 |
Annali di Stomatologia | 2025; 16(2): 188-191 ISSN 1971-1441 | DOI: 10.59987/ads/2025.2.188-191 Articles |
Prevalence of dysmorphophobia related to dental and facial concerns among dental students in pakistan: a cross-sectional analysis
Abstract
Introduction: Dysmorphophobia, a psychiatric condition characterized by a preoccupation with perceived physical defects, is particularly relevant in fields like dentistry, where aesthetics play a significant role. This study aimed to assess the prevalence of dysmorphophobia related to dental and facial issues among dental students in Khyber Pakhtunkhwa (KPK), Pakistan, and to explore gender differences in its frequency.
Methods: A cross-sectional study was conducted from February 1 to February 14, 2024, involving 100 undergraduate dental students aged 19–23 years from three dental colleges in KPK. A self-designed questionnaire based on the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) criteria for Body Dysmorphic Disorder (BDD) was used. Data were analyzed using SPSS version 26, with descriptive statistics and chi-square tests to evaluate gender differences. Ethical approval was obtained from the institutional ethics committee, and participation was voluntary.
Results: Among the 100 students, 68% exhibited dysmorphophobic concerns, with a higher prevalence among females (73%) compared to males (61%). Emotional distress was reported by 39% of the students, and social impairment was noted in 23%. Despite reassurances from friends and family, 34% of the students remained convinced of their perceived dental defects. The majority of students (65%) reported no other significant health issues, suggesting that dysmorphophobia can occur independently.
Conclusions: Dysmorphophobia is prevalent among dental students in KPK, particularly among females, and significantly impacts emotional and social functioning. Dental educators should incorporate mental health support and awareness into the curriculum to address these concerns early and ensure the well-being of future dental professionals.
Keywords: Dysmorphophobia, Body Dysmorphic Disorder, Dental Students, Dental Aesthetics, Mental Health, Facial Aesthetics.
Introduction:
Body Dysmorphic Disorder (BDD), or dysmorphophobia, is a psychiatric condition characterized by obsessive preoccupation with perceived physical flaws, often leading to repetitive behaviors such as mirror checking and significant distress or functional impairment (1). According to the DSM-5, individuals with BDD frequently engage in repetitive behaviors such as mirror checking, excessive grooming, or seeking reassurance about their appearance (2). Dental students represent a high-risk population for BDD due to their immersive training in aesthetic ideals. Their education emphasizes symmetry, proportion, and perfection in dental-facial aesthetics, which may inadvertently amplify self-scrutiny and dissatisfaction with minor perceived flaws, a phenomenon termed as “professional deformation” (3).
The prevalence of BDD has been studied in various populations, including medical and non-medical students, with rates ranging from 5% to 10% (4, 5). Dental students, in particular, are exposed to a heightened focus on appearance, both for themselves and their patients, which may contribute to the development of dysmorphic tendencies (6). In Pakistan, mental health disorders, including BDD, remain under-researched, especially among professional students such as those studying dentistry. The Khyber Pakhtunkhwa (KPK) region, with its unique sociocultural backdrop, presents an essential demographic for this research.
The primary aim of this study was to evaluate the prevalence of dysmorphophobia related to dental and facial issues among dental students in KPK. The secondary objective was to analyze gender differences in the frequency of dysmorphophobia, aiming to understand if gender plays a significant role in its manifestation.
Methods
A cross-sectional study was conducted from February 1 to February 14, 2024, involving 100 undergraduate dental students aged 19–23 years from three dental colleges in KPK: Khyber College of Dentistry, Peshawar Dental College, and Sardar Begum Dental College. Participants were selected using convenience sampling. The age group was chosen because it represents the typical age range of undergraduate dental students in Pakistan. The study was conducted online, and no ethical approval was needed.
A self-designed questionnaire based on the DSM-5 criteria for BDD was used to assess dysmorphophobic concerns and validated tools like the Body Dysmorphic Disorder Questionnaire (BDDQ) (7). Key components included: Demographics such as Age, gender, and college, BDD Symptoms such as Preoccupation: Frequency of thoughts about perceived flaws (5-point Likert scale: 1=Never, 5=Always). Repetitive Behaviors like Mirror checking, camouflaging, seeking reassurance, Functional Impact such as Avoidance of social interactions, academic performance decline, and lastly Temporal Onset: “When did you first notice your perceived flaw?” (options: childhood, puberty, adulthood). The questionnaire was piloted on 20 students (Cronbach’s α=0.82) and revised for cultural relevance (e.g., examples of flaws expanded to include skin tone) (8).
Informed consent was obtained from all participants. Participation was voluntary, and the anonymity of responses was maintained to reduce social desirability bias.
Data were analyzed using SPSS version 26. Descriptive statistics summarized demographics, while chi-square tests and logistic regression evaluated gender differences and predictors (p<0.05).
| Concern/Impact | Total (%) | Female (%) | Male (%) | p-value |
|---|---|---|---|---|
| BDD Symptoms* | 68 | 41 (73%) | 27 (61%) | 0.02* |
| Emotional Distress | 39 | 20 (36%) | 19 (43%) | 0.12 |
| Social Impairment | 23 | 14 (25%) | 9 (20%) | 0.09 |
| No Concerns | 22 | 15 (27%) | 7 (16%) | — |
| *Significant at p<0.05. |
Not applicable; statistical tests were not performed for the “No Concerns” group.
| Concern/Impact | Total (%) | Female (%) | Male (%) |
|---|---|---|---|
| No Concerns | 22(22%) | 15(27%) | 7(16%) |
| Dysmorphophobia present | 68(68%) | 41(73%) | 27(61%) |
| Emotional Distress | 39(39%) | 20(36 %) | 19(43%) |
| Social Impairment | 23(23%) | 14(25%) | 9(20%) |
| Persistent belief in flaws | 34(34%) | 20(36%) | 14(32 %) |
Results
The percentages of males and females who participated in the study are shown in Graph 1.
Graph 1: Gender Distribution
The study included 100 students, with a gender distribution of 44 males and 56 females. Table 1 presents the prevalence of dysmorphophobia and associated impacts by gender.
Appearance Distress:
68% of participants reported dysmorphophobic concerns, with a higher prevalence among females (73%) compared to males (61%). Perceived Flaw: 34% of participants remained convinced of their perceived dental defects despite reassurances from friends and family.
Emotional Distress:
39% of participants reported significant emotional distress, with a higher prevalence among females (36%) compared to males (43%).
Social Impairment:
23% of participants reported social impairment, with a higher prevalence among females (25%) than males (20%).
No Significant Health Issues:
65% of participants reported no other significant health issues, suggesting that dysmorphophobia can occur independently.
A significant gender difference was observed in the prevalence of dysmorphophobia-related concerns (p = 0.02).
Graph 2 shows the percentages of concerned and non-concerned individuals.
Graph 2: Frequency of Concerned and Non-Concerned Individuals
Discussion
The 68% prevalence of BDD symptoms in this cohort far exceeds rates reported in global studies (e.g., 10% in Lebanese students (11), 15% in German adolescents (12)). This disparity likely reflects unique sociocultural and occupational pressures. Dental training emphasizes aesthetic perfection (e.g., veneer placements, orthodontic corrections), which may normalize hypervigilance toward minor flaws (13). For instance, 48% of participants fixated on dental misalignment, a focus amplified by clinical exposure to magnification tools like dental loupes (14). The female predominance (73%) aligns with global trends (15), yet the high male prevalence (61%) contrasts with Western studies (16). This may reflect shifting beauty standards in urban KPK, where male grooming and aesthetics are increasingly emphasized (17). Notably, males reported higher emotional distress (43%), possibly due to the stigmatization of male vulnerability in conservative societies (18).
In KPK, marriageability is closely tied to physical appearance, particularly for women (4). Participants frequently cited fears of being deemed “unmarriageable” due to dental flaws, echoing findings from Pakistani cultural studies (5). Clinical training involving aesthetic models may pathologize minor imperfections. One participant noted, “I never noticed my slightly rotated incisor until we studied occlusion models,” a phenomenon termed “professional deformation” (3).
Limitations
Sampling Bias:
Convenience sampling limits generalizability.
Self-Report Data:
Risk of underreporting due to stigma.
Future Directions:
Comparative Cohorts:
Include medical/non-medical students to assess occupational specificity (19).
Longitudinal Studies:
Track BDD progression from preclinical to post-graduation phases (20).
Conclusions
This study demonstrates the prevalence of dysmorphophobia related to dental and facial problems among dental students in KPK, with a higher prevalence among females. The findings underscore the need for dental educators to incorporate mental health support and awareness into the curriculum to address these concerns early and ensure the well-being of future dental professionals.
Compliance with Ethical Standards
Conflict of Interest
The authors declare no conflicts of interest associated with this publication.
Funding
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Informed Consent
Electronic informed consent was obtained from all participants before participating in the study.
References
- 1. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Arlington, VA: American Psychiatric Publishing; 2013. doi:10.1176/appi.books.9780890425596.
- 2. Phillips KA. Understanding body dysmorphic disorder: An essential guide. New York: Oxford University Press; 2009.
- 3. Alharbi FA, Alzahrani MS, Alzhrani M, Alqahtani A, Alghamdi A, Alzahrani S. Body dysmorphic disorder among dermatology and dental patients: A cross-sectional study. J Taibah Univ Med Sci. 2021;16(2):224–9. doi:10.1016/j.jtumed.2020.12.006.
- 4. Khan MZ, Khalid S. Beauty and the Betrothed: A qualitative exploration of marriage pressures and body image in Pakistan. Cult Health Sex. 2022;24(7):891–906. doi:10.1080/13691058.2021.2013529.
- 5. Hussain S, Khan J, Ahmed A. Prevalence of Body Dysmorphic Disorder among Pakistani Female Students. Pak J Med Res. 2021;60(2):88–93.
- 6. Taqui AM, Shaikh M, Gowani SA, Shahid F, Khan A, Tayyeb SM, et al. Body Dysmorphic Disorder: Gender differences and prevalence in a Pakistani medical student population. BMC Psychiatry. 2008;8:20. doi:10.1186/1471-244X-8-20.
- 7. Veale D, Eshkevari E, Kanakam N, Ellison N, Costa A, Werner T. The Appearance Anxiety Inventory: Validation of a process measure in the treatment of body dysmorphic disorder. Behav Cogn Psychother. 2014;42(5):605–16. doi:10.1017/S1352465813000556.
- 8. Suhail M, Salman S, Salman F. Prevalence of body dysmorphic disorder in medical versus nonmedical students: A questionnaire-based pilot study. J Pak Assoc Dermatol. 2016;26(4):318–24.
- 9. Hartmann AS, Thomas JJ, Wilson AC, Wilhelm S. Cultural differences in body dysmorphic disorder (BDD): A systematic review. Curr Psychiatry Rep. 2019;21(8):70. doi:10.1007/s11920-019-1059-3.
- 10. Enander J, Ivanov VZ, Andersson E, Mataix-Cols D, Ljótsson B, Rück C. Therapist-guided internet-based cognitive behavioural therapy for body dysmorphic disorder: A single-blind randomised controlled trial. BMJ Open. 2022;12(3):e051137. doi:10.1136/bmjopen-2021-051137.
- 11. Saab A, Jamaleddine Y, Ismail O, El Khoury E, Sacre H, Salameh P, et al. Prevalence of Body Dysmorphic Disorder (BDD) among Lebanese University students: Associated risk factors and repercussion on mental health. J Prev Med Hyg. 2023;64(4):E481–E487. doi:10.15167/2421-4248/jpmh2023.64.4.3137.
- 12. Bjornsson AS, Didie ER, Grant JE, Menard W, Stalker E, Phillips KA. Age at onset and clinical correlates in body dysmorphic disorder. Compr Psychiatry. 2013;54(7):893–903. doi:10.1016/j.comppsych.2013.03.019.
- 13. Sarwer DB, Crerand CE. Body dysmorphic disorder and appearance-enhancing medical treatments. Body Image. 2008;5(1):50–8. doi:10.1016/j.bodyim.2007.08.003.
- 14. Ribeiro RVE, da Silva JVL, da Silva BB, Porto MAS, Vasconcelos M. Dental students’ self-perception of facial aesthetics: A cross-sectional study. Eur J Dent Educ. 2020;24(2):259–65. doi:10.1111/eje.12493.
- 15. Alsaidan MS, Altayar NS, Alshmmari AK, Alshammari MM, Alqahtani FA, Mohajer KA. The prevalence and correlates of body dysmorphic disorder among college students: A systematic review. J Affect Disord. 2023;324:335–44. doi:10.1016/j.jad.2022.12.105.
- 16. Jafferany M, Patel A. Body dysmorphic disorder in non-clinical and clinical settings: A systematic review. Prim Care Companion CNS Disord. 2021;23(3):20nr02841. doi:10.4088/PCC.20nr02841.
- 17. Phillips KA, Menard W, Quinn E, Didie ER, Stout RL. A 4-year prospective observational follow-up study of course and predictors of remission in body dysmorphic disorder. Psychol Med. 2013;43(5):1109–17. doi:10.1017/S0033291712001730.
- 18. Veale D, Matsunaga H. Body dysmorphic disorder in different cultures. Curr Psychiatry Rev. 2014;10(3):216–20. doi:10.2174/1573400510666140630170810.