Patterns and Drivers of Packaged (Fortified) Maize Flour Purchase in Urban and Peri-Urban Kenya.

Body Dysmorphic Disorder (BDD) is a preoccupation with perceived defects in appearance that are not clearly observable to others but cause significant distress and/or impairment in functioning (American Psychiatric Association, ). BDD prevalence is difficult to ascertain due to under‐recognition in clinical settings (Hartmann et al., ), however is estimated to be between 2% and 3% in the general population. BDD is underrepresented in research, and little attention is given to the relational context of BDD symptoms, particularly in the adult population. BDD is categorised under ‘Obsessive‐Compulsive and Related Disorders’ (OCRDs) (American Psychiatric Association, ; World Health Organization, ), reflecting shared clinical features and treatment approaches between BDD and Obsessive‐Compulsive Disorder (OCD). Both are classified by intrusive and obsessive thoughts causing significant distress, accompanied by compulsive behaviours or rituals serving to reduce distress. They share similar sex ratios and high comorbidity rates (Frare et al., ). However, their differences have treatment implications; BDD cognitions are specifically appearance related, BDD is thought to cause greater impairment in psychosocial functioning, higher comorbidity with substance use and major depressive disorders, and poorer insight compared to OCD (Didie et al., ). Suicidality rates are markedly higher in BDD populations compared to the general population, with individuals four times more likely to experience suicidal ideation and nearly three times more likely to attempt suicide (Angelakis et al., ). The National Institute for Health and Care Excellence (NICE) guidelines for BDD treatment (NICE, ) recommend the same psychological treatment as OCD: Cognitive Behavioural Therapy (CBT) with Exposure and Response Prevention (ERP) (American Psychiatric Association, ; National Institute for Health and Care Excellence [NICE], ). A systematic review and meta‐analysis of randomised controlled trials (RCT) of CBT for adult BDD found that only 48%–54% of sufferers were treatment responders (Harrison et al., ), compared to 60%–80% in CBT trials for OCD (Mataix‐Cols et al., ; Öst et al., ), emphasising the need for improved BDD treatment options. It is important to understand relational factors that influence BDD such as interpersonal dynamics, as this may have important treatment implications.