It’s National Women’s Health Week!

It’s National Women’s Health Week!

National Women’s Health Week (NWHW) is a weeklong health observance led by the U.S. Department of Health and Human Services’ Office on Women’s Health (OWH) [1].

The week May 10-16, 2020 serves as a reminder for women and girls, especially during the outbreak of COVID-19, to make their health a priority and take care of themselves [1]. It is extremely important for all women and girls, especially those with underlying health conditions, such as hypertension, diabetes, obesity, cardiovascular and respiratory conditions, and women 65 years and older, to take care of your health now [1].

What steps can I take for better health?

The Office on Women’s Health encourages women and girls to [1]:

Good mental health is essential to overall well-being.

Mental disorders can affect women and men differently* [2]. Some disorders are more common in women such  as depression and anxiety. More than 1 in 5 women in the United States experienced a mental health condition in 2019, such as depression or anxiety [3]. Many mental health conditions, such as depression and bipolar disorder, affect more women than men or affect women in different ways from men [3]. Most serious mental health conditions cannot be cured. But they can be treated, so you can get better and live well.

There are also certain types of disorders that are unique to women [2]. For example, some women may experience symptoms of mental disorders at times of hormone change, such as perinatal depression, premenstrual dysphoric disorder, and perimenopause-related depression [2]. Perimenopause, the transition to menopause, often begins in the late 40s. Perimenopause can cause sudden hormonal ups and downs which can also affect a women’s physical and mental health [4].

When it comes to other mental disorders such as schizophrenia and bipolar disorder, research has not found differences in the rates at which men and women experience these illnesses [2]. But women may experience these illnesses differently – certain symptoms may be more common in women than in men, and the course of the illness can be affected by the sex of the individual [2]. Researchers are only now beginning to tease apart the various biological and psychosocial factors that may impact the mental health of both women and men [2].

Mental health resources from the federal government and other websites:

Some tips to participate in National Women’s Health Week:

·       Educate and empower all community members to advocate for women’s health.

·       Encourage those around you to participate in health screenings and create health habits.

·       Share your personal journey with family, friends and loved ones to help them take the next step on their personal health journeys.

·       Help break the taboo surrounded around sensitive health topics especially reproductive and sexual health.

*Men’s Health Month is in June and will be covered in a separate article.

 

~ Jasneelam Kaur, MPH

 

 

 

Sources:

[1] https://www.womenshealth.gov/nwhw/about

[2] https://www.womenshealth.gov/mental-health

[3] https://www.ptsd.va.gov

[4] https://www.nimh.nih.gov/index.shtml

[5] https://www.niaaa.nih.gov

[6] https://www.drugabuse.gov

[7] https://www.samhsa.gov

How to Cope with Anxiety During Covid-19

How to Cope with Anxiety During Covid-19

We are all living in a critical time right now. Whether we are one of the hundreds of thousands affected with COVID-19, a loved one of someone affected, a health professional at the front lines, or like the majority, at home or working an essential job, doing the most you can to stay safe (and sane) during a time when rational fears mix with new, perhaps, unwarranted living conditions.

And with a forced change of routine and lifestyle, people can begin to panic or break under the pressure of having to adapt to this new way of life. Mandated to stay indoors, required to physically distance yourself from family and friends or even people in general, losing a job, all of these and more can turn even the most easygoing person into an on-edge overthinker. The current uncertainty of the future and the seeds of fear and doubt that come with it can cause anxiety to not only increase but spiral out of control.

“When the whole world is going to pieces, it’s awfully hard for the human mind—a fragile thing in the best of times—to cope, and more […] doctors are reporting the spread of despair, worry and depression among their patients, especially those already suffering from some form of anxiety disorder,” quotes Jeffrey Kluger of Time Magazine [1].

Before the coronavirus hit, the ADAA, or Anxiety and Depression Association of America, reported that “anxiety disorders are the most common mental illness in the U.S., affecting 40 million adults age 18 and older, or 18.1% of the [U.S.] population every year” [2].

Kluger states, “It’s too early in the coronavirus plague to know the exact extent to which anxiety disorders are on the rise, mostly because the clinical cases are lost in the much louder noise of the global panic. But anecdotally, at least, doctors are reporting both new anxieties among existing patients, and relapses among former ones” [3].

But all is not lost. We must realize that our situation on a global scale cannot and will not last forever. We should have hope that governments across the world will find a solution, and we as humans will be able to walk outside without fear of contracting a lethal virus.

A key component to that solution is the condition of mental health for the entire population. If we want to survive this pandemic, we must safeguard our mental health along with our physical health. On March 26, 2020 on CNN, Chief Medical Officer of the American Foundation for Suicide Prevention (AFSP), Dr. Christine Moutier stated, this is “the first time in an epidemic [that] we are paying attention to mental health.” Our brain, she said, is constantly “interacting with our life, choices, and environment”. In response to the pandemic, a variety of telehealth services are being made available to the public, and patients with mental health conditions are able to benefit from them.

Apart from telehealth services in the form of therapy sessions performed via phone or video chat, there are some tips that I, as someone with bipolar 1 disorder and chronic anxiety, find helpful in dealing with that anxiety while self-isolating.

 

 

Gratitude.
Think of 3 things to be grateful of, everyday. It can be something as simple as being thankful for a beautiful day or thankful for having clothes to keep you warm. Acknowledging the good things or people in your life shifts the focus from the negative and back to the positive.

Psychology Today states, “Feeling and expressing gratitude turns our mental focus to the positive, which compensates for our brain’s natural tendency to focus on threats, worries, and negative aspects of life…[it] creates positive emotions, like joy, love, and contentment, which research shows can undo the grip of negative emotions like anxiety. Fostering gratitude can also broaden your mind and create positive cycles of thinking and behaving in healthy, positive ways”.

Step into a hot shower or warm bath.
“A study reported in New Scientist […] concluded that taking regular afternoon baths was associated with a moderate but persistent lift in mood among people with depression. Indeed, the size of the effect was greater than that of physical exercise – a more established mood booster.
By increasing participants’ core body temperatures, the theory goes, warm baths helped to strengthen and synchronise their circadian rhythms, the daily fluctuations in behaviour and biochemistry that affect every one of our organs, including the brain” [5].

Laugh.
Watch funny YouTubes, TikTok, tv shows or films, old home videos or even look at old photos. Call up or video chat with that friend who always raises your spirit with the gift of laughter.

Get creative.
Paint a picture. Write a story or a poem perhaps about how you feel, draw, photograph obscure objects in your house or in your backyard or front yard, make up a dance. Try a new recipe.

Breathe.
When I feel myself panicking or my thoughts are spiraling out of control, I take a moment to check myself and breathe in and out slowly and deeply a few times to calm myself down. Inhale and exhale. It doesn’t always eliminate anxiety, but it keeps the room from spinning, and I find myself calmer and more able to process logical thoughts.

Challenge negative thoughts.
It is easy to ruminate as a response to a bad or stressful situation. One negative thought leads to another, and pretty soon, you’re spiraling out of control with no anchor to hold you. If you can’t ignore those negative thoughts, challenge them with reasonable ones.

 

Ben Martin, Psy.D. of Psych Central explains that, to challenge negative thoughts, some questions you can ask yourself are:

Is there evidence that confirms your thought? Am I jumping to conclusions?

You can put the situation into perspective, and ask: Is it as bad as I am making it out to be? What is the worst that can happen?

What is the best thing that can happen? What is most likely going to happen?

Will this matter in five years?

Lastly, you can use goal-oriented thinking and ask: What can I do to solve this problem? [6]

 

 

Step outside.
Breathe in the fresh air. Especially due to COVID-19, a lot of us may feel trapped inside and begin to get cabin fever. Best antidote for that? Open your front door and take a step outside. Let the sunlight hit you and breathe in the fresh air. One action like this and I am certain you will feel that much better.

Exercise.
Even while indoors! Do jumping jacks, lift weights or use resistance bands, find a yoga or pilates routine on YouTube and follow along! Anything to get those endorphins pumping!

Get it out and let it out.
If you’re anxious, sometimes you just need to get it out. Find a channel for you to do this through, whether it be doing something creative like writing or sketching, or talking to a therapist or friend, etc. Don’t hold it all inside. I know things can seem pretty lonely with everything that has been going on due to the outbreak of COVID-19, but the reality is, none of us are alone in how we are feeling. There are hotlines you can call if you need them. There are people only a phone call away. Express yourself. You’ll feel that much better.

We will get through this crisis, and these tools are only some of the ways that will help you cope.

 

~Crystal Lancaster

 

 

 

 

[1] https://time.com/5808278/coronavirus-anxiety
[2] https://adaa.org/about-adaa/press-room/facts-statistics
[3] https://time.com/5808278/coronavirus-anxiety
[4] https://www.psychologytoday.com/us/blog/the-mindful-self-express/201511/how-gratitude-leads-happier-life
[5] https://www.theguardian.com/society/shortcuts/2018/oct/23/why-a-daily-bath-helps-beat-depression-and-how-to-have-a-good-one
[6] https://psychcentral.com/lib/challenging-negative-self-talk

Coping With Change

Coping With Change

We’re in some unusual times, with the coronavirus count growing, causing many of us to change our usual way of life. Our day to day routines have to be altered, as social distancing and self-quarantining have become a part of life for many of us to contain the virus. Change can be hard, no matter the circumstances surrounding it, so we’ve compiled 5 tips on having a healthy mindset to deal with change!

1. Educate yourself 

It is essential for us to be aware of what is going on in our world, and to educate ourselves with scientifically backed up sources to know how we can prevent the spread of COVID-19. Not only will we be more conscious of what’s going on around us, educating ourselves can actually help alleviate stress, uncertainty, and ambiguity [1]. If we stay educated, we won’t feed into the misinformation that bounces around the internet, since there are so many posts that are based on rumors or even false information. It’s important to educate yourself, no matter the situation, because it can help you tackle any problems that can arise with change.

2. Focus on the positives, not the negatives

Researchers found that positive reinforcement could lower feelings on anxiety and stress [2]. Because we have to practice social distancing to prevent the spread of coronavirus, many of us now have to stay home. This is a huge adjustment and can cause us to feel trapped inside our homes and isolated from others. Instead of focusing on what you can’t do, focus on the positive side of things. Now you have the time to start that book you’ve been wanting to read, work on the creative project you never had time for, or finally get to eat lunch with your family! There are also so many creative and fun ways to stay in touch with your friends and loved ones through the internet!

3. Stop worrying about things outside of your control, and focus on things that you can

With the coronavirus going on, a lot of the things happening now can be out of our control. However, focusing on things that we have no control over can cause us to be stressed and anxious, so we need to divert our attention to the things we can [3]. We can’t control whether or not others will follow protocol like social distancing, but we can take control of our own actions to keep ourselves and others healthy by maintaining the guidelines set by the officials. Additionally, we can still plan out our day to day and set a new routine for ourselves and find what best works for us in these new times.

4. Map it out

From small changes to big changes, change throughout our lives is inevitable. I believe it is important to map out the changes, see how it affects us, and then take action to deal with it. To address the challenges we may encounter because change happens, it is important to acknowledge it so you can move past it. The coronavirus pandemic is altering our lives and it’s easy to spot the large changes we have to make. Notice the changes so that you can figure out how to adjust to it, like setting up regular facetimes with a friend to lessen the feeling of isolation. Or how about setting some goals for yourself to finish before self-quarantining is lifted!

5. A healthy body can help build a healthy mind

If you’re feeling stressed with all that is going on in the world, exercise it out! Exercising is known to help release endorphins and taking control of your body’s health is a great thing to focus on. Although many gyms have closed down to prevent the spread of COVID-19, there are so many free online workout classes to choose from and most of them don’t require you to buy anything! You can even just take a walk around your neighborhood!

Hope these tips help you navigate through these challenging times! Stay safe, stay healthy, and remember to love and be kind to each other. We can get through this together!

~Lucy Li

[1.] https://blog.innerdrive.co.uk/8-ways-to-cope-with-change
[2.]https://maxliving.com/healthy-articles/how-to-stay-positive
[3.] https://au.reachout.com/articles/7-tips-for-dealing-with-change

Stigma & Health during COVID-19

Stigma & Health during COVID-19

People in the U.S. may be worried or anxious about friends and relatives who are living in or visiting areas where COVID-19 is spreading. People are worried about the disease and have a lot of questions. Fear and anxiety can lead to social stigma, for example, towards Chinese or other Asian Americans or people who were in quarantine [1].

Stigma is discrimination against an identifiable group of people, a place, or a nation. Stigma is associated with a lack of knowledge about how COVID-19 spreads, a need to blame someone, fears about disease and death, and gossip that spreads rumors and myths [1].

Stigma hurts everyone by creating more fear or anger towards ordinary people instead of the disease that is causing the problem [1].

Anger, anxiety and fear and other feelings could lead to mental distress as well.

Some tips to take care of your mental health during this time of uncertainty:

  1. Separate what is in your control from what is notThere are things you can do, and it’s helpful to focus on those [8].
  2. Do what helpsyou feel a sense of safety. This will be different for everyone, and it’s important not to compare yourself to others.
  3. Get outside in nature–even if you are avoiding crowds.
  4. Challenge yourself to stay in the present. Perhaps your worry is compounding—you are not only thinking about what is currently happening, but also projecting into the future. When you find yourself worrying about something that hasn’t happened, gently bring yourself back to the present moment [8].
  5. Stay connected and reach out if you need more support. Talk to trusted friends about what you are feeling. If you are feeling particularly anxious or if you are struggling with your mental health, it’s ok to reach out to a mental health professional for support [8].

If you’re feeling alone and struggling, you can also reach out to The Crisis Text Line by texting TALK to 741741 or National Suicide Prevention Lifeline at 1-800-273-TALK [8].

What is COVID-19?

On February 11, 2020 the World Health Organization announced an official name for the disease that is causing the 2019 novel coronavirus outbreak, first identified in Wuhan China. The new name of this disease is coronavirus disease 2019, abbreviated as COVID-19. In COVID-19, ‘CO’ stands for ‘corona,’ ‘VI’ for ‘virus,’ and ‘D’ for disease. Formerly, this disease was referred to as “2019 novel coronavirus” or “2019-nCoV” [1].

There are many types of human coronaviruses including some that commonly cause mild upper-respiratory tract illnesses. COVID-19 is a new disease, caused be a novel (or new) coronavirus that has not previously been seen in humans [1].

WHO has been assessing this outbreak around the clock and we are deeply concerned both by the alarming levels of spread and severity, and by the alarming levels of inaction [3].

“We have therefore made the assessment that COVID-19 can be characterized as a pandemic.

Pandemic is not a word to use lightly or carelessly. It is a word that, if misused, can cause unreasonable fear, or unjustified acceptance that the fight is over, leading to unnecessary suffering and death [3].”

The Centers for Disease Control and Prevention (CDC) website is currently one of the most reliable resources. Along with the World Health Organization (WHO). You can also find an interactive web-based dashboard hosted by the Center for Systems Science and Engineering (CSSE) at Johns Hopkins University, to visualize and track reported cases in real-time. [2]

How COVID-19 Spreads:

Person-to-person spread

The virus is thought to spread mainly from person-to-person.

  • Between people who are in close contact with one another (within about 6 feet).
  • Through respiratory droplets produced when an infected person coughs or sneezes.

These droplets can land in the mouths or noses of people who are nearby or possibly be inhaled into the lungs [6].

Can someone spread the virus without being sick?

  • People are thought to be most contagious when they are most symptomatic (the sickest).
  • Some spread might be possible before people show symptoms; there have been reports of this occurring with this new coronavirus, but this is not thought to be the main way the virus spreads [6].

Spread from contact with contaminated surfaces or objects

  • It may be possible that a person can get COVID-19 by touching a surface or object that has the virus on it and then touching their own mouth, nose, or possibly their eyes, but this is not thought to be the main way the virus spreads [6].

Watch for symptoms

Reported illnesses have ranged from mild symptoms to severe illness and death for confirmed coronavirus disease 2019 (COVID-19) cases [7].

The following symptoms may appear 2-14 days after exposure.

  • Fever
  • Cough
  • Shortness of breath

You should know that older people and people with chronic diseases are at higher risk.

Call your doctor if you develop symptoms, and have been in close contact with a person known to have COVID-19 [3]. Call ahead: If you have a medical appointment, call the healthcare provider and tell them that you have or may have COVID-19. This will help the healthcare provider’s office take steps to keep other people from getting infected or exposed [5].

Steps to Prevent Illness

There is currently no vaccine to prevent coronavirus disease 2019 (COVID-19) [4].
The best way to prevent illness is to avoid being exposed to this virus.

The virus is thought to spread mainly from person-to-person.

  • Between people who are in close contact with one another (within about 6 feet).
  • Through respiratory droplets produced when an infected person coughs or sneezes.

These droplets can land in the mouths or noses of people who are nearby or possibly be inhaled into the lungs [4].

Take steps to protect yourself:

Clean your hands often

  • Wash your hands often with soap and water for at least 20 seconds especially after you have been in a public place, or after blowing your nose, coughing, or sneezing.
  • If soap and water are not readily available, use a hand sanitizer that contains at least 60% alcohol. Cover all surfaces of your hands and rub them together until they feel dry.
  • Avoid touching your eyes, nose, and mouth with unwashed hands [4].

Avoid close contact

Take steps to protect others

Stay home if you’re sick

Cover coughs and sneezes

  • Cover your mouth and nose with a tissue when you cough or sneeze or use the inside of your elbow.
  • Throw used tissues in the trash.
  • Immediately wash your hands with soap and water for at least 20 seconds. If soap and water are not readily available, clean your hands with a hand sanitizer that contains at least 60% alcohol [4].

Wear a facemask if you are sick

  • If you are sick:  You should wear a facemask when you are around other people (e.g., sharing a room or vehicle) and before you enter a healthcare provider’s office. If you are not able to wear a facemask (for example, because it causes trouble breathing), then you should do your best to cover your coughs and sneezes, and people who are caring for you should wear a facemask if they enter your room. Learn what to do if you are sick.
  • If you are NOT sick: You do not need to wear a facemask unless you are caring for someone who is sick (and they are not able to wear a facemask). Facemasks may be in short supply and they should be saved for caregivers [4].

Clean and disinfect

  • Clean AND disinfect frequently touched surfaces daily. This includes tables, doorknobs, light switches, countertops, handles, desks, phones, keyboards, toilets, faucets, and sinks.
  • If surfaces are dirty, clean them: Use detergent or soap and water prior to disinfection [4].

Please use this informational piece and use the sources listed to get educational information about COVID-19. It is important to keep yourself and your loved ones aware and informed with accurate information. It is also important to avoid panic buying. For those who do need to self-isolate, they can have family and/ or friends drop off supplies rather than anticipating ahead of time and stockpiling.

 

~Jasneelam Kaur, MPH

 

Main CDC website: https://www.cdc.gov/coronavirus/2019-nCoV/index.html.

CDC INFO: 800-232-6348

CDC EOC: 770-488-7100

 

Sources:

[1] https://www.cdc.gov/coronavirus/2019-ncov/faq.html

[2]https://www.arcgis.com/apps/opsdashboard/index.html#/bda7594740fd40299423467b48e9ecf6

[3] https://www.who.int/dg/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19—11-march-2020

[4] https://www.cdc.gov/coronavirus/2019-ncov/about/prevention.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fcoronavirus%2F2019-ncov%2Fabout%2Fprevention-treatment.html

[5] https://www.cdc.gov/coronavirus/2019-ncov/about/steps-when-sick.html

[6] https://www.cdc.gov/coronavirus/2019-ncov/about/transmission.html

[7] https://www.cdc.gov/coronavirus/2019-ncov/about/symptoms.html

[8] https://afsp.org/taking-care-of-your-mental-health-in-the-face-of-uncertainty/

 

 

How is Body Dysmorphic Disorder Related to Mental Health?

How is Body Dysmorphic Disorder Related to Mental Health?

We live in a world covered in filters. Filters of the perfect high cheek bones and the flawless complexion. We also live in a world where “body dysmorphic disorder (BDD) affects 1.7% to 2.4% of the general population- about 1 in 50 people [1].”

What is BDD?

Body dysmorphic disorder (BDD), also known as dysmorphophobia, is a body-image disorder characterized by persistent and intrusive preoccupations with an imagined or slight defect in one’s appearance [1]. With BDD, people think hours about their perceived or real flaws. Their thoughts often lead to severe emotional distress and interfere with daily life. People may stop socializing and become housebound, and even commit suicide. Because of which, BDD is associated with poor quality of life [2].

There are no known causes of BDD. Research shows that is usually begins in the adolescence or teenage years and both genders are equally affected. There are a few factors that may contribute to BDD: abnormal levels of brain chemicals, family history of BDD or a similar mental disorder, personality type and certain life experiences [3].

BDD is sometimes considered a “female disorder” because it is a body-image disorder that involves appearance but BDD appears, as common or nearly as common in males as in females [5].

Signs and Symptoms of BDD

BDD sufferers may perform some type of compulsive or repetitive behavior to try to hide or improve their flaws although these behaviors usually give only temporary relief.

Examples are listed below [1]:

  • camouflaging (with body position, clothing, makeup, hair, hats, etc.)
  • comparing body part to others’ appearance
  • seeking surgery
  • checking in a mirror
  • avoiding mirrors
  • skin picking
  • excessive grooming
  • excessive exercise
  • changing clothes excessively

BDD and Mental Health 

Currently there is a lack of research on BDD when compared with other psychiatric disorders [4]. This could be due to the reluctance of BDD patients to seek mental health support due to shame and embarrassment about symptoms, poor insight and a desire for non-mental health treatment such as cosmetic surgery. However, even though those going through BDD do seek mental health services, they are unlikely to spontaneously disclose their appearance concerns due to embarrassment.

So therefore, lack of spontaneous symptom disclosure combined with limited awareness of BDD among clinicians may result in misdiagnosis, with BDD symptoms being misclassified into other disorders that are common comorbidities, such as depression and social anxiety disorder (see table 1 [4] for more information on differential diagnosis). Furthermore, among adolescents in particular, there may be difficulty differentiating mild BDD symptoms from normative appearance concerns [4].

BDD is associated with substantial impairment in psychosocial functioning and markedly poor quality of life [6]. In a sample of 200 individuals with BDD (n=200), 36% did not work for at least one week in the past month because of psychopathology, and 11% had permanently dropped out of school because of BDD symptoms [6].

BDD and Suicidality

 Suicidality appears very common in patients with BDD. Studies have found that 78% of BDD patients have experienced suicidal ideation, 45% to 71% have had suicidal ideation attributed primarily to BDD, and 24% to 28% have attempted suicide [5]. The rates of suicidality in the United States population are very high and especially higher than for many other mental disorders.

Those with BDD have different levels of functioning but overall have poor levels. Some have functional impairment, but others manage to function fairly well while others are completely disabled [5]. One study found that 36% of 176 individuals with BDD were currently unemployed due to psychopathology, and 32% were unable to be in school or do schoolwork because of psychopathology (BDD was the primary diagnosis for most subjects) [5]. In the same study, 27% of subjects had been completely housebound for at least a week because of BDD.

Treatment

 A majority of individuals with BDD seek (71% to 76%) and receive (64% to 66%) cosmetic treatment (e.g., surgical, dermatologic, or dental) for their perceived appearance flaws [6]. Research shows that such treatment appears to only rarely improve overall BDD symptoms. In a study of 200 individuals with BDD, subjects retrospectively reported that only 3.6% of all treatments resulted in overall improvement in BDD [6]. 

Other effective treatments are available to help BDD sufferers live full, productive lives [1].

  • Cognitive-behavioral therapy (CBT) teaches patients to recognize irrational thoughts and change negative thinking patterns. Patients learn to identify unhealthy ways of thinking and behaving and replace them with positive ones.
  • Antidepressant medications, including selective serotonin reuptake inhibitors (SSRIs), can help relieve the obsessive and compulsive symptoms of BDD.

Treatment is tailored to each patient, so it is important to talk with your doctor to determine the best individual approach. Many doctors recommend using a combination of treatments for best results. This article is meant as an educational and informative piece. It is not meant to serve as a diagnosis. You should talk to your doctor or mental health professional if you have specific concerns regarding yourself specifically children and teens.

 Despite BDD’s prevalence and severity, this disorder remains underdiagnosed in clinical settings. Given the markedly poor functioning and quality of life, and high rates of suicidality, among these patients, it is important that BDD is recognized and accurately diagnosed [6].

~ Jasneelam Kaur, MPH

 

 

Resources:

[1] https://adaa.org/understanding-anxiety/related-illnesses/other-related-conditions/body-dysmorphic-disorder-bdd

[2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1414653/

[3] https://www.hopkinsmedicine.org/health/conditions-and-diseases/body-dysmorphic-disorder

[4] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5566091/

[5] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1712667/

[6] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3181960/