Empirically informed symptom severity cutoffs for body dysmorphic disorder
(2025) In Journal of Psychiatric Research 189. p.87-382- Abstract
- Background
Symptom severity cutoffs for body dysmorphic disorder (BDD) are lacking, hindering communication between professionals and with the patient community.
Method
We pooled data from 11 clinical trials or high-quality cohort studies from specialist clinics, totaling 804 individuals with BDD (80 % girls/women, 67 % adults). All participants had baseline scores on the adult or adolescent versions of the Yale-Brown Obsessive-Compulsive Scale Modified for BDD (BDD-YBOCS) and the Clinical Global Impressions–Severity scale (CGI-S). Receiver-operating characteristic analyses were used to identify BDD-YBOCS severity cutoffs, using the CGI-S as the benchmark measure. The classification performance of the cutoffs was evaluated in a... (More) - Background
Symptom severity cutoffs for body dysmorphic disorder (BDD) are lacking, hindering communication between professionals and with the patient community.
Method
We pooled data from 11 clinical trials or high-quality cohort studies from specialist clinics, totaling 804 individuals with BDD (80 % girls/women, 67 % adults). All participants had baseline scores on the adult or adolescent versions of the Yale-Brown Obsessive-Compulsive Scale Modified for BDD (BDD-YBOCS) and the Clinical Global Impressions–Severity scale (CGI-S). Receiver-operating characteristic analyses were used to identify BDD-YBOCS severity cutoffs, using the CGI-S as the benchmark measure. The classification performance of the cutoffs was evaluated in a holdout sample, consisting of 20 % of randomly selected participants.
Results
No participants had subclinical symptoms and the cutoff for clinical versus subclinical cases was not computed. A BDD-YBOCS score ≥24 distinguished moderate from mild cases (area under the curve [AUC] = 0.72 [0.64–0.81]; accuracy: 77 %), a score ≥30 distinguished severe from moderate cases (AUC = 0.83 [0.90–0.87]; accuracy: 77 %), and a score ≥37 distinguished extreme from severe cases (AUC = 0.82 [0.77–0.87]; accuracy: 80 %). The classification performance of the cutoffs was modest in the holdout sample (62 %), but consistent cutoffs were found across sexes/genders, age groups (children and adults), and participants from Europe and the United States.
Conclusion
These BDD-YBOCS severity cutoffs can be used for clinical and research purposes across different populations but should not be used as the sole basis for important clinical decisions affecting individual patients. The boundary between subclinical and clinical BDD will require further study. (Less)
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- author
- organization
- publishing date
- 2025-09
- type
- Contribution to journal
- publication status
- published
- subject
- in
- Journal of Psychiatric Research
- volume
- 189
- pages
- 87 - 382
- publisher
- Elsevier
- external identifiers
-
- pmid:40578059
- scopus:105009023512
- ISSN
- 1879-1379
- DOI
- 10.1016/j.jpsychires.2025.06.019
- language
- English
- LU publication?
- yes
- id
- 6f6e8f20-8dbf-4da4-8583-1cf5d3e85286
- date added to LUP
- 2025-09-05 11:17:49
- date last changed
- 2025-09-06 04:02:21
@article{6f6e8f20-8dbf-4da4-8583-1cf5d3e85286,
abstract = {{Background<br/>Symptom severity cutoffs for body dysmorphic disorder (BDD) are lacking, hindering communication between professionals and with the patient community.<br/>Method<br/>We pooled data from 11 clinical trials or high-quality cohort studies from specialist clinics, totaling 804 individuals with BDD (80 % girls/women, 67 % adults). All participants had baseline scores on the adult or adolescent versions of the Yale-Brown Obsessive-Compulsive Scale Modified for BDD (BDD-YBOCS) and the Clinical Global Impressions–Severity scale (CGI-S). Receiver-operating characteristic analyses were used to identify BDD-YBOCS severity cutoffs, using the CGI-S as the benchmark measure. The classification performance of the cutoffs was evaluated in a holdout sample, consisting of 20 % of randomly selected participants.<br/>Results<br/>No participants had subclinical symptoms and the cutoff for clinical versus subclinical cases was not computed. A BDD-YBOCS score ≥24 distinguished moderate from mild cases (area under the curve [AUC] = 0.72 [0.64–0.81]; accuracy: 77 %), a score ≥30 distinguished severe from moderate cases (AUC = 0.83 [0.90–0.87]; accuracy: 77 %), and a score ≥37 distinguished extreme from severe cases (AUC = 0.82 [0.77–0.87]; accuracy: 80 %). The classification performance of the cutoffs was modest in the holdout sample (62 %), but consistent cutoffs were found across sexes/genders, age groups (children and adults), and participants from Europe and the United States.<br/>Conclusion<br/>These BDD-YBOCS severity cutoffs can be used for clinical and research purposes across different populations but should not be used as the sole basis for important clinical decisions affecting individual patients. The boundary between subclinical and clinical BDD will require further study.}},
author = {{Mataix-Cols, David and Andersson, Philip and Rautio, Daniel and Flygare, Oskar and Greenberg, Jennifer and Hoeppner, Susanne and Weingarden, Hilary and Jassi, Amita and Monzani, Benedetta and Hollander, Eric and Castle, David and Krebs, Georgina and Rossell, Susan and Wilhelm, Sabine and Rück, Christian and Phillips, Katharine A and Fernández de la Cruz, Lorena and Cervin, Matti}},
issn = {{1879-1379}},
language = {{eng}},
pages = {{87--382}},
publisher = {{Elsevier}},
series = {{Journal of Psychiatric Research}},
title = {{Empirically informed symptom severity cutoffs for body dysmorphic disorder}},
url = {{http://dx.doi.org/10.1016/j.jpsychires.2025.06.019}},
doi = {{10.1016/j.jpsychires.2025.06.019}},
volume = {{189}},
year = {{2025}},
}