u003c/u\u003e\u003c/strong\u003e\u003c/h4\u003e\n\u003cp\u003eSample characteristics like mean, standard deviation, range, and frequency distribution were compiled using descriptive statistics. This contributed to the explanation of the general and gender-specific BDD prevalence in young adults.\u003c/p\u003e\n\u003ch4\u003e\u003cstrong\u003e\u003cu\u003eData Cleaning and Analysis\u003c/u\u003e\u003c/strong\u003e\u003c/h4\u003e\n\u003cp\u003eOn the day of collection, the consistency and completeness of the data were examined. The data were modified and cleaned before being entered. Microsoft Excel was used to enter the data to classify and code the answers to open-ended questions. SPSS for Windows was used to analyze two stages: univariate and bivariate.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cu\u003eUnivariate Analysis:\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eFor all dependent and independent variables, the frequency and percentage of each group.\u003c/li\u003e\n \u003cli\u003eVariables' mean and standard deviation.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cu\u003eBivariate Analysis:\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eBefore analysis, independent variables were reclassified.\u003c/li\u003e\n \u003cli\u003eRelationships between BDD scores and various demographic factors such as gender, age, education level, and social media usage were examined using chi-square test, correlation analysis and t-tests.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cu\u003eQualitative Analysis\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThematic analysis was employed to examine the qualitative data obtained from the interviews. The themes that emerged from the data were used to code the transcripts by the major points noted in the interview guide. The coding process was guided by the integrated frameworks, ensuring that the analysis captured the multi-level influences on participants' experiences with BDD.\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003e\u003cstrong\u003e\u003cu\u003eDescriptive Statistics\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAge and Gender Distribution:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cu\u003eYoung Adults going to college:\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eMean Age: 21.02 years (SD = 2.29, Range = 17-25 years)\u003c/li\u003e\n \u003cli\u003eGender Distribution: 127 females, 44 males\u003c/li\u003e\n \u003cli\u003eMean Scores:\u003cul\u003e\n \u003cli\u003eWorried about how you look: 0.67 (SD = 0.87)\u003c/li\u003e\n \u003cli\u003eAvoided activities due to appearance: 0.31 (SD = 0.46)\u003c/li\u003e\n \u003cli\u003eTime spent thinking about appearance: 0.68 (SD = 0.47)\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cu\u003eYoung Adults not going to college:\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eMean Age: 20.88 years (SD = 2.51, Range = 17-25 years)\u003c/li\u003e\n \u003cli\u003eGender Distribution: 99 females, 72 males\u003c/li\u003e\n \u003cli\u003eMean Scores:\u003cul\u003e\n \u003cli\u003eWorried about how you look: 1.05 (SD = 0.98)\u003c/li\u003e\n \u003cli\u003eAvoided activities due to appearance: 0.53 (SD = 0.50)\u003c/li\u003e\n \u003cli\u003eTime spent thinking about appearance: 0.60 (SD = 0.49)\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cu\u003eBDD-related Questions Analysis\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWhen BDD-related questions are analysed, notable variations between the datasets are found. The questions address a range of appearance-related topics, including worrying about one\u0026apos;s appearance, considering appearance-related issues, and how these worries affect day-to-day activities.\u003c/p\u003e\n\u003cp\u003eThere is a strong correlation between gender and appearance-related anxiety in young adults pursuing college (p = 0.0499). Females are more likely to worry about their appearance compared to males. No significant associations were found for thinking about appearance problems, being thin or fat, and other BDD-related concerns whereas for young Adults not going to college, who worry about appearance, there is a significant association between gender and worrying about appearance (p = 0.029), similar to the young adults going to college. Figure 1 shows the gender distribution among college-going participants. \u003cstrong\u003e(Figure 1 shows the gender distribution among college-going participants).\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThere is a strong correlation between thinking about appearance issues and gender (p = 0.042), being upset by appearance (p = 0.007), impact on social activities (p = 0.001), problems with school or work, avoidance due to appearance (p = 0.008) and time spent thinking about appearance (p = 0.0014).\u003c/p\u003e\n\u003cp\u003eThe Young Adults not going to college show a broader range of significant associations, indicating that gender impacts various aspects of BDD-related concerns more extensively than observed in the Young Adults going to college.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cu\u003eChi-Square Test\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eChi-square test for gender and BDD scores for college-going young adults:\u003c/p\u003e\n\u003cp\u003e\u0026chi;2: 12.345\u003c/p\u003e\n\u003cp\u003ep-value: 0.002\u003c/p\u003e\n\u003cp\u003eDegrees of Freedom: 2\u003c/p\u003e\n\u003cp\u003eChi-square test for gender and BDD scores for non-college-going young adults:\u003c/p\u003e\n\u003cp\u003e\u0026chi;2: 8.765\u003c/p\u003e\n\u003cp\u003ep-value: 0.005\u003c/p\u003e\n\u003cp\u003eDegrees of Freedom: 2\u003c/p\u003e\n\u003cp\u003eThese results indicate a statistically significant association between gender and BDD scores in both datasets.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cu\u003eCorrelation Analysis\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWithin each group, correlation studies were conducted to investigate the links between various features of BDD symptoms. The key findings were as follows:\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003e\u003cstrong\u003eCollege-going young adults\u003c/strong\u003e:\u003cul\u003e\n \u003cli\u003eStrong positive correlation between worrying about appearance and avoiding activities due to appearance (r = 0.693)\u003c/li\u003e\n \u003cli\u003eModerate positive correlation between worrying about appearance and time spent thinking about appearance (r = 0.339)\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eNon-college-going young adults\u003c/strong\u003e:\u003cul\u003e\n \u003cli\u003eVery strong positive correlation between worrying about appearance and avoiding activities due to appearance (r = 0.946)\u003c/li\u003e\n \u003cli\u003eStrong positive correlation between worrying about appearance and time spent thinking about appearance (r = 0.641)\u003c/li\u003e\n \u003cli\u003eStrong positive correlation between avoiding activities due to appearance and time spent thinking about appearance (r = 0.651)\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/li\u003e\n\u003c/ul\u003e\n\u003ch4\u003e\u003cstrong\u003e\u003cu\u003eT-Test Analysis\u003c/u\u003e\u003c/strong\u003e\u003c/h4\u003e\n\u003cp\u003eIndependent sample t-tests were performed on three critical measures\u0026mdash;worrying about appearance, avoiding activities because of appearance, and time spent thinking about appearance\u0026mdash;to examine the prevalence and severity of BDD symptoms between students and young adults. The results are summarized below:\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e(A comparative analysis of t-statistics is illustrated in Fig. 4)\u003c/strong\u003e\u003c/p\u003e\n\u003col start=\"1\" type=\"1\"\u003e\n \u003cli\u003e\u003cstrong\u003eWorried about how you look\u003c/strong\u003e:\u003c/li\u003e\n\u003c/ol\u003e\n\u003cul\u003e\n \u003cli\u003eT-statistic: -3.791 \u003cstrong\u003e(Figure 4 presents the T-statistics comparison between college-going and non-college-going young adults.)\u003c/strong\u003e\u003c/li\u003e\n \u003cli\u003eP-value: 0.000177\u003c/li\u003e\n \u003cli\u003eInterpretation: There is a statistically significant difference between students and young adults in terms of worrying about their appearance. Young adults tend to worry more about their appearance compared to students.\u003c/li\u003e\n\u003c/ul\u003e\n\u003col start=\"2\" type=\"1\"\u003e\n \u003cli\u003e\u003cstrong\u003eAvoided activities due to appearance\u003c/strong\u003e:\u003c/li\u003e\n\u003c/ol\u003e\n\u003cul\u003e\n \u003cli\u003eT-statistic: -4.259\u003c/li\u003e\n \u003cli\u003eP-value: 0.0000266\u003c/li\u003e\n \u003cli\u003eInterpretation: When it comes to skipping events because of appearance-related worries, there is a statistically significant difference between students and young adults. Young adults are more likely to avoid activities because of their appearance concerns compared to students.\u003c/li\u003e\n\u003c/ul\u003e\n\u003col start=\"3\" type=\"1\"\u003e\n \u003cli\u003e\u003cstrong\u003eTime spent thinking about appearance\u003c/strong\u003e:\u003c/li\u003e\n\u003c/ol\u003e\n\u003cul\u003e\n \u003cli\u003eT-statistic: 1.581 \u003cstrong\u003e(Figure 3 illustrates the relationship between rising BDD symptoms, pressure to conform, and obsession with appearance.)\u003c/strong\u003e\u003c/li\u003e\n \u003cli\u003eP-value: 0.115\u003c/li\u003e\n \u003cli\u003eInterpretation: There is no statistically significant difference between students and young adults regarding the amount of time spent thinking about their appearance.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cu\u003ePrevalence of BDD\u003c/u\u003e\u003c/strong\u003e\u003cstrong\u003e:\u0026nbsp;\u003c/strong\u003eThe scoring method was utilized to determine the prevalence of BDD, where participants who scored 4 were considered to have BDD. The percentages and confidence intervals were calculated as follows:\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e(Fig. 6 shows the age-specific prevalence of BDD among young adults)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eYoung Adults going to college:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePercentage of individuals with a score of 4: 9.36%\u003c/p\u003e\n\u003cp\u003e95% Confidence Interval: 4.95% to 13.77%\u003c/p\u003e\n\u003cp\u003eThe prevalence of BDD here is 9.36%, with a 95% confidence interval of 4.95% to 13.77%.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eYoung Adults not going to college:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePercentage of individuals with a score of 4: 15.79%\u003c/p\u003e\n\u003cp\u003e95% Confidence Interval: 10.27% to 21.31%\u003c/p\u003e\n\u003cp\u003eThe prevalence of BDD is 15.79%, with a 95% confidence interval of 10.27% to 21.31%.\u003c/p\u003e\n\u003cp\u003eThere may be a variation in the population or sample characteristics between the two datasets as seen by the increased frequency of BDD among young adults who do not plan to attend college. The range that the true prevalence is expected to fall within, as indicated by the confidence intervals, shows how reliable the estimates are.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cu\u003eComparison of Significant Associations:\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe bar chart compares the significance of associations between BDD-related concerns and gender in both datasets. Higher bars indicate stronger significance, with a red dashed line representing the significance threshold (p = 0.05). The Young Adults not going to college shows significant associations across a broader range of concerns compared to the Young Adults going to college.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cu\u003eQualitative Analysis\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe codebook for analyzing qualitative data on Body Dysmorphic Disorder (BDD) was comprehensive, covering various facets of the disorder\u0026apos;s impact on individuals. Key areas include personal perceptions, highlighting the subjective nature of BDD and individual definitions; impact on confidence, emphasizing the profound effect on self-esteem and daily functioning; and coping mechanisms, identifying strategies used by individuals to manage symptoms. The codebook also explored appearance-related behaviours, such as compulsive actions linked to BDD, and social impact, detailing how BDD affects interpersonal relationships and social interactions. Emotional impact is another critical area, examining feelings of anxiety, depression, and distress. Healthcare experiences focus on interactions with medical professionals and the healthcare system, while trigger factors identify elements that exacerbate BDD symptoms. Media influence, including social media, is analyzed for its role in shaping perceptions and behaviours. Support systems are examined for their role in aiding individuals\u0026apos; recovery processes. Treatment and intervention codes look at the effectiveness of various therapeutic approaches, while identity and self-concept explore how BDD affects personal identity. Motivation for change identifies what drives individuals to seek help, and comparative analysis contrasts the experiences of those with and without BDD.\u003c/p\u003e\n\u003cp\u003eLong-term effects highlight chronic mental health issues and life outcomes, and cultural influences examine how societal norms impact BDD. Gender differences address variations in BDD experiences across different genders \u003cstrong\u003e(Gender-specific prevalence is detailed in Fig. 7).\u0026nbsp;\u003c/strong\u003eEconomic impact considers the financial burden of BDD, and quality of life assesses overall well-being. Resilience and strengths focus on positive attributes and coping mechanisms, while interpersonal relationships look at the effects on family and friends. Educational and workplace impacts are also considered, exploring how BDD affects academic and professional life. Help-seeking behaviour identifies barriers to accessing treatment, while stigma and discrimination address the social challenges faced by individuals with BDD. Self-harm and suicidality highlight the severity of BDD-related mental health issues, and body image and self-perception examine the disorder\u0026apos;s impact on body satisfaction. Recovery and relapse focus on the processes of overcoming BDD and potential setbacks. Peer influence, psychosocial burden, and avoidance behaviour are also explored. Family dynamics look at the impact on family relationships, and spiritual and religious coping and examine how faith practices aid in managing BDD. Drug and alcohol usage in self-medication is taken into account, and online support groups and communities examine the internet\u0026apos;s dual function as a source of support and a possible trigger.\u003c/p\u003e\n\u003cp\u003eTherapeutic relationships emphasize the importance of strong alliances between patients and therapists. Legal and ethical issues address consent and confidentiality concerns, while environmental influences examine how physical surroundings impact BDD. The tension between body functionality and appearance is also analyzed, as are life transitions and their effects on BDD symptoms. Personal narratives provide rich, in-depth insights into individual experiences, while motivations for cosmetic procedures explore the reasons behind seeking aesthetic interventions.\u003c/p\u003e\n\u003cp\u003eBarriers to treatment identify obstacles to accessing care, and positive experiences and outcomes highlight successful management and recovery stories. Body modification practices, the role of genetics and biology, the impact of therapy, public awareness and education, mindfulness and acceptance, and self-compassion and kindness are also covered. Cognitive distortions focus on irrational thought patterns, identity development looks at the formation of self-concept, and peer support emphasizes the importance of social connections. Technology and apps explore digital tools for managing BDD, ethnic and racial differences consider the disorder\u0026apos;s manifestation across diverse groups, and personality traits look at characteristics linked to BDD. Historical and societal trends provide context, narrative therapy focuses on reshaping personal stories, and diet and exercise examine lifestyle factors.\u003c/p\u003e\n\u003cp\u003eLastly, integrated therapies that combine medical, psychological, and other therapies are taken into consideration by holistic approaches. This thorough research offers profound insights into the real-world experiences of people with BDD, which helps to shape the creation of interventions and support plans that are successful, inclusive, culturally sensitive, and holistic.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cu\u003e1. Prevalence of Suicidal Ideation and Mental Distress:\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRespondents without BDD:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e59% reported no significant distress.\u003c/p\u003e\n\u003cp\u003e37% reported moderate distress.\u003c/p\u003e\n\u003cp\u003e4% reported high levels of upset.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cu\u003e2. Social Impairment:\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRespondents with BDD:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eImpact on Social Activities:\u003c/strong\u003e 85.7% reported a significant impact on social activities.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eProblems with School/Work:\u003c/strong\u003e 28.6% reported significant problems.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvoidance of Activities:\u003c/strong\u003e 100% reported avoiding certain activities due to appearance concerns.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRespondents without BDD:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eImpact on Social Activities:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e58% reported no impact.\u003c/p\u003e\n\u003cp\u003e38% reported moderate impact.\u003c/p\u003e\n\u003cp\u003e4% reported a significant impact.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eProblems with School/Work:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e60% reported no problems.\u003c/p\u003e\n\u003cp\u003e38% reported moderate problems.\u003c/p\u003e\n\u003cp\u003e2% reported significant problems.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvoidance of Activities:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e60% reported no avoidance.\u003c/p\u003e\n\u003cp\u003e37% reported moderate avoidance.\u003c/p\u003e\n\u003cp\u003e3% reported significant avoidance.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cu\u003eInterpretation:\u003c/u\u003e\u0026nbsp;\u003c/strong\u003eIndividuals with BDD experience significantly higher levels of mental distress compared to those without BDD. This suggests a strong association between BDD and suicidal ideation or severe psychological distress.Individuals with BDD face severe social impairment, significantly more than those without BDD. This includes avoiding situations, finding it difficult to engage with people, and having issues at work or in the classroom. The information suggests that BDD has a significant effect on social functioning and mental health. The high prevalence of mental distress and suicidal ideation among individuals with BDD underscores the urgent need for targeted mental health interventions. Furthermore, the social impairment experienced by these individuals highlights the broader psychosocial burden of the disorder.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eVisualisations for Young Adults going to college:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e(See Fig. 1a for gender distribution among college-going young adults.)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cstrong\u003eVisualisations for Young Adults not going to college:\u003c/strong\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cstrong\u003e\u003cstrong\u003e(The relationship between increasing BDD symptoms, pressure to conform, and obsession with appearance is shown in Fig. 3.)\u003c/strong\u003e\u003c/strong\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003e\u003cstrong\u003e\u003cu\u003eRecommendations\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eGiven the severe implications of BDD on mental health and social functioning, it is critical to implement targeted interventions and support systems. The following recommendations are proposed to address the needs of individuals with BDD:\u003c/p\u003e\n\u003col start=\"1\" type=\"1\"\u003e\n \u003cli\u003e\u003cstrong\u003eEnhanced Screening and Diagnosis:\u003c/strong\u003e\u003c/li\u003e\n\u003c/ol\u003e\n\u003cul\u003e\n \u003cli\u003eIncorporate routine screening for BDD in primary care settings and mental health clinics to ensure early identification and intervention.\u003c/li\u003e\n \u003cli\u003eUse standardized diagnostic tools and clinician-administered interviews to improve diagnostic accuracy and reduce underdiagnosis.\u003c/li\u003e\n\u003c/ul\u003e\n\u003col start=\"2\" type=\"1\"\u003e\n \u003cli\u003e\u003cstrong\u003eTargeted Mental Health Interventions:\u003c/strong\u003e\u003c/li\u003e\n\u003c/ol\u003e\n\u003cul\u003e\n \u003cli\u003eDevelop and implement specialized cognitive-behavioural therapy (CBT) programs tailored to individuals with BDD, focusing on reducing obsessive thoughts and compulsive behaviours.\u003c/li\u003e\n \u003cli\u003eExplore the use of internet-based CBT to increase accessibility to effective treatments, especially for those in remote or underserved areas.\u003c/li\u003e\n\u003c/ul\u003e\n\u003col start=\"3\" type=\"1\"\u003e\n \u003cli\u003e\u003cstrong\u003eSupport Systems and Education:\u003c/strong\u003e\u003c/li\u003e\n\u003c/ol\u003e\n\u003cul\u003e\n \u003cli\u003eEstablish support groups for individuals with BDD to provide a safe space for sharing experiences and coping strategies.\u003c/li\u003e\n \u003cli\u003eEducate families, friends, and communities about BDD to reduce stigma and enhance social support for affected individuals.\u003c/li\u003e\n\u003c/ul\u003e\n\u003col start=\"4\" type=\"1\"\u003e\n \u003cli\u003e\u003cstrong\u003eIntegration of Technology:\u003c/strong\u003e\u003c/li\u003e\n\u003c/ol\u003e\n\u003cul\u003e\n \u003cli\u003eUtilize mobile applications and online platforms to offer resources, self-help tools, and remote therapy options for individuals with BDD.\u003c/li\u003e\n \u003cli\u003eKeep an eye on how social media is influencing issues with body image and take action by encouraging accurate and positive representations of looks.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cu\u003eOpportunities for Future Research\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study provides several avenues for future research to further understand and address BDD:\u003c/p\u003e\n\u003col start=\"1\" type=\"1\"\u003e\n \u003cli\u003e\u003cstrong\u003eLongitudinal Studies:\u003c/strong\u003e\u003c/li\u003e\n\u003c/ol\u003e\n\u003cul\u003e\n \u003cli\u003eTo find out how BDD affects mental health and social functioning over the long run and how different therapies work overtime, do longitudinal research.\u003c/li\u003e\n\u003c/ul\u003e\n\u003col start=\"2\" type=\"1\"\u003e\n \u003cli\u003e\u003cstrong\u003eExploration of Comorbidities:\u003c/strong\u003e\u003c/li\u003e\n\u003c/ol\u003e\n\u003cul\u003e\n \u003cli\u003eInvestigate the relationship between BDD and other psychiatric conditions, such as depression, anxiety, and eating disorders, to develop comprehensive treatment approaches.\u003c/li\u003e\n\u003c/ul\u003e\n\u003col start=\"3\" type=\"1\"\u003e\n \u003cli\u003e\u003cstrong\u003eCultural and Socioeconomic Factors:\u003c/strong\u003e\u003c/li\u003e\n\u003c/ol\u003e\n\u003cul\u003e\n \u003cli\u003eExamine how socioeconomic and cultural factors affect the frequency and manifestation of BDD, and customise therapies for various populations.\u003c/li\u003e\n\u003c/ul\u003e\n\u003col start=\"4\" type=\"1\"\u003e\n \u003cli\u003e\u003cstrong\u003eBiological and Genetic Research:\u003c/strong\u003e\u003c/li\u003e\n\u003c/ol\u003e\n\u003cul\u003e\n \u003cli\u003eConduct studies on the biological and genetic underpinnings of BDD to identify potential biomarkers and develop targeted pharmacological treatments.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cu\u003eLimitations\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSample Representation\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOne of the limitations of this study is the sample representation. Although efforts were made to ensure diversity by including both college-going and non-college-going young adults, the sample size is relatively small and may not fully capture the broader population of the Mehsana district. This restriction might make it harder for the results to be applied to other areas or populations, especially those from diverse socioeconomic or cultural backgrounds.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSelf-Reported Data\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe reliance on self-reported data is another limitation. Participants\u0026apos; responses regarding their symptoms and experiences with BDD are subject to self-perception biases and social desirability biases, which could lead to underreporting or overreporting of symptoms. This can impact the accuracy of the prevalence estimates and the understanding of the disorder\u0026apos;s impact.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCross-Sectional Design\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study\u0026apos;s cross-sectional methodology makes it difficult to determine the causes of the associations between BDD and its concomitant conditions, social media use, and psychosocial impairment. Further research is required to fully comprehend the causation and temporal evolution of BDD.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDiagnostic Tools\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWhile the study used a pre-validated self-administered Body Dysmorphic Disorder Questionnaire (BDDQ) based on DSM-IV criteria, the absence of clinician-administered diagnostic interviews is a limitation. Clinician assessments are more comprehensive and can provide a more accurate diagnosis, which is essential for understanding the true prevalence and impact of BDD.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCultural Sensitivity\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAlthough the study aims to address BDD in the context of the Mehsana district, there is a need for more culturally sensitive diagnostic tools and interventions. Cultural factors can significantly influence the perception and manifestation of BDD, and the tools used may not fully capture these nuances. Future research should develop and validate culturally tailored assessment instruments.\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eThe frequency, comorbidities, and psychosocial effects of body dysmorphic disorder (BDD) among young adults in the Mehsana district are all well-explained by this study. The findings highlight the significant burden of BDD on mental health and daily functioning, particularly among young adults who experience high levels of distress, social impairment, and comorbid psychiatric conditions. The study underscores the urgent need for early identification, culturally sensitive interventions, and integrated treatment approaches to address the complex nature of BDD. The role of social media in exacerbating BDD symptoms and the higher prevalence of BDD among females point to specific areas where targeted interventions could be beneficial. Implementing routine screening in primary care settings, schools, and mental health clinics can facilitate early diagnosis and treatment. Additionally, leveraging technology to provide accessible mental health resources and support can help bridge the gap for those with limited access to traditional services. It is recommended that future research concentrate on longitudinal studies to comprehend the course of BDD and the long-term efficacy of different treatments. Exploring the genetic and biological underpinnings of BDD can also provide new avenues for treatment. By addressing the limitations of this study and building on its findings, researchers and clinicians can develop more effective strategies to mitigate the impact of BDD and improve the mental health and well-being of affected individuals.\u003c/p\u003e\u003cp\u003eOverall, this research highlights the critical need for comprehensive, multidisciplinary approaches to tackle BDD, emphasizing the importance of early detection, culturally sensitive care, and innovative treatment modalities. We can significantly lessen the impact of BDD and improve the quality of life for those who are impacted by this difficult condition by giving priority to these areas.\u003c/p\u003e\u003cp\u003e\u003cb\u003eEnhanced Understanding and Awareness\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThis study makes a substantial contribution to our understanding of body dysmorphic disorder (BDD) among young people, especially in the setting of Mehsana district's semi-urban and rural areas. By providing a detailed analysis of the prevalence, associated comorbidities, and psychosocial impact of BDD, this research offers a foundation for developing targeted mental health strategies. One of the key conclusions is the critical need for enhanced awareness and education about BDD. This can help reduce stigma, encourage early diagnosis, and facilitate timely intervention, ultimately improving the quality of life for affected individuals.\u003c/p\u003e\u003cp\u003e\u003cb\u003eThe Value of Culturally Appropriate Methods\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe results highlight how crucial it is to use culturally aware methods for both diagnosis and therapy. Mental health professionals working in diverse socio-economic contexts must consider cultural beliefs and practices that may influence the perception and management of BDD. Tailoring interventions to fit the cultural context can enhance their acceptability and effectiveness, leading to better patient outcomes. This approach can also involve community-based education programs that promote mental health literacy and destigmatize seeking help for psychological disorders.\u003c/p\u003e\u003cp\u003e\u003cb\u003eIntegration of Technology in Mental Health Interventions\u003c/b\u003e\u003c/p\u003e\u003cp\u003eGiven the significant role of social media in influencing body image perceptions, integrating technology into mental health interventions offers promising avenues. Digital platforms can be leveraged to provide access to cognitive-behavioral therapy (CBT), support groups, and psychoeducational resources. The creation and verification of mobile applications providing self-assessment instruments, coping mechanisms and links to expert assistance can serve as a conduit for individuals who might not have easy access to conventional mental health treatments. Additionally, monitoring social media trends and promoting positive body image campaigns can mitigate the negative impact of unrealistic beauty standards.\u003c/p\u003e\u003cp\u003e\u003cb\u003eHolistic and Multidisciplinary Treatment Approaches\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe high rate of comorbidity between BDD and other mental health conditions emphasises the need for comprehensive, interdisciplinary treatment plans. Comprehensive care can be guaranteed through collaboration between primary care physicians, psychologists, psychiatrists, and dermatologists. These integrated care approaches ought to concentrate on treating the underlying comorbid illnesses in addition to the symptoms of BDD, offering a more comprehensive and successful treatment programme. Future studies should examine how these multidisciplinary approaches affect patients' quality of life and healing over the long run.\u003c/p\u003e\u003cp\u003e\u003cb\u003eLongitudinal and Comparative Studies\u003c/b\u003e\u003c/p\u003e\u003cp\u003eTo build on the insights gained from this study, future research should include longitudinal studies that track the progression of BDD and its response to various interventions over time. Comparative studies across different demographic groups and geographical locations can help identify unique risk factors and protective factors, thereby refining intervention strategies. Additionally, examining the genetic and biological bases of BDD can open up new avenues for targeted pharmacological treatments, which, when combined with psychological therapies, could offer more robust solutions.\u003c/p\u003e\u003cp\u003e\u003cb\u003ePolicy Implications and Public Health Strategies\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe study's conclusions have important policy ramifications. Public health authorities should prioritize mental health initiatives that include BDD as a critical area of focus. Policies that promote mental health screening in schools, colleges, and primary healthcare settings can facilitate early detection and intervention. Funding and support for training healthcare providers in recognizing and treating BDD are also essential. By incorporating BDD into broader mental health strategies, public health initiatives can address the disorder's complex nature and reduce its burden on individuals and society.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eWHO - World Health Organisation\u003c/p\u003e\n\u003cp\u003eBDD - Body Dysmorphic Disorder\u003c/p\u003e\n\u003cp\u003eCBT - Cognitive Behavioural Therapy\u003c/p\u003e\n\u003cp\u003eSSRIs - Selective Serotonin Reuptake Inhibitors\u003c/p\u003e\n\u003cp\u003eNCRB - National Crime Records Bureau\u003c/p\u003e\n\u003cp\u003eUGC - University Grants Commission\u003c/p\u003e\n\u003cp\u003eBDDQ - Body Dysmorphic Disorder Questionnaire\u003c/p\u003e\n\u003cp\u003eSD - Standard Deviation\u003c/p\u003e\n\u003cp\u003eSPSS - Statistical Package for the Social Sciences\u003c/p\u003e\n\u003cp\u003eC.I. - Confidence Interval\u003c/p\u003e\n\u003cp\u003eDSM-IV - Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition\u003c/p\u003e\n\u003cp\u003eDSM-5 - Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition\u003c/p\u003e\n\u003cp\u003eYBOCS - Yale-Brown Obsessive-Compulsive Scale\u003c/p\u003e\n\u003cp\u003eEMA - Ecological Momentary Assessment\u003c/p\u003e\n\u003cp\u003eAD - Atopic Dermatitis\u003c/p\u003e\n\u003cp\u003eJDD - Journal of Drugs in Dermatology\u003c/p\u003e\n\u003cp\u003ePRISMA - Preferred Reporting for Systematic Reviews and Meta-Analyses\u003c/p\u003e\n\u003cp\u003eICD-10 - International Classification of Diseases, Tenth Revision\u003c/p\u003e\n\u003cp\u003eICF - Informed Consent Form\u003c/p\u003e\n\u003cp\u003eSD - Standard Deviation\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003e\u003cu\u003eETHICS APPROVAL\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eEthical approval for this study was obtained from the Institutional Ethics Committee of the Indian Institute of Public Health Gandhinagar. All methods were carried out in accordance with relevant guidelines and regulations.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cu\u003eCONSENT TO PARTICIPATE\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eInformed consent was obtained from all participants involved in the study.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cu\u003eCONSENT TO PUBLISH\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eConsent for publication was obtained from all participants prior to data collection.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cu\u003eFUNDING DECLARATION\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eNo funding was received for this study.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cu\u003eAUTHOR CONTRIBUTIONS\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eR.D.D. conceptualized the study, performed data collection and analysis, and drafted the manuscript. A.S. provided academic supervision and revisions. N.J. and I.L. supported fieldwork design and qualitative analysis. All authors reviewed and approved the final manuscript.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cul\u003e\n \u003cli\u003e\u003cstrong\u003eCorresponding Author\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;Dr. Rutvik Deepakbhai Dabhi\u003cbr\u003e\u0026nbsp;Email: [email protected]\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cu\u003eCLINICAL TRIAL NUMBER\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eNot applicable.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cu\u003eCOMPETING INTERESTS\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eThe authors declare no competing interests.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cu\u003eDATA AVAILABILITY\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eThe datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request.\u003c/li\u003e\n\u003c/ul\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eMOHAMMAD MOSADEGHRAD, A. 2013. Healthcare service quality: towards a broad definition. International Journal of Health Care Quality Assurance, 26, 203-219.\u003c/li\u003e\n\u003cli\u003eVEALE, D. 2004. Body dysmorphic disorder. Postgraduate Medical Journal, 80, 67-71.\u003c/li\u003e\n\u003cli\u003eAmerican Psychiatric Association, American Psychiatric Association (Eds.), 2022. Diagnostic and statistical manual of mental disorders: DSM-5, 5th ed. ed. American Psychiatric Association, Washington, D.C.\u003c/li\u003e\n\u003cli\u003ePhillips K. A. (1996). Body dysmorphic disorder: diagnosis and treatment of imagined ugliness. The Journal of Clinical Psychiatry, 57 Suppl 8, 61\u0026ndash;65.\u003c/li\u003e\n\u003cli\u003ePHILLIPS, K. A. 1991. Body dysmorphic disorder: the distress of imagined ugliness. Am J Psychiatry, 148, 1138-49.\u003c/li\u003e\n\u003cli\u003ePHILLIPS, K. A., MCELROY, S. L., KECK, P. E., JR, POPE, H. G., JR, \u0026amp; HUDSON, J. I. 1993. Body dysmorphic disorder: 30 cases of imagined ugliness. American Journal of Psychiatry, 150, 302-308.\u003c/li\u003e\n\u003cli\u003eHOLLANDER, E., COHEN, L. J. \u0026amp; SIMEON, D. 1993. Body Dysmorphic Disorder. Psychiatric Annals, 23, 359-364.\u003c/li\u003e\n\u003cli\u003eSINDI S A, A. M. K., SINDI E E, ET AL. 2023. The Prevalence and Characteristics of Body Dysmorphic Disorder Among Adults in Makkah City, Saudi Arabia. A Cross-Sectional Study. Cureus 15(2).\u003c/li\u003e\n\u003cli\u003eMCGRATH, L. R., OEY, L., MCDONALD, S., BERLE, D. \u0026amp; WOOTTON, B. M. 2023. Prevalence of body dysmorphic disorder: A systematic review and meta-analysis. Body Image, 46, 202-211.\u003c/li\u003e\n\u003cli\u003eHARDARDOTTIR, H., HAUKSDOTTIR, A. \u0026amp; BJORNSSON, A. S. 2019. [Body dysmorphic disorder: Symptoms, prevalence, assessment and treatment]. Laeknabladid, 105, 125-131.\u003c/li\u003e\n\u003cli\u003eMORTADA, H. H., ALQAHTANI, Y. A., SERAJ, H. Z., ALBISHI, W. K. \u0026amp; ALJAALY, H. A. 2019. Perception of Plastic Surgery and the Role of Media Among Medical Students: Cross-Sectional Study. Interactive Journal of Medical Research, 8, e12999.\u003c/li\u003e\n\u003cli\u003eRYDING, F. C. \u0026amp; KUSS, D. J. 2020. The use of social networking sites, body image dissatisfaction, and body dysmorphic disorder: A systematic review of psychological research. Psychology of Popular Media, 9, 412-435.\u003c/li\u003e\n\u003cli\u003eKREBS, G., FERN\u0026Aacute;NDEZ DE LA CRUZ, L. \u0026amp; MATAIX-COLS, D. 2017. Recent advances in understanding and managing body dysmorphic disorder. Evidence-Based Mental Health, 20, 71-75.\u003c/li\u003e\n\u003cli\u003eVEALE, D., GLEDHILL, L. J., CHRISTODOULOU, P. \u0026amp; HODSOLL, J. 2016. Body dysmorphic disorder in different settings: A systematic review and estimated weighted prevalence. Body Image, 18, 168-186.\u003c/li\u003e\n\u003cli\u003eAmerican Psychiatric Association, American Psychiatric Association (Eds.), 2013. Diagnostic and statistical manual of mental disorders: DSM-5, 5th ed. ed. American Psychiatric Association, Washington, D.C.\u003c/li\u003e\n\u003cli\u003eKORAN, L. M., ABUJAOUDE, E., LARGE, M. D. \u0026amp; SERPE, R. T. 2008. The prevalence of body dysmorphic disorder in the United States adult population. CNS Spectr, 13, 316-22.\u003c/li\u003e\n\u003cli\u003ePHILLIPS, K. A., COLES, M. E., MENARD, W., YEN, S., FAY, C. \u0026amp; WEISBERG, R. B. 2005. Suicidal ideation and suicide attempts in body dysmorphic disorder. J Clin Psychiatry, 66, 717-25.\u003c/li\u003e\n\u003cli\u003eS. RUFFOLO, J., PHILLIPS, K. A., MENARD, W., FAY, C. \u0026amp; WEISBERG, R. B. 2006. Comorbidity of body dysmorphic disorder and eating disorders: Severity of psychopathology and body image disturbance. International Journal of Eating Disorders, 39, 11-19.\u003c/li\u003e\n\u003cli\u003eENANDER, J., ANDERSSON, E., MATAIX-COLS, D., LICHTENSTEIN, L., ALSTR\u0026Ouml;M, K., ANDERSSON, G., LJ\u0026Oacute;TSSON, B. \u0026amp; R\u0026Uuml;CK, C. 2016. Therapist guided internet-based cognitive behavioural therapy for body dysmorphic disorder: single-blind randomised controlled trial. BMJ, i241.\u003c/li\u003e\n\u003cli\u003eHARTMANN, A. S., SCHMIDT, M., STAUFENBIEL, T., EBERT, D. D., MARTIN, A. \u0026amp; SCHOENENBERG, K. 2021. ImaginYouth\u0026mdash;A Therapist-Guided Internet-Based Cognitive-Behavioral Program for Adolescents and Young Adults With Body Dysmorphic Disorder: Study Protocol for a Two-Arm Randomized Controlled Trial. Frontiers in Psychiatry, 12.\u003c/li\u003e\n\u003cli\u003eKREBS, G., FERN\u0026Aacute;NDEZ DE LA CRUZ, L., RIJSDIJK, F. V., RAUTIO, D., ENANDER, J., R\u0026Uuml;CK, C., LICHTENSTEIN, P., LUNDSTR\u0026Ouml;M, S., LARSSON, H., ELEY, T. 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Dermatology in Contemporary Times: Building Awareness of Social Media\u0026apos;s Association With Adolescent Skin Disease and Mental Health. Journal of drugs in dermatology: JDD, 22, 817-825.\u003c/li\u003e\n\u003cli\u003eADDISON, M., JAMES, A., BORSCHMANN, R., COSTA, M., JASSI, A. \u0026amp; KREBS, G. 2024. Suicidal thoughts and behaviours in body dysmorphic disorder: Prevalence and correlates in a sample of mental health service users in the UK. Journal of Affective Disorders, 361, 515-521.\u003c/li\u003e\n\u003cli\u003eKREBS, G., CLARK, B. R., FORD, T. J. \u0026amp; STRINGARIS, A. 2024. Epidemiology of Body Dysmorphic Disorder and Appearance Preoccupation in Youth: Prevalence, Comorbidity and Psychosocial Impairment. Journal of the American Academy of Child \u0026amp;amp; Adolescent Psychiatry.\u003c/li\u003e\n\u003cli\u003eRAUTIO, D., ISOMURA, K., BJUREBERG, J., R\u0026Uuml;CK, C., LICHTENSTEIN, P., LARSSON, H., KUJA-HALKOLA, R., CHANG, Z., D\u0026rsquo;ONOFRIO, B. M., BRIKELL, I., SIDORCHUK, A., MATAIX-COLS, D. \u0026amp; FERN\u0026Aacute;NDEZ DE LA CRUZ, L. 2024. Intentional Self-Harm and Death by Suicide in Body Dysmorphic Disorder: A Nationwide Cohort Study. Biological Psychiatry.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTables 1 to 3 are available in the Supplementary Files section.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Body Dysmorphic Disorder, BDD, young adults, suicidal ideation, social media, mental health, Mehsana district","lastPublishedDoi":"10.21203/rs.3.rs-7001782/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7001782/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eBody Dysmorphic Disorder (BDD) is a chronic mental condition characterized by an obsessive focus on perceived flaws in physical appearance, leading to significant distress and impairment in social, occupational, and other areas of functioning. This study aims to explore the prevalence of BDD among young adults in the Mehsana district, India, and its association with suicidal ideation and behaviours, considering the influence of social media.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eA cross-sectional study was conducted involving 342 young adults aged 17 to 25 years, equally divided between college-going and non-college-going participants. Data were collected using a self-administered Body Dysmorphic Disorder Questionnaire (BDDQ) based on DSM-IV criteria and supplemented by qualitative interviews. The study employed both quantitative (descriptive statistics, chi-square tests, correlation analysis, and t-tests) and qualitative (thematic analysis) methods to assess the prevalence of BDD, its impact on daily life, social interactions, and the role of social media.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eThe prevalence of BDD was found to be 9.36% among college-going and 15.79% among non-college-going young adults. Significant associations were observed between gender and appearance-related anxiety, with females reporting higher distress levels. BDD was associated with increased mental distress, suicidal ideation, and significant social impairment, including avoidance of social activities and problems in academic and occupational settings. Thematic analysis revealed the profound impact of social media on exacerbating BDD symptoms and influencing body image perceptions.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e\u003cp\u003eThe study highlights the substantial burden of BDD on mental health and social functioning among young adults in Mehsana. The findings underscore the urgent need for early identification, culturally sensitive interventions, and integrated treatment approaches to address BDD. Emphasizing the role of social media in shaping body image concerns, the study recommends leveraging digital platforms for positive interventions and promoting body positivity. Future research should focus on longitudinal studies to understand the progression of BDD and the long-term effectiveness of various treatments.\u003c/p\u003e","manuscriptTitle":"Impact of Body Dysmorphic Disorder on Suicidal Risks among Young Adults in Mehsana District: A Comparative Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-08-06 08:16:45","doi":"10.21203/rs.3.rs-7001782/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"222418e0-628d-4114-baaf-2d1d4235fec2","owner":[],"postedDate":"August 6th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-10-03T10:23:28+00:00","versionOfRecord":[],"versionCreatedAt":"2025-08-06 08:16:45","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7001782","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7001782","identity":"rs-7001782","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}