‘Barbie Doll Syndrome’. A case report of body dysmorphic disorder

„Das Barbie Syndrom“. Ein Fallbericht über die Körperdysmorphe Störung (=‘Barbie Doll Syndrome’. A case report of body dysmorphic disorder). Gruber, M., Jahn, R., Stolba, K. et al. Neuropsychiatr (2017). https://doi.org/10.1007/s40211-017-0241-2

Summary

Background: This case report aims to present a 37-year-old women striving to shape her body like a Barbie doll of which she has been fascinated since childhood. She could hardly tolerate any deviation from this beauty ideal. She has been admitted to the psychosomatic ward due to an eating disorder.

Methods: The ICD-10 and DSM-5 criteria were established for axis I disorders and the German version of the SCID II interview (for DSM-4) was applied for axis II disorders. Additionally, the “modified Yale-Brown Obsessive Compulsive Scale for body dysmorphic disorder” was carried out.

Results: The diagnosis of dysmorphophobia (ICD-10: F45.21) or body dysmorphic disorder (DSM-5: 300.7) and bulimia nervosa (ICD-10: F50.2; DSM-5: 307.51) was confirmed. The patient fulfilled criteria of an avoidant, depressive and histrionic personality disorder.

Psychopharmacological treatment with Fluoxetine was started and the patient participated in an intensive inpatient psychosomatic program. The body image, self-concept and the sense of shame were therapeutic key topics.

Conclusion: The present case report focuses on body dysmorphic disorder as a distinctive entity with high prevalence. Diagnostic criteria of different classification systems were contrasted and comorbidity with eating disorders was discussed. In clinical praxis, body dysmorphic disorder remains underdiagnosed, especially when cooccurring with an eating disorder. However, the correct diagnosis could be relevant for therapy planning.

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approx translation: [The appearance of the patient is impressive. Her artificial style with toupled hair and artificial hair parts (Beehive hair style), a heavily painted face with a focus on the eyes, framed by the thick eyelid with the false eyelashes and the delicate, somewhat aged skin with the dark solarium-browned complexion. The physique is delicate except the large breasts.

The patient grew up with a stable twin-sister and an older sister in stable family circumstances. She describes the twin sister as her "mirror image", both had always placed great emphasis on their appearance, compared to each other and revised and criticized each other. At school, the sisters would sometimes have been teased because of their "mirror image". Furthermore she describes a great fascination for Barbie dolls, which would continue today. At the age of 17, she met her ex-husband, with whom she became engaged and had two children. After the birth of the second child had a postpartum depression with a resulting bonding disorder to the son. The patient did not seek professional help. Four years later, she describes a two-year "happy phase", which leads her back to the successful professional life (good merit as unskilled assistant). She would have received recognition and be able to face more self-respect.

[...]

The patient suffers from hard-to-correct beliefs about physical disfigurement, a disturbance of body perception ("the belly would be too fat," "the legs would be too straight," "the butt would be too shallow," "cellulite would be too strong, the skin too pale ") and forced thoughts through the constant comparison of one's own appearance with others. There are numerous body-related fears ("getting too fat," "hair could slip," the make-up could be blurred), as well as social-phobic fears ("fear of appearance and behavior affect others embarrassingly or embarrassingly" ). The patient is compulsive with food and the external appearance and invests up to three hours daily in the body care and cosmetics (camouflage) and two to three hours daily in the course of ritualized eating / vomiting. At the same time, there is also a strong reinsurance tendency with frequent glances in the mirror, selfies or queries. It shows an avoidance behavior (avoids strangers looking intently, to visit public baths, or to show herself naked).]