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Biomedical subjects

Katharine A Phillips

Publications and source records attributed to Katharine A Phillips.

At least 19 recordsLinked to original sources
PubMed2007

Obsessive-compulsive disorder versus body dysmorphic disorder: a comparison study of two possibly related disorders.

The relationship between obsessive-compulsive disorder (OCD) and body dysmorphic disorder (BDD) is unclear. BDD has been proposed to be an OCD-spectrum disorder or even a type of OCD. However, few studies have directly compared these disorders' clinical features. We compared characteristics of subjects with OCD (n=210), BDD (n=45), and comorbid BDD/OCD (n=40). OCD and BDD did not significantly differ in terms of demographic features, age of OCD or BDD onset, illness duration, and many other variables. However, subjects with BDD had significantly poorer insight than those with OCD and were more likely to be delusional. Subjects with BDD were also significantly more likely than those with OCD to have lifetime suicidal ideation, as well as lifetime major depressive disorder and a lifetime substance use disorder. The comorbid BDD/OCD group evidenced greater morbidity than subjects with OCD or BDD in a number of domains, but differences between the comorbid BDD/OCD group and the BDD group were no longer significant after controlling for BDD severity. However, differences between the comorbid BDD/OCD group and the OCD group remained significant after controlling for OCD severity. In summary, OCD and BDD did not significantly differ on many variables but did have some clinically important differences. These findings have implications for clinicians and for the classification of these disorders.

Adult↗
PubMed2006

Childhood abuse and neglect in body dysmorphic disorder.

OBJECTIVE: No published studies have examined childhood abuse and neglect in body dysmorphic disorder (BDD). This study examined the prevalence and clinical correlates of abuse and neglect in individuals with this disorder. METHODS: Seventy-five subjects (69.3% female, mean age=35.4+/-12.0) with DSM-IV BDD completed the Childhood Trauma Questionnaire and were interviewed with other reliable and valid measures. RESULTS: Of these subjects, 78.7% reported a history of childhood maltreatment: emotional neglect (68.0%), emotional abuse (56.0%), physical abuse (34.7%), physical neglect (33.3%), and sexual abuse (28.0%). Forty percent of subjects reported severe maltreatment. Among females (n=52), severity of reported abuse and neglect were .32-.57 standard deviation units higher than norms for a health maintenance organization (HMO) sample of women. Severity of sexual abuse was the only type of maltreatment significantly associated with current BDD severity (r=.23, p=.047). However, severity of sexual abuse did not predict current BDD severity in a simultaneous multiple regression analysis with age and current treatment status. There were other significant associations with childhood maltreatment: history of attempted suicide was related to emotional (p=.004), physical (p=.014), and sexual abuse (p=.038). Childhood emotional abuse was associated with a lifetime substance use disorder (r=.26, p=.02), and physical abuse was negatively associated with a lifetime mood disorder (r=-.37, p=.001). CONCLUSIONS: A high proportion of individuals with BDD reported childhood abuse and neglect. Certain types of abuse and neglect appear modestly associated with BDD symptom severity and with gender, suicidality, and certain disorders.

Adult↗
PubMed2006

Clinical features and correlates of major depressive disorder in individuals with body dysmorphic disorder.

BACKGROUND: Body dysmorphic disorder (BDD) and major depressive disorder (MDD) appear highly comorbid. However, MDD in individuals with BDD has received little investigation. METHODS: The prevalence and characteristics of comorbid MDD were assessed in 178 BDD subjects. BDD subjects with current comorbid MDD (n=68) were compared to BDD subjects without current comorbid MDD (n=96) on demographic and clinical characteristics. Predictors of current MDD were determined using logistic regression. RESULTS: 74.2% of subjects had lifetime MDD, and 38.2% had current MDD. The melancholic subtype was most common, and a majority of depressed subjects had recurrent episodes. Mean onset of BDD occurred at a younger age than MDD. Subjects with current comorbid MDD had many similarities to those without MDD, although those with comorbid MDD had more severe BDD. Subjects with comorbid MDD were also more likely to have an anxiety or personality disorder, as well as a family history of MDD. They also had greater social anxiety, suicidality, and poorer functioning and quality of life. Current MDD was independently predicted by a personality disorder and more severe BDD. LIMITATIONS: It is unclear how generalizable the results are to the community or to subjects ascertained for MDD who have comorbid BDD. The study lacked a comparison group such as MDD subjects without BDD. CONCLUSIONS: MDD is common in individuals with BDD. Individuals with current MDD had greater morbidity in some clinically important domains, including suicidality, functioning, and quality of life. A personality disorder and more severe BDD independently predicted the presence of current MDD.

Activities of Daily Living↗
PubMed2006

Weight concerns in individuals with body dysmorphic disorder.

OBJECTIVE: To determine the prevalence of weight concerns in individuals with BDD, and to examine similarities and differences between those with and those without weight concerns. METHOD: We assessed 200 participants with BDD for clinically significant weight concerns and compared those with weight concerns (in addition to other body area concerns) to those without weight concerns on measures of BDD symptoms, other symptom severity, comorbidity, suicidality, functioning, and quality of life. RESULTS: 58 (29.0%) participants had weight concerns. Participants with weight concerns were younger, more likely to be female, and had more body areas of concern; a higher frequency of certain BDD behaviors, suicide attempts, and comorbidity; greater body image disturbance and depression; and poorer social functioning. The two groups were similar on other measures. DISCUSSION: Weight concerns in BDD deserve further study, as they appear relatively common and are associated with greater symptom severity and psychopathology in several domains.

Adolescent↗
PubMed2006

Clinical features of body dysmorphic disorder in adolescents and adults.

Body dysmorphic disorder (BDD) usually begins during adolescence, but its clinical features have received little investigation in this age group. Two hundred individuals with BDD (36 adolescents; 164 adults) completed interviewer-administered and self-report measures. Adolescents were preoccupied with numerous aspects of their appearance, most often their skin, hair, and stomach. Among the adolescents, 94.3% reported moderate, severe, or extreme distress due to BDD, 80.6% had a history of suicidal ideation, and 44.4% had attempted suicide. Adolescents experienced high rates and levels of impairment in school, work, and other aspects of psychosocial functioning. Adolescents and adults were comparable on most variables, although adolescents had significantly more delusional BDD beliefs and a higher lifetime rate of suicide attempts. Thus, adolescents with BDD have high levels of distress and rates of functional impairment, suicidal ideation, and suicide attempts. BDD's clinical features in adolescents appear largely similar to those in adults.

Adolescent↗
PubMed2006

Body dysmorphic disorder and social phobia: cross-sectional and prospective data.

Much attention has been paid to the relationship between body dysmorphic disorder (BDD) and obsessive-compulsive disorder (OCD). However, to our knowledge, no published study has focused directly on the relationship between BDD and social phobia (SP). This is striking given similar clinical features of the two disorders, data showing elevated comorbidity between them, and Eastern conceptualizations of BDD as a form of SP. In this study, 39.3% of 178 individuals with current BDD had comorbid lifetime SP, and 34.3% had current SP. SP onset was typically before BDD. Individuals with BDD, with and without lifetime SP, were similar on many general characteristics (e.g., age of BDD onset, gender distribution, BDD severity, overall functional disability). However, subjects with BDD+SP were significantly less likely to be employed, were more likely to report lifetime suicidal ideation, and had poorer global social adjustment on one of two measures. Both BDD and SP were associated with elevated social anxiety; subjects with BDD+SP experienced additional social anxiety that appeared independent of BDD symptoms. Examining 1-year prospective data available for 161 subjects, BDD+SP subjects were somewhat less likely to experience remission (partial or full) of their BDD symptoms over 1-year follow-up, although this difference was not statistically significant (hazard ratio = .64, P = .18). In summary, these findings, including elevated rates of SP in patients with BDD, highlight a need for additional research on the relationship between BDD and SP.

Adult↗
PubMed2006

Comorbidity of body dysmorphic disorder and eating disorders: severity of psychopathology and body image disturbance.

OBJECTIVE: The current study examined comorbidity and clinical correlates of eating disorders in a large sample of individuals with body dysmorphic disorder (BDD). METHOD: Two hundred individuals with DSM-IV (4th ed. of the Diagnostic and Statistical Manual of Mental Disorders. Washington, DC: American Psychiatric Association; 1994) BDD completed reliable interviewer-administered and self-report measures, including diagnostic assessments and measures of body image, symptom severity, delusionality, psychosocial functioning, quality of life (QOL), and history of psychiatric treatment. RESULTS: A total of 32.5% of BDD subjects had a comorbid lifetime eating disorder: 9.0% had anorexia nervosa, 6.5% had bulimia nervosa, and 17.5% had an eating disorder not otherwise specified. Comparisons of subjects with a comorbid lifetime eating disorder (n = 65) and subjects without an eating disorder (n = 135) indicated that the comorbid group was more likely to be female, less likely to be African American, had more comorbidity, and had significantly greater body image disturbance and dissatisfaction. There were no significant group differences in BDD symptom severity, degree of delusionality, or suicidal ideation or attempts. Functioning and QOL were notably poor in both groups, with no significant between-group differences. However, a higher proportion of the comorbid eating disorder group had been hospitalized for psychiatric problems. This group had also received a greater number of psychotherapy sessions and psychotropic medications. CONCLUSION: Eating disorders appear relatively common in individuals with BDD. BDD subjects with a comorbid eating disorder differed on several demographic variables, had greater comorbidity and body image disturbance, and had received more mental health treatment than subjects without a comorbid eating disorder. These findings have important implications for the assessment and treatment of these comorbid body image disorders.

Adolescent↗
PubMed2006

Body dysmorphic disorder and other clinically significant body image concerns in adolescent psychiatric inpatients: prevalence and clinical characteristics.

BACKGROUND: This study assessed prevalence and clinical correlates of body dysmorphic disorder (BDD), eating disorders (ED), and other clinically significant body image concerns in 208 consecutively admitted adolescent inpatients. It was hypothesized that adolescents with BDD would have higher levels of depression, anxiety, and suicidality. Adolescents with eating disorders were expected to have higher levels of depression, anxiety, and trauma-related symptoms. Trauma-related symptoms were also examined in relation to BDD, in the absence of specific hypotheses. METHOD: Participants completed the Body Dysmorphic Disorder Questionnaire (BDDQ) and reliable and valid self-report measures of suicidality, depression, anxiety, post-traumatic stress disorder (PTSD), dissociation, and sexual preoccupation/distress. Prevalence of BDD, eating disorders, and other clinically significant body image concerns was determined, and clinical correlates were examined. RESULTS: 6.7% (n = 14) of participants met DSM-IV criteria for definite (n = 10) or probable (n = 4) DSM-IV BDD, 3.8% (n = 8) met criteria for an eating disorder, and 22.1% (n = 46) had clinically significant shape/weight concerns (SWC) that did not clearly meet criteria for BDD or an eating disorder. Both the BDD and SWC groups scored significantly higher than the group with no significant body image concerns (no BDD/ED/SWC group) on measures of anxiety and suicidality. The BDD, SWC, and ED groups all had significantly higher levels of depression than the no BDD/ED/SWC group. Only the SWC group scored significantly higher than the no BDD/ED/SWC group on measures of PTSD, dissociation, and sexual preoccupation/distress. CONCLUSIONS: A high proportion of participants had clinically significant body image concerns or a body image disorder. These concerns/disorders were associated with higher levels of depression, anxiety, and suicidality. In addition, the group concerned with body shape or weight had significantly greater symptoms of PTSD, dissociation, and sexual preoccupation/distress. These relatively common body image concerns and disorders deserve further study in adolescents.

Adolescent↗
PubMed2006

Tanning in body dysmorphic disorder.

Tanning in body dysmorphic disorder (BDD) has not previously been studied. In this study, 200 subjects with BDD were evaluated with measures to examine the prevalence of BDD-related tanning--i.e., darkening one's skin color by direct exposure to sunlight or artificial light which is motivated by a desire to improve a perceived appearance defect (i.e., a BDD concern). We also examined clinical characteristics of individuals who engaged in BDD-related tanning. 25% (95% CI, 19.0%-31.0%) of subjects reported BDD-related tanning. Among tanners, the skin was the most common body area of concern (84.0%). All tanners experienced functional impairment due to BDD, 26% had attempted suicide, and quality of life was markedly poor. 52% of tanners had received dermatologic treatment, which was usually ineffective for BDD symptoms. Tanners were more likely than non-tanners to compulsively pick their skin. In conclusion, tanning--a behavior with well-known health risks--is a relatively frequent BDD-related behavior.

Adolescent↗
PubMed2006

Social functioning in body dysmorphic disorder: assessment considerations.

Individuals with body dysmorphic disorder (BDD) have markedly poor social functioning; however, previous reports may underestimate impairment. Scoring on certain functioning measures such as the Social Adjustment Scale-Self Report (SAS-SR) potentially excludes more severely ill individuals from some domains, thereby possibly underestimating functional impairment. To explore this issue, 73 individuals with BDD who reported having no primary relationship (and were therefore excluded from scoring on the SAS-SR Primary Relationship domain) were compared to 58 individuals with BDD who had a primary relationship. Subjects without a primary relationship had significantly poorer global social adjustment on several measures. They also had poorer scores on the Global Assessment of Functioning Scale and greater severity of BDD and depressive symptoms at a trend level. These findings suggest that the SAS-SR may underestimate social impairment. This underestimation may pertain to other domains of functioning, other disorders, and certain other functioning and quality of life measures.

Adult↗
PubMed2006

Obsessive-compulsive spectrum of disorders: a defensible construct?

OBJECTIVE: To explore critically whether there is a robust basis for the concept of an obsessive-compulsive (OC) spectrum of disorders, and if so, which disorders should be included. METHOD: Selective literature review concentrating on three proposed members of the OC spectrum, namely body dysmorphic disorder, hypochondriasis and trichotillomania. RESULTS: Obsessive-compulsive disorder (OCD) itself is a heterogeneous condition or group of conditions, and this needs to be appreciated in any articulation of a 'spectrum' of OC disorders. The basis for 'membership' of the spectrum is inconsistent and varied, with varying level of support for inclusion in the putative spectrum. CONCLUSION: A more fruitful approach may be to consider behaviours and dimensions in OCD and OC spectrum disorders, and that this should be encompassed in further developments of the OC spectrum model.

Humans↗
PubMed2006

An open-label study of escitalopram in body dysmorphic disorder.

Body dysmorphic disorder (BDD) is a relatively common and impairing disorder. Selective serotonin reuptake inhibitors (SRIs) appear selectively efficacious for BDD, but pharmacotherapy research is limited, and escitalopram has not been studied. Fifteen subjects with BDD were treated with escitalopram and assessed with reliable and valid measures. BDD symptoms significantly improved (P<0.001), and 73.3% (n=11) of subjects were responders. Of the subjects, 46.7% were very much improved, and 33.3% were much improved. Depressive symptoms, delusionality, functioning and quality of life also significantly improved. Escitalopram was well tolerated. These preliminary data suggest that escitalopram is safe and efficacious for BDD.

Adolescent↗
PubMed2006

A 12-month follow-up study of the course of body dysmorphic disorder.

OBJECTIVE: This study investigated the course of body dysmorphic disorder (BDD), a relatively common and severe disorder, in the first prospective follow-up study, to the authors' knowledge. METHOD: In this study, the authors obtained data with the Longitudinal Interval Follow-Up Evaluation on weekly BDD symptom status and treatment received over 1 year for 183 broadly ascertained subjects. Probabilities of full remission, partial remission, and relapse during this year were examined. Full remission was defined as minimal or no BDD symptoms and partial remission, as meeting less than full DSM-IV criteria for at least 8 consecutive weeks. Relapse was defined as meeting full BDD criteria for at least 2 consecutive weeks after attaining partial or full remission from BDD. RESULTS: Over 1 year, the probability of full remission from BDD was only 0.09, and the probability of partial remission was 0.21. Although 84.2% of the subjects received mental health treatment during the 1-year period, mean BDD severity scores during the year reflected full DSM-IV criteria for BDD, and the mean proportion of time that the subjects met full BDD criteria was 80%. Gender and ethnicity did not significantly predict remission from BDD. Among the subjects whose BDD symptoms partially or fully remitted, the probability of relapse was 0.15. CONCLUSIONS: These findings indicate that BDD tends to be chronic. Remission probabilities were lower than reported for mood disorders, most anxiety disorders, and personality disorders in studies with similar methods.

Adult↗
PubMed2006

Suicidality in body dysmorphic disorder: a prospective study.

OBJECTIVE: Cross-sectional/retrospective data have indicated that individuals with body dysmorphic disorder (BDD) have high rates of suicidal ideation and attempts. However, no study, to the authors' knowledge, has prospectively examined suicidality in BDD. METHOD: In the first prospective study of BDD's course, the authors examined suicidality in 185 subjects for up to 4 years. RESULTS: Suicidal ideation was reported by a mean of 57.8% of the subjects per year, and a mean of 2.6% attempted suicide per year. Two subjects (0.3% per year) completed suicide. CONCLUSIONS: Individuals with BDD have high rates of suicidal ideation and attempts. The completed suicide rate is preliminary but suggests that the rate of completed suicide in BDD is markedly high.

Adult↗
PubMed2006

The Presentation of Body Dysmorphic Disorder in Medical Settings.

Body dysmorphic disorder (BDD) is a relatively common psychiatric illness that often presents to mental health professionals as well as nonpsychiatric physicians. However, BDD usually goes unrecognized and undiagnosed in clinical settings. It is important to recognize and accurately diagnose BDD because this often secret illness may be debilitating. Patients with BDD typically have markedly impaired functioning, notably poor quality of life, and a high rate of suicidal ideation and suicide attempts. Thus, it is important to screen patients for BDD and avoid misdiagnosing it as another illness. Nonpsychiatric treatments (eg, dermatologic, surgical), which most patients seek and receive, appear ineffective for BDD and can be risky for physicians to provide. This article provides a clinically focused overview of BDD, including its symptoms, morbidity, case examples, nonpsychiatric (ie, cosmetic) treatment, diagnostic "do's" and "don'ts," and suggestions for how to persuade patients to accept appropriate psychiatric care.

Journal Article↗
PubMed2005

Associations in the longitudinal course of body dysmorphic disorder with major depression, obsessive-compulsive disorder, and social phobia.

Body dysmorphic disorder (BDD) is an impairing and relatively common disorder that has high comorbidity with certain Axis I disorders. However, the longitudinal associations between BDD and comorbid disorders have not previously been examined. Such information may shed light on the nature of BDD's relationship to putative "near-neighbor" disorders, such as major depression, obsessive-compulsive disorder (OCD), and social phobia. This study examined time-varying associations between BDD and these comorbid disorders in 161 participants over 1-3 years of follow-up in the first prospective longitudinal study of the course of BDD. We found that BDD had significant longitudinal associations with major depression--that is, change in the status of BDD and major depression was closely linked in time, with improvement in major depression predicting BDD remission, and, conversely, improvement in BDD predicting depression remission. We also found that improvement in OCD predicted BDD remission, but that BDD improvement did not predict OCD remission. No significant longitudinal associations were found for BDD and social phobia (although the results for analyses of OCD and social phobia were less numerically stable). These findings suggest (but do not prove) that BDD may be etiologically linked to major depression and OCD, i.e., that BDD may be a member of both the putative OCD spectrum and the affective spectrum. However, BDD does not appear to simply be a symptom of these comorbid disorders, as BDD symptoms persisted in a sizable proportion of subjects who remitted from these comorbid disorders. Additional studies are needed to elucidate the nature of BDD's relationship to commonly co-occurring disorders, as this issue has important theoretical and clinical implications.

Adult↗