Institute of Psychology, Osnabrück University, Osnabrück, Germany.
Institute of Psychology, Münster University, Münster, Germany.
PLoS One. 2020 Jun 3;15(6):e0233153. doi: 10.1371/journal.pone.0233153. eCollection 2020.
Body dysmorphic disorder (BDD), together with its subtype muscle dysmorphia (MD), has been relocated from the Somatoform Disorders category in the DSM-IV to the newly created Obsessive-Compulsive and Related Disorders category in the DSM-5. Both categorizations have been criticized, and an empirically derived classification of BDD is lacking. A community sample of N = 736 participants completed an online survey assessing different psychopathologies. Using a structural equation modeling approach, six theoretically derived models, which differed in their allocation of BDD symptoms to various factors (i.e. general psychopathology, somatoform, obsessive-compulsive and related disorders, affective, body image, and BDD model) were tested in the full sample and in a restricted sample (n = 465) which indicated primary concerns other than shape and weight. Furthermore, measurement invariance across gender was examined. Of the six models, only the body image model showed a good fit (CFI = 0.972, RMSEA = 0.049, SRMR = 0.027, TLI = 0.959), and yielded better AIC and BIC indices than the competing models. Analyses in the restricted sample replicated these findings. Analyses of measurement invariance of the body image model showed partial metric invariance across gender. The findings suggest that a body image model provides the best fit for the classification of BDD and MD. This is in line with previous studies showing strong similarities between eating disorders and BDD, including MD. Measurement invariance across gender indicates a comparable presentation and comorbid structure of BDD in males and females, which also corresponds to the equal prevalence rates of BDD across gender.
躯体变形障碍（BDD）及其亚型肌肉变形障碍（MD）已从 DSM-IV 中的躯体形式障碍类别重新归类到 DSM-5 中新增的强迫及相关障碍类别。这两种分类都受到了批评，并且缺乏对 BDD 的经验性分类。一个由 N=736 名参与者组成的社区样本完成了一项在线调查，评估了不同的精神病理学。使用结构方程建模方法，对六个理论上衍生的模型进行了测试，这些模型在其将 BDD 症状分配到不同因素（即一般精神病理学、躯体形式、强迫及相关障碍、情感、身体意象和 BDD 模型）方面存在差异。这些模型在全样本和一个表明除了形状和体重之外还有其他主要关注点的受限样本（n=465）中进行了测试。此外，还检查了性别之间的测量不变性。在六个模型中，只有身体意象模型表现出良好的拟合度（CFI=0.972，RMSEA=0.049，SRMR=0.027，TLI=0.959），并且比竞争模型具有更好的 AIC 和 BIC 指数。在受限样本中的分析复制了这些发现。对身体意象模型的测量不变性分析表明，性别之间存在部分度量不变性。研究结果表明，身体意象模型为 BDD 和 MD 的分类提供了最佳拟合。这与之前的研究一致，这些研究表明，进食障碍和 BDD 之间存在很强的相似性，包括 MD。性别之间的测量不变性表明 BDD 在男性和女性中的表现和共病结构相似，这也与 BDD 在性别之间的患病率相等相对应。
