Status and Correlates of Body Dysmorphic Disorder symptoms among School-Aged female adolescents in Jordan

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Hejjeh, Shaher H. Hmaideh, Lobna Harazneh, Ahmad M Rayani, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6783893/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 07 Mar, 2026 Read the published version in BMC Psychology → Version 1 posted 14 You are reading this latest preprint version Abstract Background : Adolescence is a phase characterized by different changes in the brain, hormones, mind, and social environment. Half of all mental illnesses, including body dysmorphic disorder, begin around the age of 14 and are often preceded by nonspecific psychosocial problems that could probably progress to any major mental illness. Body dysmorphic disorder is one of the mental illnesses that might have negative consequences on school-age female adolescents’ academic, social, and psychological functioning. Purposes : The purpose of this study is to examine the status and correlates of Body Dysmorphic Disorder symptoms among school-aged female adolescents in Jordan. Methods : A cross-sectional, descriptive-correlational design was employed using convenience sampling techniques of 402 school-aged female adolescents from the north, center, and southern regions of Jordan. The ages of the students ranged from 12 to 18 years. BDD symptoms were measured using the Body Dysmorphic Disorder-Symptoms scale. Results : The analysis revealed that female adolescents had a low level of BDD symptoms, however; the the highest severity was observed in the “grooming group” with a mean of 3.3 (SD = 2.6), while the lowest severity was in the weight and shape group with a mean of 1.8 (SD = 2.3). The results showed that (10.4%) of the female adolescent had weight/shape BBD symptoms, dermatological/surgical (17.3%), avoidance (26.2%), cognition related to BDD (27.5%), skin picking/hair pulling (32.9%), checking (38.6%), and grooming (52.9%). The most frequent symptoms of BDD were “changing clothes,” from the “grooming group,” expressed by 94.8% of the female adolescents. Significant differences were found in BDD symptom severity in relation to congenital problems/deformities (t = -6.8, p < 0.001; t = -5.9, p < 0.001, respectively), and health problems (t = -2.4, p = 0.016). Conclusion : The findings of this study revealed BDD symptoms impact individuals in various aspects of life, including sleep, academics, appetite, and social life, which requires an organized mental health monitoring and screening for such mental disturbances in schools. Body Dysmorphic Disorder Adolescents Prevalence Of Body Dysmorphic Disorder Introduction Adolescence is a phase characterized by the period of life between puberty and adulthood, which varies depending on individual development and cultural norms. The World Health Organization ( 1 ) emphasized the importance of this time and asserted that emotional, physical, and social changes, violations, and abuse can predispose adolescents to mental illnesses. Half of all mental illnesses begin around the age of 14 and are often preceded by nonspecific psychosocial problems ( 2 , 3 ). Among the mental disturbances that are observed among young people, Body Dysmorphic Disorder (BDD). According to the Diagnostic and Statistical Manual for Mental Disorders-5-TR (DSM-5-TR), individuals with BDD have a preoccupation with one or more perceived defects in physical appearance that are not observable or appear slight to others ( 4 ). This preoccupation is time-consuming and difficult to resist, causing social and occupational impairment ( 4 , 5 ). For adolescents, females in particular, appearance and how they look are a significant inclusion in their definition of identity. Therefore, preoccupation with their physical appearance and outlook might predispose them to BDD symptoms. The puberty stage involves a rapid increase in estrogen in females that contributes to their mental illness later in life if uncontrolled or severely disturbed ( 1 , 6 ). Beauty is an important pillar for females, and physical charms are considered their most significant social responsibility ( 7 ). Additionally, culture influences standards of beauty. For example, in Middle Eastern culture, there are many standards of beauty, such as a round or oval face, raised eyebrows, wide and almond-shaped eyes, full lips and cheeks, a small nose, a prominent jaw, and a pointed chin ( 7 ). This has contributed to the preoccupation and strict attention of female adolescents to their physical shape. In particular, where hijab (the cover and scarf), which is a traditional and religious dress for most Arabs and Muslims, may switch preoccupation to face as it is more apparent and noted for others ( 7 ). Such a context of cultural influence might and might not predispose female adolescents to BDD symptoms similar to other cultures. Eventually, the literature has not addressed this point adequately, which prompted this study. Globally, the prevalence rate of BDD is 5.0–10.0% among cosmetic dentistry patients, 20% among rhinoplasty surgery patients, and 13.0–15.0% among general cosmetic surgery patients ( 8 ). The prevalence rate of BDD among university students in the USA was 1.7% ( 27 ), 4.4% among female medical students in Saudi Arabia ( 8 ), and 14.1% among Arab dermatology patients in Saudi Arabia ( 9 ). In Jordan, the prevalence rate of BDD among university students was 20.3% ( 14 ). The special attention to BDD among female adolescents is due to its remarkable negative impact on their school and academic performance, including failing exams, dropping out of school, and lacking concentration in the classroom ( 10 , 11 ). Understanding of BDD is still lagging, particularly among female adolescents who often cover their worries about their physical image and appearance due to embarrassment ( 12 ). Such defensive behaviors may contribute to misdiagnosing BDD with other mental illnesses or disturbances such as social anxiety, isolation, and depressive feelings ( 13 ). Poor insight and an intense desire for cosmetic procedures are common compensatory defense mechanisms of female adolescents with BDD that might jeopardize mental health status and increase the risk of self-harm ( 14 , 15 ). In Jordan, little is known about BDD symptoms among female adolescents. In general, females are more disappointed with their bodies than males ( 16 ). The role of culture in deciding the Dress code for females and the rules and effects of the religious beliefs of Muslims are factors that need to be investigated among female adolescents to enhance our understanding of the status and correlates of BDD among female school-age adolescents in Jordan. This study addresses one of the significant psychosocial problems that influences and directly affects the integrity and social well-being of female adolescents. Therefore, the purpose of this study was to examine the status and correlates of body dysmorphic disorder symptoms among school-aged female adolescents in Jordan. Specific aims were to: To identify the status of body dysmorphic disorder symptoms among school-aged female adolescents in Jordan. To examine differences and correlates of body dysmorphic disorder symptoms in relation to the selected sociodemographic characteristics of school-aged female adolescents in Jordan. Methods Design A cross-sectional, descriptive design was used to examine the prevalence of BDD symptoms among school-aged female adolescents in Jordan. Setting Data was collected from governmental and private schools in Jordan. Jordanian schools (1 private and 4 governmental from each region), including school-aged female adolescents aged 12–18 years, were randomly selected from the three main regions in the country (North, Center, and South) Sample and sampling The convenience sampling technique was used to recruit school-aged female adolescents. We have targeted students ages 12 to 18 in this. This was because the mean age of BDD onset is 16–17 years, and the symptoms begin at age 12 or 13 ( 10 ). Inclusion criteria include ( 1 ) being in the seventh to twelfth grade (Tawjehi) and ( 2 ) being able to read and write Arabic. Exclusion criteria were ( 1 ) being diagnosed with a mental disorder according to school records or family consent. The total sample approached was 409, and the sample included in the study was. Data collection Ethical approval for data collection was obtained from the Institutional Review Board (IRB) at XYZ University and the Ministry of Education. Schools from the Southern, Northern, and Central regions were randomly selected. The researcher initiated communication with school principals via phone, introducing the study, its purpose, and its methodology. A copy of the Ministry of Education’s approval and the online questionnaire were provided. Upon the principal’s approval, the questionnaire link was shared with teachers responsible for grades 7–12, who distributed it via WhatsApp groups. Established during the COVID-19 pandemic, these groups remained a common communication tool between students, teachers, and parents. The questionnaire included study details in Arabic, a consent form, and the researcher’s contact information. The parents were asked to provide their approval for having their children participate in the study, and the children were also asked to provide their approval. Those who agreed to participate in the study were provided with a link. Participants were not asked to provide their names or phone numbers. The soft copies of the surveys were kept in a password-protected computer that is not accessible except to the research team. Instruments : The Arabic version of the scales has been used. The original language of BDD-SS was English. Therefore, it had to be translated into Arabic to provide an Arabic version suitable for our cultures. WHO guidelines on the translation and adaptation of instruments (2022) were followed to translate the instrument into Arabic. The translated instrument should be acceptable and work in the same way by using both forward and back translations. Implementation of this procedure included four steps: forward translation, expert panel, back translation, and final version. The instrument was translated forward from the original language (English) to the target language by one bilingual translator, a health professional who is familiar with the terminology of the topic covered by the instrument and the content area of the instrument construction in the desired target language (Arabic). The instrument was then translated into English by an independent translator who did not know the questionnaire and whose first language is English. It was validated as being equivalent to the original. Cultural and conceptual equivalence, rather than linguistic equivalence, were used in the back-translation. Later, the back-translation version was sent to the original author, who approved it. The Body Dysmorphic Disorder Symptoms Scale (BDD-SS) ( 16 , 17 ) was used to examine the presence and severity of symptoms. The BDD-SS consists of 54 symptoms distributed into seven groups, with each group containing 2–19 symptoms. The groups of symptoms, respectively, are checking, grooming, shape/weight, hair pulling/skin picking, surgery/dermatology seeking, avoidance, and BDD-related cognition. Individuals endorse (yes or no) the symptoms they suffered in the last week. Therefore, opposite to all symptoms in each group, there is a rating scale from 0 to 10 (0 = no problem, 10 = very severe). Individuals were asked to rate the overall severity of the symptoms, in which at least one symptom was endorsed in the group. The BDD-SS provides two critical scores: BDD-SS Symptom (which represents the number of symptoms experienced and the score range from 0 to 54 (number of symptoms endorsed)) and BDD-SS Severity (which represents the total of all severity ratings that range from 0 to 70 (sum of the severity scores in seven groups. Any symptom group with a severity level of 5 (moderate) required medical attention, but symptom groups with a severity level of 0 indicated no need for medical attention. To verify the content validity of this instrument, a panel of expert physicians from the Massachusetts General Hospital Obsessive-Compulsive Disorder (MGH OCD) and other related disorders programs that conduct studies in the BDD field reviewed all items. A study conducted to determine the internal consistency of the BDD-SS showed that the reliability of the BDD-SS (symptoms) was Kuder-Richardson Formula − 20 (KR-20 = 0.81). In addition, the reliability of the BDD-SS (severity) scales was Cronbach’s α = 0.75 (Wilhelm et al., 2016). Sociodemographic characteristics were assessed using a researcher-adapted questionnaire. The collected information was related to school-aged female adolescents’ age, class, school type, academic average in the last semester, height, weight, presence of any mental disorder, presence of any health problems, presence of congenital problems/deformities, presence of dermatological problems, using regular medications, using social media, and being bullied for reasons related to appearance. Data analysis The Statistical Package for the Social Sciences (SPSS), version 26, was used for statistical analysis. Descriptive statistics were used to describe the variables of the study (central tendency and dispersion measures). Categorical variables described using frequencies and percentages. In addtion, and inferential statistics (t-test, Pearson r, ANOVA) were used to examine differences, making comparison, testing correlations mong the variables. Ethical approval: This study was conducted by the ethical principles outlined in the Declaration of Helsinki. Ethical approval for conducting the research was obtained from the Institutional Review Board (IRB) at the University of Jordan , and permission was granted by the Jordanian Ministry of Education to access school settings and recruit participants. Participation in the study was voluntary. Informed consent was obtained from the parents of all participating adolescents, and assent was also secured from the adolescents themselves before data collection. Confidentiality and anonymity of the participants were maintained throughout the study. No personal identifiers were collected, and all data were stored securely on a password-protected device accessible only to the research team. Results Demographic characteristics A total of 409 Jordanian school-aged female adolescents were approached, and 402 of them met the inclusion criteria. The analysis showed that participants’ ages ranged between 12.0 and 18.0, with a mean of 15.0 (SD = 2) years old. Regarding school information, 85.6% (n = 344) of them were at governmental schools, 35.9% (n = 144) of them were in high school study level, and 35.3% (n = 142) of them had an academic average ranging from 81.0 to 90.0. Concerning social media, 81.8% (n = 329) of them use it regularly, and 14.7% (n = 59) of them suffer from bullying. Health-related factors The analysis (Table 2) showed that 49.0% (n = 197) of participants’ height ranged between 151.0 to 160.0cm, and 34.8% (n = 140) of their weight ranged between 40 to 50 kg. Moreover, 4.7% (n = 19) of participants have congenital problems or deformities, 11.2% (n = 45) have health problems, 17.4% (n = 70) have dermatological problems, and 10.4% (n = 42) regularly use one or more medications. Body Dysmorphic Disorder Symptoms The analysis revealed that the total score of BDD symptoms ranged from zero to 48, with a mean score of 16.3 (SD = 10.3). Using the interquartile equation, the analysis showed that 50% of the participants had a score of 13.5, and 25% of the participants had a score of 21 or higher. This indicates that, given the expected range of scores up to 54, female adolescents had a low level of BDD symptoms. This has been supported by the fact that 75% of the participants had a score of 9.0 or higher. Furthermore, the analysis revealed that the body dysmorphic disorder domain percentage ranged from weight/shape 10.4%, dermatological/surgical 17.3%, avoidance 26.2%, cognition related to BDD 27.5%, skin picking/hair pulling 32.9%, checking 38.6%, and grooming 52.9%. (Table 3) showed that the most frequent symptom among participants in the “checking group” was “checking mirrors repeatedly” was reported by 59.5% (n = 239), while the least frequent symptom among participants in the “checking group” was “measuring specific body parts,” at 22.4% (n = 90). Likewise, the most frequent symptom among participants in the “grooming group” was “changing clothes” by 94.8% (n = 381), while the least frequent symptom among participants from the “grooming group” was “tanning” by 5.0% (n = 20). Moreover, the most frequent symptom among participants from the “weight/shape group” was “eating in special ways,” at 20.1% (n = 81), while the least frequent symptom among participants from the “weight/shape group” was “using steroids,” by 4% (n = 16). Furthermore, the most frequent symptom among participants from “Picking/plucking” was “Pulling or plucking hair” by 41.3% (n = 166), while the least frequent symptom was “Skin picking” by 24.6% (n = 99). As well, the most frequent symptom among participants from the “avoidance group” was “avoiding being seen with a few clothes” by 46% (n = 185), while the least frequent symptom among participants from the “avoidance group” was “avoiding mirrors or reflective surfaces” by 14.4% (n = 58). Additionally, the most frequent symptom among participants from the “Surgical/Dermatological group” was “using medication or topical treatment to correct defects,” by 23.9% (n = 96), while the least frequent symptom among participants from the “Surgical/Dermatological Group” was “obtaining cosmetic surgery” by 4.7% (n = 19). Likewise, the most frequent symptom among participants from the “Cognition group” was “what I look like is an important part of who I am” by 65.9% (n = 265), while the least frequent symptom among participants from the “Cognition group” was “if my appearance is defective, I am helpless” by 10.2% (n = 41). Severity of BDD The total score of BDD severity ranged from zero to 10, with a mean score of 2.5 (SD = 2.1). Using the interquartile equation, the analysis showed that 50% of the participants had a score of 2.0, and 25% of the participants had a score of 3.7 or higher. Given that the expected range of scores is up to 10, the results indicate that female students had a low BDD symptom severity level. This has been supported by the fact that 75% of the participants had a score of 0.9 or higher. Furthermore, the results (Table 3) showed that the highest severity was observed in the “grooming group” with a mean of 3.3 (SD = 2.6), while the lowest severity was in the weight and shape group with a mean of 1.8 (SD = 2.3). Bivariate Analysis Differences and correlates in BDD related to socio-demographics and health factors The analysis showed that there was no significant relationship between BDD symptoms and severity regarding the age of participants (r = -0.026, p = 0.601, r = -0.052, p = 0.300, respectively). A significant difference in the school type regarding BDD symptoms and severity (t = -3.3, p = 0.001; t = -2.8, p = 0.005, respectively) was found. In addition, there was a significant difference in the congenital problems/deformities associated with BDD symptoms and severity (t = -6.8, p < 0.001; t = -5.9, p < 0.001, respectively). Likewise, there was a significant difference in the health problems related to BDD symptom severity (t = -2.4, p = 0.016), but no significant difference in the health problems related to BDD symptoms. Furthermore, there is a significant difference in the dermatological problems of BDD symptoms and severity (t = -6.4, p < 0.001; t = -4.4, p < 0.001, respectively). As well, there was a significant difference in the use of regular medications in relation to BDD symptoms (t = -2.7, p = 0.006), but no significant difference in the use of regular medications about BDD symptom severity. See table 5 Differences in BDD related to social media use Analysis revealed a significant difference in the use of social media about BDD symptoms and severity (t = -3.061, p = 0.002; t = -2.239, p = 0.026, respectively). Likewise, there was a significant difference in the suffering from bullying about BDD symptoms and severity (t = -6.824, p < 0.001; t = -5.514, p < 0.001, respectively). See table 5 Differences in BDD related to academic performance A one-way ANOVA test has been used to assess the differences in the mean score of continuous and categorical variables. The analysis (Table 5) showed that there was a significant difference in the mean academic average about BDD symptom severity (F = 3.1, p = 0.016). In addition, there was no significant difference in the mean academic average between BDD symptoms. Furthermore, the analysis revealed no significant difference in the mean grade of BDD symptoms and severity. See table 5 Discussion Female adolescents lack the experience to manage their psychosocial needs, making them at higher risk of psychosocial disturbances. Several studies conducted lately and found that female adolescents in Arab culture are suffering various forms of psychosocial disturbances such as eating problems (18), anxiety and depression (19-20), substance use (21), internet addiction (22), and general pain and emotional expression dysfunction (23-24). These studies have proved that female adolescents do suffer psychosocial disturbances. This study emphasizes one significant component related to the identity of females, in general, and for female adolescents in particular, which relates to their perceptions of appearance. We have assessed the prevalence and severity of body dysmorphic symptoms and their socio-demographic predictors. We found that the severity of BDD symptoms in this study was low; however, the figures may indicate a serious mental dysfunction that interfered with females’ ability to perform their age-related functions. The participants in this study are female adolescents at the high school level, which may indicate that BDD is directly affected by sociocultural factors and their sex-role perception. It is assumed that BDD might be higher in types that concern females more than males and within the cultural perspective and explanation of the disease. The sociocultural theory assumes that social norms related to parents, peers' perceptions, and media send messages that affect the behavior and thought processes of young people (25). It is also noted that adolescents are notoriously known to go through many hormonal changes during puberty (26), which may contribute to several explanations for the perception of appearance among female adolescents. Comparing current results with previous studies might be challenging due to the lack of standardized screening tools and the lack of similar studies within the Jordanian population, acknowledging that such a topic has been addressed by the literature in other cultures, which might not enable comparison or highlight similarities. Eating disorder symptoms, which a related to the topic of BBD symptoms, have been reported with alarming proportions among female adolescents in Jordan (18). In terms of obsessive behaviors related to BDD, it has been found that the prevalence of BDD symptoms among female adolescents was 4.5% (16). The most frequent obsessive behavior was checking in front of a mirror, and the least frequent symptom was excessive cleaning. Furthermore, the percentage of excessive grooming among participants was lower than in our study (16). These variations may be due to differences in the screening tools used and the age of the participants, who were between 18 and 25 years old. Furthermore, and compared to other cultures, it was found that the percentage of grooming in our study was lower than in the Stockholm sample, 61.6% (25). This variation may be referring to the screening tools used and the nature of the sample, which included 172 adolescents and children diagnosed with BDD and not just suffering symptoms of BBD, which is the sample of this study. Summers et al. (26) found that the most frequent symptom among participants was “checking or inspecting certain parts of my body” from the “checking group, unlike our study, where we found that “changing clothes” was the most frequent symptom from the “grooming group.” Our findings were nearly similar to this study in the most frequent symptoms within the “weight/shape group,” which was “eating in special ways,” and the “surgical/dermatological group,” which was “using medication or topical treatment to correct defects.” The analysis also showed that sociodemographic characteristics of school-aged female adolescents, such as age, were not significantly associated with BDD symptoms and severity. The results did partly support the previous finding that no association was found between BDD symptoms and age and grade among female students (6). The results also disagree with others who found that BDD was associated with age and was significantly higher among young people (25). Concerning academic performance, we found that there was a significant difference in the severity of BDD symptoms, while others found that females were significantly different in their BDD from their academic average (27). Nevertheless, a previous Jordanian study (28) found a positive correlation between body image dissatisfaction and low academic performance. Regarding school type, we found significant differences between participants who were from private and governmental schools, while Alam et al. (29) found that the students in private Universities had a higher probability of having BDD symptoms than the students in public universities. The small number of participants from private schools and their high socioeconomic status might have contributed to this result, as it is known that students from private schools typically come from higher socioeconomic classes and have better financial status. Moreover, regarding the use of social media, this study revealed significant differences between participants who used social media and those who did not. This study confirmed a previous study that found that BDD was positively associated with spending more time on Snapchat and Instagram applications (1). There have been abundant studies about the effect of using social media on BDD symptoms, but little is known about what negates these differences. Adolescents were influenced by universal features of appearance that were conveyed via social media and compared their appearance to these features, resulting in body dissatisfaction. In the current study, the analysis showed significant differences between the participants who suffered from bullying and those who did not suffer from bullying. Adverse childhood experiences, such as bullying at school, could influence mental health (24-26). Our findings were consistent with previous studies regarding BDD symptoms and bullying. Studies revealed that the types of adverse childhood experiences (abuse, teasing, neglect, and bullying) were significantly associated with BDD symptoms (26-28). Concerning health-related factors, the analysis revealed that BDD symptoms were significantly different from congenital problems/deformities, dermatological problems, and the use of regular medications. In addition, there was a significant difference in health problems about the severity of BDD symptoms. Regarding congenital problems/deformities, one of the studies conducted to assess the negative effects of keloids on body image showed that 40% of the participants had negative parts of their body image (BDSS scores ≥6) (29). Interestingly, in a cross-sectional study conducted in KSA among females in governmental secondary schools, the authors excluded all participants with congenital deformities such as a cleft palate and acquired deformities related to burns, trauma, illness, and scars (30, 31). Regarding health problems, the literature revealed that there was a significant relationship between BDD and obesity. One of the studies conducted in Makkah, KSA, revealed that there was an insignificant difference in obesity between non-BDD and BDD groups (31). In terms of dermatological problems, the results found a high prevalence of BDD among patients with acne, among 406 patients diagnosed with acne (32). Concerns related to skin and nose were the most frequently reported by females from secondary school in KSA ( 32). This was relatively in agreement with the concerns of female students in the college of medicine, where skin represented the most frequent concern related to their bodies (31). The high rates of skin concerns could be related to acne vulgaris, which is common among adolescents (30-33). Regarding using regular medications, a case presentation of a female who suffered from several health problems. This study has some limitations that include using a structured format of data collection, in which further investigation and clinical evaluation for participants might reveal informative outcomes. Conclusion This study sheds light on an important, yet often overlooked, issue affecting female adolescents in Arab societies—their struggles with body image and the symptoms of body dysmorphic disorder (BDD). While the overall severity of BDD symptoms among the participants was low, the results still point to a deeper concern that could affect their mental health and day-to-day life. Social pressures from media, peer comparisons, and societal expectations—combined with personal experiences like bullying, skin conditions, and chronic health issues—played a significant role in shaping female adolescents’ perception of their appearance and body. Differences based on school type and social media use also stood out, showing just how influential environment and exposure can be. The study has implications for mental and psychological counselors at the school and community. There is a need to recognize and acknowledge females’ perception of their bodies during the middle and late adolescence period for their implicit influence on their quality of mental wellbeing and performance. School counselors need to address and educate female adolescents to express their unsatisfied feelings about their bodies to enable early detection and management of such a problem before it becomes at severe form. Although comparing these results with other research was difficult due to cultural differences and varying tools of measurement, it’s clear that more attention needs to be given to how adolescent girls perceive their bodies. Future research should incorporate more personal and clinical assessments to better understand and support the needs of these young women. Abbreviations BDD Body Dysmorphic Disorder WHO World Health Organization DSM-5-TR Diagnostic and Statistical Manual for Mental Disorders, edition 5, text review APA American Psychiatric Association BDD-SS Body Dysmorphic Disorder Symptoms Scale BDDQ Body Dysmorphic Disorder Questionnaire BIDS Body Image Disturbance Questionnaires IOCDF International Obsessive-Compulsive Disorder Foundation SCID Structured Clinical Interview for DSM-5 BDDE Body Dysmorphic Disorder Examination BDD-YBOCS Yale-Brown Obsessive-Compulsive Scale Modified for Body Dysmorphic Disorder ADAA Anxiety and Depression Association of America OCD Obsessive-Compulsive Disorder MOE Ministry of Education IRB Institutional Review Board KR Kuder-Richardson SPSS Statistical Package for the Social Sciences SD Standard Deviation N/n Number M Mean P Probability Declarations Ethics approval and consent to participate This study was conducted by the ethical standards of the Declaration of Helsinki and approved by the Institutional Review Board (IRB) of the University of Jordan and the Ministry of Education. Written informed consent was obtained from all participants and, where applicable, from their parents or legal guardians before participation. Consent for Publication Not applicable Availability of data and materials The datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request. Competing interests The authors declare that they have no competing interests. Source of Funding No funding was received to assist with the preparation of this manuscript. Authors contributions Conceptualization: RSH, AHM, LH, SHH Study design: RSH, AHM, AR, LH Data collection: RSH, AR, LH, Data analysis: RSH, AHM, AR, LH, SHH Manuscript writing: RSH, AHM, AR, LH, SHH Acknowledgments The author of this study extends appreciation to the Ongoing Research Funding program (ORF-2025-1032), King Saud University, Riyadh, Saudi Arabia References World Health Organization. Guidelines on translation and adaptation of instruments [Internet]. 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The prevalence of depressive symptoms among Arab adolescents: findings from Jordan. Public Health Nurs. 2018;35:100–8. https://doi.org/10.1111/phn.12363 . Ahamed SS, Enani J, Alfaraidi L, et al. Prevalence of body dysmorphic disorder and its association with body features in female medical students. Iran J Psychiatry Behav Sci. 2016;10(2):e3868. Momani F, Al-Amri M. The predictability of using selfie and self-image editing behaviors in body dysmorphic disorder among Yarmouk University students. Jordan J Soc Sci. 2022;15. Available from: https://journals.ju.edu.jo/JJSS/article/view/111632 Alfoukha M, Hamdan-Mansour A, Bani Hani M. Social and Psychological factors related to Risk of Eating Disorders among High School Girls. J Sch Nurs. 2019;35(3):169–77. https://doi.org/10.1177/1059840517737140 . Alazzam M, Abuhammad S, Alhmoud A et al. Predictors of Depression and Anxiety among Senior High School Students during COVID-19 Pandemic: The Context of Home-Quarantine and Online Education. J Sch Nurs, 20121;37 (4): 241–8. https://doi.org/10.1177/1059840520988548 Ghannam B, Khatib H, Al Zayyat A, et al. The relationship between perception of wellbeing and depression among adolescents in Jordan: Using PERMA model as a theoretical framework. Men Health Soc Inc. 2024;28(5):604–16. https://doi.org/10.1108/MHSI-04-2023-0047 . Khalil M, Tabar NA, Alsadi M, Khrais H, Oweidat I, Hamaideh SH, Hamdan-Mansour AM. Factors Associated with Substance Use Disorder: Male Adolescents’ Lived Experience. Int J Ment Health Addict. 2023;21(5):3258–75. Abdallah FM, Hamdan-Mansour AM. Status and sociodemographic correlates of pathological internet use among adolescents in Jordan: a cross-sectional study. Middle East Curr Psychiatry. 2024;31(1):69. Alslman E, Thultheen I, Hamaideh SH, et al. The mediating effect of psychological distress and bullying victimization on the relationship between alexithymia and fibromyalgia among school adolescents. Ment Health Soc Incl. 2024;28(5):842–56. Hamdan-Mansour AM, Alsalman ET, Hamaideh SH. Psychological predictors of fibromyalgia among high school students. J Psychosoc Nurs Ment Health Serv. 2022;60(8):19–25. Motoki THC, Isoldi FC, Brito MJA, et al. Keloid negatively affects body image. Burns. 2019;45(3):610–4. Summers BJ, Hoeppner SS, Beatty CC, Wilhelm S, Greenberg JL. An evaluation of the Body Dysmorphic Disorder Symptom Scale as a measure of treatment response and remission in psychotherapy and medication trials. Behav Ther. 2022;53(3):521–34. Mahelele A, Al-Hamdan Y. Eating problems and its relation with body dysmorphic obsessive among adolescent girls in Jerash Governorate in Jordan. IUG J Educ Psychol Sci. 2021;29. Available from: https://www.researchgate.net/publication/372451348_mshklat_alakl_wlaqtha_bwswas_tshwh_swrt_aljsd_ldy_almrahqat_fy_mhafzt_jrsh_fy_alardn Momani F, Al-Amri M. The predictability of using selfie and self-image editing behaviors in body dysmorphic disorder among Yarmouk University students. Jordan J Soc Sci. 2022;15. Available from: https://journals.ju.edu.jo/JJSS/article/view/111632 Alam MM, Basak N, Shahjalal M, et al. Body dysmorphic disorder (BDD) symptomatology among undergraduate university students of Bangladesh. J Affect Disord. 2022;314:333–40. https://doi.org/10.1016/j.jad.2022.07.019 . Chang EC, editor. Handbook of Adult Psychopathology in Asians: Theory, Diagnosis, and treatment. New York: Oxford University Press; 2012. Grant JE, Lust K, Chamberlain SR. Body dysmorphic disorder and its relationship to sexuality, impulsivity, and addiction. Psychiatry Res. 2019;273:260–5. https://doi.org/10.1016/j.psychres.2019.01.036 . Hakim RF, Alrahmani DA, Ahmed DM, et al. Association of body dysmorphic disorder with anxiety, depression, and stress among university students. J Taibah Univ Med Sci. 2021;16(5):689–94. Himanshu KA, Kaur A, Singla G. Rising dysmorphia among adolescents: a cause for concern. J Fam Med Prim Care. 2020;9(2):567–70. https://doi.org/10.4103/jfmpc.jfmpc_738_19 . Tables Table 1: Sociodemographic characteristics of students (N= 402). Categorical variables n % School type Governmental 344 85.6 Private 58 14.4 Grade Seventh 47 11.7 Eighth 67 16.7 Ninth 65 16.2 Tenth 79 19.7 Eleventh 75 18.7 Twelfth 69 17.2 Academic average 50-60 15 3.7 61-70 26 6.5 71-80 87 21.6 81-90 142 35.3 91-100 132 32.8 Using social media No 73 18.2 Yes 329 81.8 Suffering from bullying No 343 85.3 Yes 59 14.7 Table 2: Health related factors of students (N= 402). Categorical variables n % Height 170cm 15 3.7 Weight 70 kg 33 8.2 Congenital problems/deformities No 382 95.3 Yes 19 4.7 Health problems No 357 88.8 Yes 45 11.2 Dermatological problems No 332 82.6 Yes 70 17.4 Using regular medications No 360 89.6 Yes 42 10.4 Table 3: Body Dysmorphic Disorder symptoms (N=402). Variables Yes n % Checking Inspect certain parts of body Measuring specific body parts 110 90 27.4 22.4 Checking parts of body 106 26.4 Asking questions about my appearance 142 35.3 Reviewing past events to know how people react to my shape 194 48.3 Checking mirrors repeatedly 239 59.5 Comparing my appearance to others Scrutinizing others Grooming 149 209 37.1 52.0 Grooming myself longer than necessary 147 36.6 Spending a lot of money to improve my appearance 92 22.9 Tanning 20 5 Combing hair 354 88.1 Applying makeup 179 44.5 Shaving 316 78.6 Changing clothes Weight/shape 381 94.8 Lifting weights 33 8.2 Using steroids 16 4 Exercising excessively 37 9.2 Eating in special ways Picking/plucking 81 20.1 Skin picking 99 24.6 Pulling or plucking hair Avoidance 166 41.3 Avoiding mirrors or reflective surfaces 58 14.4 Avoiding social situations 87 21.6 Avoiding public areas 69 17.2 Avoiding intimate or close contact with others 88 21.9 Avoiding physical activities like exercise 64 15.9 Avoiding being seen with few clothes 185 46 Hiding appearance(such as by applying make-up or using hats) 77 19.2 Changing appearance (getting a haircut) 122 30.3 Discounting compliments 156 38.8 Becoming upset by compliments Surgical/dermatological 146 36.3 Visiting plastic surgeons, dermatologists, and dentist 88 21.9 Obtaining cosmetic surgery 19 4.7 Using medications or topical treatment to correct defects 96 23.9 Changing appearance to avoid embarrassment (self-surgery) Cognition 75 18.7 I believe others are thinking of my appearance 157 39.1 People notice the wrong in my appearance 97 24.1 I think that others are staring at or talking about me 142 35.3 I believe others treat me differently because of my physical defects 54 13.4 If my appearance is defective, I am worthless 42 10.4 If my appearance is defective, I will end up alone and isolated 57 14.2 If my appearance is defective, I am helpless 41 10.2 No one can like me as long as I look the way I do 114 28.4 If my appearance is defective, I am unlovable 61 15.2 I must look perfect 217 54.0 I look defective or abnormal I am unattractive person 70 17.4 74 18.4 What I look like is an important part of who I am 265 65.9 Outward appearance is a sign of the inner person 146 36.3 No one else my age looks as bad as I do 64 15.9 If I could look just the way I wish, I would be much happier 209 52 People would like me less if they knew what I really looked like 109 27.1 My appearance is more important than my personality, intelligence, values, skills, how I relate to others, and my performance at work 65 16.2 If I learn to accept myself, I’ll lose my motivation to look better 118 29.4 Table 4: The severity of Body Dysmorphic Disorder symptoms (N=402) Severity related to each group M SD Group1: checking practices 2.64 2.49 Group 2: grooming practices 3.29 2.59 Group 3: weight and shape related practices 1.77 2.25 Group 4: skin picking and hair pulling practices 1.94 2.40 Group 5: dermatology and seeking practices 2.75 2.69 Group 6: avoidance 2.00 2.50 Group 7: cognition related to BDD 2.92 2.90 Table 5: Difference in Body Dysmorphic Disorder symptoms and severity related to health, academic and sociodemographic factors (N=402). Variables Descriptive t-test M SD Test statistics P Independent variable: BDD symptoms School Type Governmental 15.61 9.70 -3.336 0.001 Private 20.41 12.42 Congenital problems/deformities No 15.55 9.73 -6.771 < 0.001 Yes 31.05 9.71 Health problems No 16.01 10.20 -1.594 0.112 Yes 18.60 10.54 Dermatological problems No 14.86 9.09 -6.434 < 0.001 Yes 23.14 12.56 Using regular medications No 15.83 10.11 -2.741 0.006 Yes 20.38 10.72 Using social media No 13.01 8.55 -3.061 0.002 Yes 17.0 10.47 Suffering from bullying No 14.93 9.52 -6.824 < 0.001 Yes 24.28 10.84 Independent variable: BDD symptoms severity School Type Governmental 2.35 1.98 -2.840 0.005 Private 3.17 2.31 Congenital problems/deformities No 2.33 1.98 -5.854 < 0.001 Yes 5.05 1.70 Health problems No 2.38 2.01 -2.415 0.016 Yes 3.16 2.24 Dermatological problems No 2.27 1.95 -4.372 < 0.001 Yes 3.42 2.25 Using regular medications No 2.41 2.06 -1.569 0.117 Yes 2.94 1.93 Using social media No 1.98 2.05 -2.239 0.026 Yes 2.58 2.04 Suffering from bullying No 2.24 1.97 -5.514 < 0.001 Yes 3.78 1.99 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 07 Mar, 2026 Read the published version in BMC Psychology → Version 1 posted Editorial decision: Revision requested 26 Oct, 2025 Reviews received at journal 25 Oct, 2025 Reviewers agreed at journal 25 Oct, 2025 Reviews received at journal 05 Aug, 2025 Reviews received at journal 27 Jul, 2025 Reviewers agreed at journal 27 Jul, 2025 Reviewers agreed at journal 22 Jul, 2025 Reviews received at journal 16 Jul, 2025 Reviewers agreed at journal 16 Jul, 2025 Reviewers invited by journal 15 Jul, 2025 Editor assigned by journal 09 Jul, 2025 Editor invited by journal 23 Jun, 2025 Submission checks completed at journal 21 Jun, 2025 First submitted to journal 21 Jun, 2025 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. 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Hejjeh","email":"","orcid":"","institution":"the University of Jordan","correspondingAuthor":false,"prefix":"","firstName":"Ruba","middleName":"S.","lastName":"Hejjeh","suffix":""},{"id":486156379,"identity":"a83ae305-4300-4f8d-bf90-c29dfda5930a","order_by":1,"name":"Shaher H. Hmaideh","email":"","orcid":"","institution":"The Hashemite University","correspondingAuthor":false,"prefix":"","firstName":"Shaher","middleName":"H.","lastName":"Hmaideh","suffix":""},{"id":486156381,"identity":"19a4a6c8-75d2-4a0f-8d68-0d6f257dabf8","order_by":2,"name":"Lobna Harazneh","email":"","orcid":"","institution":"Arab American University","correspondingAuthor":false,"prefix":"","firstName":"Lobna","middleName":"","lastName":"Harazneh","suffix":""},{"id":486156383,"identity":"61f1425a-d627-425e-9f4f-8afadefd131b","order_by":3,"name":"Ahmad M Rayani","email":"","orcid":"","institution":"King Saud University","correspondingAuthor":false,"prefix":"","firstName":"Ahmad","middleName":"M","lastName":"Rayani","suffix":""},{"id":486156388,"identity":"f6ad54e3-6a85-4544-8030-83c94f90bf58","order_by":4,"name":"Ayman M. Hamdan-Mansour","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA2ElEQVRIiWNgGAWjYFAD9oYEIMkMxAeI1cJzgGQtEiAdYC0EAH8Dd+Lngj82idtnPngmwVBhndjAeBi/NRIHeDdLz2xLS5xzOyFNguFMemIDw7EE/NYc4N0gzdtwOHGGNFALY9thoJYzBnh1yANt+c3zB6hF8gBQyz8itBgc4N0mzcMG1CLBANTSQIQWw8O826x529KMZ/AkJFskHEs3biPkF7njvZtv8/yxkZ3Bfibxxocaa9l+CQIhhhQRPAkMIOPZJAjoQALsUKX8DURrGQWjYBSMgpEBAEVLR0HYu7xtAAAAAElFTkSuQmCC","orcid":"","institution":"the University of Jordan","correspondingAuthor":true,"prefix":"","firstName":"Ayman","middleName":"M.","lastName":"Hamdan-Mansour","suffix":""}],"badges":[],"createdAt":"2025-05-30 10:38:21","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6783893/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6783893/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s40359-026-04271-5","type":"published","date":"2026-03-07T15:59:13+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":104251502,"identity":"ce543ca4-537d-4d44-b127-560fc1c729a1","added_by":"auto","created_at":"2026-03-09 16:13:35","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1432177,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6783893/v1/a0de00b7-34ba-429c-91e5-8a55751ef810.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Status and Correlates of Body Dysmorphic Disorder symptoms among School-Aged female adolescents in Jordan","fulltext":[{"header":"Introduction","content":"\u003cp\u003eAdolescence is a phase characterized by the period of life between puberty and adulthood, which varies depending on individual development and cultural norms. The World Health Organization (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) emphasized the importance of this time and asserted that emotional, physical, and social changes, violations, and abuse can predispose adolescents to mental illnesses. Half of all mental illnesses begin around the age of 14 and are often preceded by nonspecific psychosocial problems (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). Among the mental disturbances that are observed among young people, Body Dysmorphic Disorder (BDD). According to the Diagnostic and Statistical Manual for Mental Disorders-5-TR (DSM-5-TR), individuals with BDD have a preoccupation with one or more perceived defects in physical appearance that are not observable or appear slight to others (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). This preoccupation is time-consuming and difficult to resist, causing social and occupational impairment (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). For adolescents, females in particular, appearance and how they look are a significant inclusion in their definition of identity. Therefore, preoccupation with their physical appearance and outlook might predispose them to BDD symptoms.\u003c/p\u003e\u003cp\u003eThe puberty stage involves a rapid increase in estrogen in females that contributes to their mental illness later in life if uncontrolled or severely disturbed (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). Beauty is an important pillar for females, and physical charms are considered their most significant social responsibility (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). Additionally, culture influences standards of beauty. For example, in Middle Eastern culture, there are many standards of beauty, such as a round or oval face, raised eyebrows, wide and almond-shaped eyes, full lips and cheeks, a small nose, a prominent jaw, and a pointed chin (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). This has contributed to the preoccupation and strict attention of female adolescents to their physical shape. In particular, where hijab (the cover and scarf), which is a traditional and religious dress for most Arabs and Muslims, may switch preoccupation to face as it is more apparent and noted for others (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). Such a context of cultural influence might and might not predispose female adolescents to BDD symptoms similar to other cultures. Eventually, the literature has not addressed this point adequately, which prompted this study.\u003c/p\u003e\u003cp\u003eGlobally, the prevalence rate of BDD is 5.0\u0026ndash;10.0% among cosmetic dentistry patients, 20% among rhinoplasty surgery patients, and 13.0\u0026ndash;15.0% among general cosmetic surgery patients (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). The prevalence rate of BDD among university students in the USA was 1.7% (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e), 4.4% among female medical students in Saudi Arabia (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e), and 14.1% among Arab dermatology patients in Saudi Arabia (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). In Jordan, the prevalence rate of BDD among university students was 20.3% (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). The special attention to BDD among female adolescents is due to its remarkable negative impact on their school and academic performance, including failing exams, dropping out of school, and lacking concentration in the classroom (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). Understanding of BDD is still lagging, particularly among female adolescents who often cover their worries about their physical image and appearance due to embarrassment (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). Such defensive behaviors may contribute to misdiagnosing BDD with other mental illnesses or disturbances such as social anxiety, isolation, and depressive feelings (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). Poor insight and an intense desire for cosmetic procedures are common compensatory defense mechanisms of female adolescents with BDD that might jeopardize mental health status and increase the risk of self-harm (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eIn Jordan, little is known about BDD symptoms among female adolescents. In general, females are more disappointed with their bodies than males (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). The role of culture in deciding the Dress code for females and the rules and effects of the religious beliefs of Muslims are factors that need to be investigated among female adolescents to enhance our understanding of the status and correlates of BDD among female school-age adolescents in Jordan. This study addresses one of the significant psychosocial problems that influences and directly affects the integrity and social well-being of female adolescents. Therefore, the purpose of this study was to examine the status and correlates of body dysmorphic disorder symptoms among school-aged female adolescents in Jordan. Specific aims were to:\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eTo identify the status of body dysmorphic disorder symptoms among school-aged female adolescents in Jordan.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eTo examine differences and correlates of body dysmorphic disorder symptoms in relation to the selected sociodemographic characteristics of school-aged female adolescents in Jordan.\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003eDesign\u003c/strong\u003e\u003cp\u003eA cross-sectional, descriptive design was used to examine the prevalence of BDD symptoms among school-aged female adolescents in Jordan.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eSetting\u003c/strong\u003e\u003cp\u003eData was collected from governmental and private schools in Jordan. Jordanian schools (1 private and 4 governmental from each region), including school-aged female adolescents aged 12\u0026ndash;18 years, were randomly selected from the three main regions in the country (North, Center, and South)\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eSample and sampling\u003c/strong\u003e\u003cp\u003eThe convenience sampling technique was used to recruit school-aged female adolescents. We have targeted students ages 12 to 18 in this. This was because the mean age of BDD onset is 16\u0026ndash;17 years, and the symptoms begin at age 12 or 13 (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). Inclusion criteria include (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) being in the seventh to twelfth grade (Tawjehi) and (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) being able to read and write Arabic. Exclusion criteria were (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) being diagnosed with a mental disorder according to school records or family consent. The total sample approached was 409, and the sample included in the study was.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eData collection\u003c/strong\u003e\u003cp\u003eEthical approval for data collection was obtained from the Institutional Review Board (IRB) at XYZ University and the Ministry of Education. Schools from the Southern, Northern, and Central regions were randomly selected. The researcher initiated communication with school principals via phone, introducing the study, its purpose, and its methodology. A copy of the Ministry of Education\u0026rsquo;s approval and the online questionnaire were provided. Upon the principal\u0026rsquo;s approval, the questionnaire link was shared with teachers responsible for grades 7\u0026ndash;12, who distributed it via WhatsApp groups. Established during the COVID-19 pandemic, these groups remained a common communication tool between students, teachers, and parents. The questionnaire included study details in Arabic, a consent form, and the researcher\u0026rsquo;s contact information. The parents were asked to provide their approval for having their children participate in the study, and the children were also asked to provide their approval. Those who agreed to participate in the study were provided with a link. Participants were not asked to provide their names or phone numbers. The soft copies of the surveys were kept in a password-protected computer that is not accessible except to the research team.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eInstruments\u003c/b\u003e: The Arabic version of the scales has been used. The original language of BDD-SS was English. Therefore, it had to be translated into Arabic to provide an Arabic version suitable for our cultures. WHO guidelines on the translation and adaptation of instruments (2022) were followed to translate the instrument into Arabic. The translated instrument should be acceptable and work in the same way by using both forward and back translations. Implementation of this procedure included four steps: forward translation, expert panel, back translation, and final version. The instrument was translated forward from the original language (English) to the target language by one bilingual translator, a health professional who is familiar with the terminology of the topic covered by the instrument and the content area of the instrument construction in the desired target language (Arabic). The instrument was then translated into English by an independent translator who did not know the questionnaire and whose first language is English. It was validated as being equivalent to the original. Cultural and conceptual equivalence, rather than linguistic equivalence, were used in the back-translation. Later, the back-translation version was sent to the original author, who approved it.\u003c/p\u003e\u003cp\u003e\u003cb\u003eThe Body Dysmorphic Disorder Symptoms Scale (BDD-SS)\u003c/b\u003e (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e) was used to examine the presence and severity of symptoms. The BDD-SS consists of 54 symptoms distributed into seven groups, with each group containing 2\u0026ndash;19 symptoms. The groups of symptoms, respectively, are checking, grooming, shape/weight, hair pulling/skin picking, surgery/dermatology seeking, avoidance, and BDD-related cognition. Individuals endorse (yes or no) the symptoms they suffered in the last week. Therefore, opposite to all symptoms in each group, there is a rating scale from 0 to 10 (0\u0026thinsp;=\u0026thinsp;no problem, 10\u0026thinsp;=\u0026thinsp;very severe). Individuals were asked to rate the overall severity of the symptoms, in which at least one symptom was endorsed in the group. The BDD-SS provides two critical scores: BDD-SS Symptom (which represents the number of symptoms experienced and the score range from 0 to 54 (number of symptoms endorsed)) and BDD-SS Severity (which represents the total of all severity ratings that range from 0 to 70 (sum of the severity scores in seven groups. Any symptom group with a severity level of 5 (moderate) required medical attention, but symptom groups with a severity level of 0 indicated no need for medical attention. To verify the content validity of this instrument, a panel of expert physicians from the Massachusetts General Hospital Obsessive-Compulsive Disorder (MGH OCD) and other related disorders programs that conduct studies in the BDD field reviewed all items. A study conducted to determine the internal consistency of the BDD-SS showed that the reliability of the BDD-SS (symptoms) was Kuder-Richardson Formula \u0026minus;\u0026thinsp;20 (KR-20\u0026thinsp;=\u0026thinsp;0.81). In addition, the reliability of the BDD-SS (severity) scales was Cronbach\u0026rsquo;s α\u0026thinsp;=\u0026thinsp;0.75 (Wilhelm et al., 2016).\u003c/p\u003e\u003cp\u003e\u003cb\u003eSociodemographic characteristics\u003c/b\u003e were assessed using a researcher-adapted questionnaire. The collected information was related to school-aged female adolescents\u0026rsquo; age, class, school type, academic average in the last semester, height, weight, presence of any mental disorder, presence of any health problems, presence of congenital problems/deformities, presence of dermatological problems, using regular medications, using social media, and being bullied for reasons related to appearance.\u003c/p\u003e\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eData analysis\u003c/h2\u003e\u003cp\u003eThe Statistical Package for the Social Sciences (SPSS), version 26, was used for statistical analysis. Descriptive statistics were used to describe the variables of the study (central tendency and dispersion measures). Categorical variables described using frequencies and percentages. In addtion, and inferential statistics (t-test, Pearson r, ANOVA) were used to examine differences, making comparison, testing correlations mong the variables.\u003c/p\u003e\u003c/div\u003e\n\u003cp\u003eEthical approval:\u003c/p\u003e\n\u003cp\u003eThis study was conducted by the ethical principles outlined in the Declaration of Helsinki. Ethical approval for conducting the research was obtained from the Institutional Review Board (IRB) at the University of Jordan , and permission was granted by the Jordanian Ministry of Education to access school settings and recruit participants. Participation in the study was voluntary. Informed consent was obtained from the parents of all participating adolescents, and assent was also secured from the adolescents themselves before data collection. Confidentiality and anonymity of the participants were maintained throughout the study. No personal identifiers were collected, and all data were stored securely on a password-protected device accessible only to the research team.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eDemographic characteristics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA total of 409 Jordanian school-aged female adolescents were approached, and 402 of them met the inclusion criteria. The analysis showed that participants\u0026rsquo; ages ranged between 12.0 and 18.0, with a mean of 15.0 (SD = 2) years old. Regarding school information, 85.6% (n = 344) of them were at governmental schools, 35.9% (n = 144) of them were in high school study level, and 35.3% (n = 142) of them had an academic average ranging from 81.0 to 90.0. Concerning social media, 81.8% (n = 329) of them use it regularly, and 14.7% (n = 59) of them suffer from bullying.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHealth-related factors\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe analysis (Table 2) showed that 49.0% (n = 197) of participants\u0026rsquo; height ranged between 151.0 to 160.0cm, and 34.8% (n = 140) of their weight ranged between 40 to 50 kg. Moreover, 4.7% (n = 19) of participants have congenital problems or deformities, 11.2% (n = 45) have health problems, 17.4% (n = 70) have dermatological problems, and 10.4% (n = 42) regularly use one or more medications.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eBody Dysmorphic Disorder Symptoms\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe analysis revealed that the total score of BDD symptoms ranged from zero to 48, with a mean score of 16.3 (SD = 10.3). Using the interquartile equation, the analysis showed that 50% of the participants had a score of 13.5, and 25% of the participants had a score of 21 or higher. This indicates that, given the expected range of scores up to 54, female adolescents had a low level of BDD symptoms. This has been supported by the fact that 75% of the participants had a score of 9.0 or higher.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFurthermore, the analysis revealed that the body dysmorphic disorder domain percentage ranged from weight/shape 10.4%, dermatological/surgical 17.3%, avoidance 26.2%, cognition related to BDD 27.5%, skin picking/hair pulling 32.9%, checking 38.6%, and grooming 52.9%. (Table 3) showed that the most frequent symptom among participants in the \u0026ldquo;checking group\u0026rdquo; was \u0026ldquo;checking mirrors repeatedly\u0026rdquo; was reported by 59.5% (n = 239), while the least frequent symptom among participants in the \u0026ldquo;checking group\u0026rdquo; was \u0026ldquo;measuring specific body parts,\u0026rdquo; at 22.4% (n = 90). Likewise, the most frequent symptom among participants in the \u0026ldquo;grooming group\u0026rdquo; was \u0026ldquo;changing clothes\u0026rdquo; by 94.8% (n = 381), while the least frequent symptom among participants from the \u0026ldquo;grooming group\u0026rdquo; was \u0026ldquo;tanning\u0026rdquo; by 5.0% (n = 20). Moreover, the most frequent symptom among participants from the \u0026ldquo;weight/shape group\u0026rdquo; was \u0026ldquo;eating in special ways,\u0026rdquo; at 20.1% (n = 81), while the least frequent symptom among participants from the \u0026ldquo;weight/shape group\u0026rdquo; was \u0026ldquo;using steroids,\u0026rdquo; by 4% (n = 16). Furthermore, the most frequent symptom among participants from \u0026ldquo;Picking/plucking\u0026rdquo; was \u0026ldquo;Pulling or plucking hair\u0026rdquo; by 41.3% (n = 166), while the least frequent symptom was \u0026ldquo;Skin picking\u0026rdquo; by 24.6% (n = 99). \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAs well, the most frequent symptom among participants from the \u0026ldquo;avoidance group\u0026rdquo; was \u0026ldquo;avoiding being seen with a few clothes\u0026rdquo; by 46% (n = 185), while the least frequent symptom among participants from the \u0026ldquo;avoidance group\u0026rdquo; was \u0026ldquo;avoiding mirrors or reflective surfaces\u0026rdquo; by 14.4% (n = 58). Additionally, the most frequent symptom among participants from the \u0026ldquo;Surgical/Dermatological group\u0026rdquo; was \u0026ldquo;using medication or topical treatment to correct defects,\u0026rdquo; by 23.9% (n = 96), while the least frequent symptom among participants from the \u0026ldquo;Surgical/Dermatological Group\u0026rdquo; was \u0026ldquo;obtaining cosmetic surgery\u0026rdquo; by 4.7% (n = 19). Likewise, the most frequent symptom among participants from the \u0026ldquo;Cognition group\u0026rdquo; was \u0026ldquo;what I look like is an important part of who I am\u0026rdquo; by 65.9% (n = 265), while the least frequent symptom among participants from the \u0026ldquo;Cognition group\u0026rdquo; was \u0026ldquo;if my appearance is defective, I am helpless\u0026rdquo; by 10.2% (n = 41).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSeverity of BDD\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe total score of BDD severity ranged from zero to 10, with a mean score of 2.5 (SD = 2.1). Using the interquartile equation, the analysis showed that 50% of the participants had a score of 2.0, and 25% of the participants had a score of 3.7 or higher. Given that the expected range of scores is up to 10, the results indicate that female students had a low BDD symptom severity level. This has been supported by the fact that 75% of the participants had a score of 0.9 or higher. Furthermore, the results (Table 3) showed that the highest severity was observed in the \u0026ldquo;grooming group\u0026rdquo; \u0026nbsp;with a mean of 3.3 (SD = 2.6), while the lowest severity was in the weight and shape group with a mean of 1.8 (SD = 2.3).\u003c/p\u003e\n\u003ch2\u003eBivariate Analysis\u003c/h2\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eDifferences and correlates in BDD related to socio-demographics and health factors\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;The analysis showed that there was no significant relationship between BDD symptoms and severity regarding the age of participants (r = -0.026, p = 0.601, r = -0.052, p = 0.300, respectively). A significant difference in the school type regarding BDD symptoms and severity (t = -3.3, p = 0.001; t = -2.8, p = 0.005, respectively) was found. In addition, there was a significant difference in the congenital problems/deformities associated with BDD symptoms and severity (t = -6.8, p \u0026lt; 0.001; t = -5.9, p \u0026lt; 0.001, respectively). Likewise, there was a significant difference in the health problems related to BDD symptom severity (t = -2.4, p = 0.016), but no significant difference in the health problems related to BDD symptoms. Furthermore, there is a significant difference in the dermatological problems of BDD symptoms and severity (t = -6.4, p \u0026lt; 0.001; t = -4.4, p \u0026lt; 0.001, respectively). As well, there was a significant difference in the use of regular medications in relation to BDD symptoms (t = -2.7, p = 0.006), but no significant difference in the use of regular medications about BDD symptom severity. See table 5\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eDifferences in BDD related to social media use\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAnalysis revealed a significant difference in the use of social media about BDD symptoms and severity (t = -3.061, p = 0.002; t = -2.239, p = 0.026, respectively). Likewise, there was a significant difference in the suffering from bullying about BDD symptoms and severity (t = -6.824, p \u0026lt; 0.001; t = -5.514, p \u0026lt; 0.001, respectively). See table 5\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eDifferences in BDD related to academic performance\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA one-way ANOVA test has been used to assess the differences in the mean score of continuous and categorical variables. The analysis (Table 5) showed that there was a significant difference in the mean academic average about BDD symptom severity (F = 3.1, p = 0.016). In addition, there was no significant difference in the mean academic average between BDD symptoms. Furthermore, the analysis revealed no significant difference in the mean grade of BDD symptoms and severity. See table 5\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eFemale adolescents lack the experience to manage their psychosocial needs, making them at higher risk of psychosocial disturbances. \u0026nbsp;Several studies conducted lately and found that female adolescents in Arab culture are suffering various forms of psychosocial disturbances such as eating problems (18), anxiety and depression (19-20), substance use (21), internet addiction (22), and general pain and emotional expression dysfunction (23-24). These studies have proved that female adolescents do suffer psychosocial disturbances. This study emphasizes one significant component related to the identity of females, in general, and for female adolescents in particular, which relates to their perceptions of appearance. We have assessed the prevalence and severity of body dysmorphic symptoms and their socio-demographic predictors. We found that the severity of BDD symptoms in this study was low; however, the figures may indicate a serious mental dysfunction that interfered with females’ ability to perform their age-related functions. The participants in this study are female adolescents at the high school level, which may indicate that BDD is directly affected by sociocultural factors and their sex-role perception. It is assumed that BDD might be higher in types that concern females more than males and within the cultural perspective and explanation of the disease. The sociocultural theory assumes that social norms related to parents, peers' perceptions, and media send messages that affect the behavior and thought processes of young people (25). It is also noted that adolescents are notoriously known to go through many hormonal changes during puberty (26), which may contribute to several explanations for the perception of appearance among female adolescents. Comparing current results with previous studies might be challenging due to the lack of standardized screening tools and the lack of similar studies within the Jordanian population, acknowledging that such a topic has been addressed by the literature in other cultures, which might not enable comparison or highlight similarities. Eating disorder symptoms, which a related to the topic of BBD symptoms, have been reported with alarming proportions among female adolescents in Jordan (18).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn terms of obsessive behaviors related to BDD, it has been found that the prevalence of BDD symptoms among female adolescents was 4.5% (16). The most frequent obsessive behavior was checking in front of a mirror, and the least frequent symptom was excessive cleaning. Furthermore, the percentage of excessive grooming among participants was lower than in our study (16). These variations may be due to differences in the screening tools used and the age of the participants, who were between 18 and 25 years old. Furthermore, and compared to other cultures, it was found that the percentage of grooming in our study was lower than in the Stockholm sample, 61.6% (25). This variation may be referring to the screening tools used and the nature of the sample, which included 172 adolescents and children diagnosed with BDD and not just suffering symptoms of BBD, which is the sample of this study.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSummers et al. (26) found that the most frequent symptom among participants was “checking or inspecting certain parts of my body” from the “checking group, unlike our study, where we found that “changing clothes” was the most frequent symptom from the “grooming group.” Our findings were nearly similar to this study in the most frequent symptoms within the “weight/shape group,” which was “eating in special ways,” and the “surgical/dermatological group,” which was “using medication or topical treatment to correct defects.” \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe analysis also showed that sociodemographic characteristics of school-aged female adolescents, such as age, were not significantly associated with BDD symptoms and severity. The results did partly support the previous finding that no association was found between BDD symptoms and age and grade among female students (6). The results also disagree with others who found that BDD was associated with age and was significantly higher among young people (25). Concerning academic performance, we found that there was a significant difference in the severity of BDD symptoms, while others found that females were significantly different in their BDD from their academic average (27). Nevertheless, a previous Jordanian study (28) found a positive correlation between body image dissatisfaction and low academic performance. Regarding school type, we found significant differences between participants who were from private and governmental schools, while Alam et al. (29) found that the students in private Universities had a higher probability of having BDD symptoms than the students in public universities. The small number of participants from private schools and their high socioeconomic status might have contributed to this result, as it is known that students from private schools typically come from higher socioeconomic classes and have better financial status. Moreover, regarding the use of social media, this study revealed significant differences between participants who used social media and those who did not. This study confirmed a previous study that found that BDD was positively associated with spending more time on Snapchat and Instagram applications (1). There have been abundant studies about the effect of using social media on BDD symptoms, but little is known about what negates these differences. Adolescents were influenced by universal features of appearance that were conveyed via social media and compared their appearance to these features, resulting in body dissatisfaction.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn the current study, the analysis showed significant differences between the participants who suffered from bullying and those who did not suffer from bullying. Adverse childhood experiences, such as bullying at school, could influence mental health (24-26). Our findings were consistent with previous studies regarding BDD symptoms and bullying. Studies revealed that the types of adverse childhood experiences (abuse, teasing, neglect, and bullying) were significantly associated with BDD symptoms (26-28).\u003c/p\u003e\n\u003cp\u003eConcerning health-related factors, the analysis revealed that BDD symptoms were significantly different from congenital problems/deformities, dermatological problems, and the use of regular medications. In addition, there was a significant difference in health problems about the severity of BDD symptoms. Regarding congenital problems/deformities, one of the studies conducted to assess the negative effects of keloids on body image showed that 40% of the participants had negative parts of their body image (BDSS scores ≥6) (29). Interestingly, in a cross-sectional study conducted in KSA among females in governmental secondary schools, the authors excluded all participants with congenital deformities such as a cleft palate and acquired deformities related to burns, trauma, illness, and scars (30, 31). Regarding health problems, the literature revealed that there was a significant relationship between BDD and obesity. One of the studies conducted in Makkah, KSA, revealed that there was an insignificant difference in obesity between non-BDD and BDD groups (31). In terms of dermatological problems, the results found a high prevalence of BDD among patients with acne, among 406 patients diagnosed with acne (32). Concerns related to skin and nose were the most frequently reported by females from secondary school in KSA ( 32). This was relatively in agreement with the concerns of female students in the college of medicine, where skin represented the most frequent concern related to their bodies (31). The high rates of skin concerns could be related to acne vulgaris, which is common among adolescents (30-33). Regarding using regular medications, a case presentation of a female who suffered from several health problems.\u003c/p\u003e\n\u003cp\u003eThis study has some limitations that include using a structured format of data collection, in which further investigation and clinical evaluation for participants might reveal informative outcomes.\u0026nbsp;\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study sheds light on an important, yet often overlooked, issue affecting female adolescents in Arab societies—their struggles with body image and the symptoms of body dysmorphic disorder (BDD). While the overall severity of BDD symptoms among the participants was low, the results still point to a deeper concern that could affect their mental health and day-to-day life. Social pressures from media, peer comparisons, and societal expectations—combined with personal experiences like bullying, skin conditions, and chronic health issues—played a significant role in shaping female adolescents’ perception of their appearance and body. Differences based on school type and social media use also stood out, showing just how influential environment and exposure can be. The study has implications for mental and psychological counselors at the school and community. There is a need to recognize and acknowledge females’ perception of their bodies during the middle and late adolescence period for their implicit influence on their quality of mental wellbeing and performance. School counselors need to address and educate female adolescents to express their unsatisfied feelings about their bodies to enable early detection and management of such a problem before it becomes at severe form. Although comparing these results with other research was difficult due to cultural differences and varying tools of measurement, it’s clear that more attention needs to be given to how adolescent girls perceive their bodies. Future research should incorporate more personal and clinical assessments to better understand and support the needs of these young women.\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"635\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eBDD\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eBody Dysmorphic Disorder\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eWHO\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eWorld Health Organization\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eDSM-5-TR\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eDiagnostic and Statistical Manual for Mental Disorders, edition 5, text review\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eAPA\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eAmerican Psychiatric Association\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eBDD-SS\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eBody Dysmorphic Disorder Symptoms Scale\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eBDDQ\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eBody Dysmorphic Disorder Questionnaire\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eBIDS\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eBody Image Disturbance Questionnaires\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eIOCDF\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eInternational Obsessive-Compulsive Disorder Foundation\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eSCID\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eStructured Clinical Interview for DSM-5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eBDDE\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eBody Dysmorphic Disorder Examination\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eBDD-YBOCS\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eYale-Brown Obsessive-Compulsive Scale Modified for Body Dysmorphic Disorder\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eADAA\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eAnxiety and Depression Association of America\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eOCD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eObsessive-Compulsive Disorder\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eMOE\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMinistry of Education\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eIRB\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eInstitutional Review Board\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eKR\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eKuder-Richardson\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eSPSS\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eStatistical Package for the Social Sciences\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eSD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eStandard Deviation\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eN/n\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNumber\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eM\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMean\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eP\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eProbability\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"Declarations","content":"\u003ch3\u003eEthics approval and consent to participate\u003c/h3\u003e\n\u003cp\u003eThis study was conducted by the ethical standards of the Declaration of Helsinki and approved by the Institutional Review Board (IRB) of the University of Jordan and the Ministry of Education. Written informed consent was obtained from all participants and, where applicable, from their parents or legal guardians before participation.\u003c/p\u003e\n\u003ch3\u003eConsent for Publication\u003c/h3\u003e\n\u003cp\u003eNot applicable\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003cbr\u003e\u003c/strong\u003e The datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSource of Funding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eNo funding\u003c/em\u003e was received to assist with the preparation of this manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors contributions\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConceptualization: RSH, AHM, LH, SHH\u003c/p\u003e\n\u003cp\u003eStudy design: RSH, AHM, AR, LH\u003c/p\u003e\n\u003cp\u003eData collection: RSH, AR, LH, \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eData analysis: RSH, AHM, AR, LH, SHH\u003c/p\u003e\n\u003cp\u003eManuscript writing: RSH, AHM, AR, LH, SHH\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe author of this study extends appreciation to the Ongoing Research Funding program (ORF-2025-1032), King Saud University, Riyadh, Saudi Arabia\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eWorld Health Organization. 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J Fam Med Prim Care. 2020;9(2):567\u0026ndash;70. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.4103/jfmpc.jfmpc_738_19\u003c/span\u003e\u003cspan address=\"10.4103/jfmpc.jfmpc_738_19\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable 1: Sociodemographic characteristics of students (N= 402).\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eCategorical variables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003en\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003eSchool type\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eGovernmental\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e344\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e85.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003ePrivate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e14.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"6\"\u003e\n \u003cp\u003eGrade\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eSeventh\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e11.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eEighth\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e16.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eNinth\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e16.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eTenth\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e19.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eEleventh\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e18.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eTwelfth\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e17.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"5\"\u003e\n \u003cp\u003eAcademic average\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e50-60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;3.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e61-70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;6.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e71-80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e21.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e81-90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e142\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e35.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e91-100\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e132\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e32.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003eUsing social media\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e18.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e329\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e81.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003eSuffering from bullying\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e343\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e85.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e14.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2: Health related factors of students (N= 402).\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eCategorical variables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003en\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"5\" valign=\"top\"\u003e\n \u003cp\u003eHeight\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026lt; 140cm\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;3.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e140-150\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e18.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e151-160\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e197 \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e49.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e161-170\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e102\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e25.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026gt; 170cm\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;3.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"5\" valign=\"top\"\u003e\n \u003cp\u003eWeight\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026lt; 40 kg\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;8.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e40-50 kg\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e140\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e34.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e51-60 kg\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e132\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e32.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e61-70 kg\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e16.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026gt; 70 kg\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;8.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eCongenital problems/deformities\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e382\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e95.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;4.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eHealth problems\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e357\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e88.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e11.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eDermatological problems\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e332\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e82.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e17.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eUsing regular medications\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e360\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e89.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e10.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3: Body Dysmorphic Disorder symptoms (N=402).\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"107%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eYes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003en\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eChecking\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd colspan=\"3\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003eInspect certain parts of body\u003c/p\u003e\n \u003cp\u003eMeasuring specific body parts\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e110\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e27.4\u003c/p\u003e\n \u003cp\u003e22.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003eChecking parts of body\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e106\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e26.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003eAsking questions about my appearance\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e142\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e35.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003eReviewing past events to know how people react to my shape\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e194\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e48.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003eChecking mirrors repeatedly\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e239\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e59.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003eComparing my appearance to others\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eScrutinizing others \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eGrooming\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e149\u003c/p\u003e\n \u003cp\u003e209\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e37.1\u003c/p\u003e\n \u003cp\u003e52.0\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003eGrooming myself longer than necessary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e147\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e36.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003eSpending a lot of money to improve my appearance\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e22.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003eTanning\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp; 20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp; 5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003eCombing hair\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e354\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e88.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003eApplying makeup\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e179\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e44.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003eShaving\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e316\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e78.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003eChanging clothes\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eWeight/shape\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e381\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e94.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003eLifting weights\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp; 33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp; 8.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003eUsing steroids\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp; 16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp; 4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003eExercising excessively\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp; 37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp; 9.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003eEating in special ways\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003ePicking/plucking\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp; 81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e20.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003eSkin picking\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;99\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e24.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003ePulling or plucking hair\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eAvoidance\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e166\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e41.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003eAvoiding mirrors or reflective surfaces\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e14.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003eAvoiding social situations\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e21.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003eAvoiding public areas\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e17.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003eAvoiding intimate or close contact with others\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e21.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003eAvoiding physical activities like exercise\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e15.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003eAvoiding being seen with few clothes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e185\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e46\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003eHiding appearance(such as by applying make-up or using hats)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e19.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003eChanging appearance (getting a haircut)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e122\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e30.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003eDiscounting compliments\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e156\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e38.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003eBecoming upset by compliments\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eSurgical/dermatological\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e146\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e36.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003eVisiting plastic surgeons, dermatologists, and dentist\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e21.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003eObtaining cosmetic surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;4.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003eUsing medications or topical treatment to correct defects\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e23.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003eChanging appearance to avoid embarrassment (self-surgery)\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eCognition\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e18.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003eI believe others are thinking of my appearance\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e157\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e39.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003ePeople notice the wrong in my appearance\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e24.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003eI think that others are staring at or talking about me\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e142\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e35.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003eI believe others treat me differently because of my physical defects\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e13.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003eIf my appearance is defective, I am worthless\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e10.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003eIf my appearance is defective, I will end up alone and isolated\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e14.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003eIf my appearance is defective, I am helpless\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e10.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003eNo one can like me as long as I look the way I do\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e114\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e28.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003eIf my appearance is defective, I am unlovable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e15.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003eI must look perfect\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e217\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e54.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eI look defective or abnormal\u003c/p\u003e\n \u003cp\u003eI am unattractive person\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e17.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e18.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003eWhat I look like is an important part of who I am\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e265\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e65.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003eOutward appearance is a sign of the inner person\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e146\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e36.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003eNo one else my age looks as bad as I do\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e15.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003eIf I could look just the way I wish, I would be much happier\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e209\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e52\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003ePeople would like me less if they knew what I really looked like\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e109\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e27.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003eMy appearance is more important than my personality, intelligence, values, skills, how I relate to others, and my performance at work\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp; 65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e16.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003eIf I learn to accept myself, I\u0026rsquo;ll lose my motivation to look better\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e118\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e29.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4: The severity of Body Dysmorphic Disorder symptoms (N=402)\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eSeverity related to each group\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eM\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eSD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eGroup1:\u0026nbsp;checking practices\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2.64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2.49\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eGroup 2: grooming practices\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e3.29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2.59\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eGroup 3: weight and shape related practices\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2.25\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eGroup 4: skin picking and hair pulling practices\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2.40\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eGroup 5: dermatology and seeking practices\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2.75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2.69\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eGroup 6: avoidance\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2.50\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eGroup 7: cognition related to BDD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2.92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2.90\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable 5: Difference in Body Dysmorphic Disorder symptoms and severity related to health, academic and sociodemographic factors (N=402).\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eDescriptive\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003et-test\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eM\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eSD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eTest statistics\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eP\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\"\u003e\n \u003cp\u003e\u003cstrong\u003eIndependent variable: BDD symptoms\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eSchool Type\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eGovernmental\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e15.61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e9.70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003e-3.336\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003ePrivate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e20.41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e12.42\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eCongenital problems/deformities\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e15.55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e9.73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003e-6.771\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e31.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e9.71\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eHealth problems\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e16.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e10.20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003e-1.594\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003e0.112\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e18.60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e10.54\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eDermatological problems\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e14.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e9.09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003e-6.434\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e23.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e12.56\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eUsing regular medications\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e15.83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e10.11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003e-2.741\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003e0.006\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e20.38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e10.72\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eUsing social media\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e13.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e8.55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003e-3.061\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e17.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e10.47\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eSuffering from bullying\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e14.93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e9.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003e-6.824\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e24.28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e10.84\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\"\u003e\n \u003cp\u003e\u003cstrong\u003eIndependent variable: BDD symptoms severity\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eSchool Type\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eGovernmental\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2.35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003e-2.840\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003e0.005\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003ePrivate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e3.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2.31\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eCongenital problems/deformities\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003e-5.854\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e5.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.70\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eHealth problems\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2.38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003e-2.415\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003e0.016\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e3.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2.24\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eDermatological problems\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003e-4.372\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e3.42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2.25\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eUsing regular medications\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2.41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003e-1.569\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003e0.117\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2.94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.93\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eUsing social media\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003e-2.239\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003e0.026\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2.58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2.04\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eSuffering from bullying\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2.24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003e-5.514\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e3.78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.99\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-psychology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"psyo","sideBox":"Learn more about [BMC Psychology](http://bmcpsychology.biomedcentral.com/)","snPcode":"","submissionUrl":"","title":"BMC Psychology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Body Dysmorphic Disorder, Adolescents, Prevalence Of Body Dysmorphic Disorder","lastPublishedDoi":"10.21203/rs.3.rs-6783893/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6783893/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e: Adolescence is a phase characterized by different changes in the brain, hormones, mind, and social environment. Half of all mental illnesses, including body dysmorphic disorder, begin around the age of 14 and are often preceded by nonspecific psychosocial problems that could probably progress to any major mental illness. Body dysmorphic disorder is one of the mental illnesses that might have negative consequences on school-age female adolescents’ academic, social, and psychological functioning.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePurposes\u003c/strong\u003e: The purpose of this study is to examine the status and correlates of Body Dysmorphic Disorder symptoms among school-aged female adolescents in Jordan.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e: A cross-sectional, descriptive-correlational design was employed using convenience sampling techniques of 402 school-aged female adolescents from the north, center, and southern regions of Jordan. The ages of the students ranged from 12 to 18 years. BDD symptoms were measured using the Body Dysmorphic Disorder-Symptoms scale.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e: The analysis revealed that female adolescents had a low level of BDD symptoms, however; the the highest severity was observed in the “grooming group” with a mean of 3.3 (SD = 2.6), while the lowest severity was in the weight and shape group with a mean of 1.8 (SD = 2.3). The results showed that (10.4%) of the female adolescent had weight/shape BBD symptoms, dermatological/surgical (17.3%), avoidance (26.2%), cognition related to BDD (27.5%), skin picking/hair pulling (32.9%), checking (38.6%), and grooming (52.9%). The most frequent symptoms of BDD were “changing clothes,” from the “grooming group,” expressed by 94.8% of the female adolescents. Significant differences were found in BDD symptom severity in relation to congenital problems/deformities (t = -6.8, p \u0026lt; 0.001; t = -5.9, p \u0026lt; 0.001, respectively), and health problems (t = -2.4, p = 0.016).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e: The findings of this study revealed BDD symptoms impact individuals in various aspects of life, including sleep, academics, appetite, and social life, which requires an organized mental health monitoring and screening for such mental disturbances in schools.\u003c/p\u003e","manuscriptTitle":"Status and Correlates of Body Dysmorphic Disorder symptoms among School-Aged female adolescents in Jordan","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-07-17 13:39:04","doi":"10.21203/rs.3.rs-6783893/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-10-27T03:51:52+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-25T12:25:52+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"212388068194427531508836522106981771466","date":"2025-10-25T12:19:51+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-08-05T18:00:47+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-07-27T11:41:32+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"32013346017033373145407917451499157975","date":"2025-07-27T10:13:03+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"257431964093221482452996898960075396422","date":"2025-07-22T12:57:11+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-07-16T07:18:58+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"272567677917424816086927343004109907219","date":"2025-07-16T06:59:13+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-07-15T07:48:33+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-07-09T11:55:44+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-06-23T11:06:15+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-06-21T10:28:33+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Psychology","date":"2025-06-21T10:25:16+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-psychology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"psyo","sideBox":"Learn more about [BMC Psychology](http://bmcpsychology.biomedcentral.com/)","snPcode":"","submissionUrl":"","title":"BMC Psychology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"555a0e35-2aaf-44d4-a440-8e34d4c08c98","owner":[],"postedDate":"July 17th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-03-09T16:09:35+00:00","versionOfRecord":{"articleIdentity":"rs-6783893","link":"https://doi.org/10.1186/s40359-026-04271-5","journal":{"identity":"bmc-psychology","isVorOnly":false,"title":"BMC Psychology"},"publishedOn":"2026-03-07 15:59:13","publishedOnDateReadable":"March 7th, 2026"},"versionCreatedAt":"2025-07-17 13:39:04","video":"","vorDoi":"10.1186/s40359-026-04271-5","vorDoiUrl":"https://doi.org/10.1186/s40359-026-04271-5","workflowStages":[]},"version":"v1","identity":"rs-6783893","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6783893","identity":"rs-6783893","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}