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PubMed2005

Placebo-controlled study of pimozide augmentation of fluoxetine in body dysmorphic disorder.

OBJECTIVE: Although body dysmorphic disorder often responds to serotonin reuptake inhibitors (SRIs), most patients do not respond or respond only partially. However, placebo-controlled studies of augmentation of SRIs have not been done. Furthermore, although 40%-50% of patients are delusional, studies of antipsychotic medications have not been done. METHOD: Twenty-eight patients with body dysmorphic disorder or its delusional variant participated in an 8-week, placebo-controlled, double-blind, parallel-group study of pimozide augmentation of fluoxetine. RESULTS: Pimozide was not more effective than placebo: two (18.2%) of 11 subjects responded to pimozide and three (17.6%) of 17 subjects responded to placebo. There was no significant effect of baseline delusionality on endpoint severity of body dysmorphic disorder. Delusionality did not decrease significantly more with pimozide than placebo. CONCLUSIONS: Pimozide augmentation of fluoxetine treatment for body dysmorphic disorder was not more effective than placebo, even in more delusional patients. Further studies of augmentation for SRIs are needed.

Adult↗

PubMed2002

Diagnosis and treatment of body dysmorphic disorder in adolescents.

Body dysmorphic disorder (BDD) is an underrecognized and underdiagnosed problem that is relatively common among adolescents. Although the onset of the disorder occurs in adolescence, BDD research in child and adolescent psychiatry is relatively limited. Body dysmorphic disorder has a high rate of co-morbidity with depression and suicide, which indicates important implications for prompt diagnosis and treatment in adolescents with BDD. Effective treatment options include cognitive behavioral therapy (CBT) and pharmacotherapy with serotonin reuptake inhibitors (SRIs). This paper provides a brief overview of BDD in adolescents, presents and evaluates the most recent literature on approaches to diagnosis and treatment, and highlights some of the characteristics that distinguish BDD from other disorders such as obsessive-compulsive disorder, social phobia, depression, and eating disorders.

Adolescent↗

PubMedDate not supplied

Personality disorders and traits in patients with body dysmorphic disorder.

Individuals with body dysmorphic disorder (BDD) have been postulated to have schizoid, narcissistic, and obsessional personality traits and to be sensitive, introverted, perfectionistic, and insecure. However, data on personality traits and disorders in BDD are limited. This study assessed 148 subjects with BDD, 26 of whom participated in a fluvoxamine treatment study; 74 subjects were assessed for personality disorders with the Structured Clinical Interview for DSMIII-R Personality Disorders (SCID-II), 100 subjects completed the NEO-Five Factor Inventory (NEO-FFI), and 51 subjects completed the Rathus Assertiveness Scale. Forty-two subjects (57%) had one or more personality disorders, with avoidant personality disorder (43%) being most common, followed by dependent (15%), obsessive-compulsive (14%), and paranoid (14%) personality disorders. On the NEO-FFI, the mean scores were in the very high range for neuroticism, the low range for extraversion and conscientiousness, the low-average range for agreeableness, and the average range for openness to experience. On the Rathus Assertiveness Scale, the mean score was -17.1 +/- 32.0 for women and -17.0 +/- 32.3 for men. Among fluvoxamine responders, the number of personality disorders significantly decreased between the study baseline and endpoint. These findings suggest that the rate of personality disorders in BDD is relatively high, with avoidant personality disorder being most common. The high neuroticism scores and low extraversion scores are consistent with this finding.

Adolescent↗

PubMed2006

Body dysmorphic disorder and cosmetic surgery.

BACKGROUND: Body dysmorphic disorder is a relatively common psychiatric disorder among persons who seek cosmetic surgical and minimally invasive treatments. METHODS: This article reviews the history of the diagnosis and the current diagnostic criteria. Etiologic theories, clinical and demographic characteristics, and comorbidity, including the relationship of body dysmorphic disorder to obsessive-compulsive spectrum and impulse control disorders, are discussed. The prevalence of body dysmorphic disorder in cosmetic populations is highlighted. Treatments for body dysmorphic disorder, including medical, psychiatric, and psychological interventions, are reviewed. RESULTS: Body dysmorphic disorder is an often severe, impairing disorder. Among patients presenting for cosmetic treatments, 7 to 15 percent may suffer from the condition. Retrospective outcome studies suggest that persons with body dysmorphic disorder typically do not benefit from cosmetic procedures. Pharmacotherapy and cognitive-behavioral psychotherapy, in contrast, appear to be effective treatments for body dysmorphic disorder. CONCLUSIONS: Because of the frequency with which persons with body dysmorphic disorder pursue cosmetic procedures, providers of cosmetic surgical and minimally invasive treatments may be able to identify and refer these patients for appropriate mental health care. Directions for future research are suggested.

Cosmetic Techniques↗

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↗

PubMedDate not supplied

Emotion recognition deficits in body dysmorphic disorder.

Patients with Body Dysmorphic Disorder (BDD) are characterized by excessive concerns about imagined defects in their appearance, most commonly, facial features. In this study, we investigated (1) the ability to identify facial expressions of emotion, and (2) to discriminate single facial features in BDD patients, Obsessive-Compulsive Disorder (OCD) patients, and in healthy control participants. Specifically, their ability for general facial feature discrimination was assessed using the Short Form of the Benton Facial Recognition Test (Benton AL, Hamsher KdeS, Varney NR, Spreen O. Contributions to neuropsychological assessment: a clinical manual. New York: Oxford University Press; 1983). However, findings of the BFRT indicate no differences among the groups. Moreover, participants were presented with facial photographs from the Ekman and Friesen (Ekman P, Friesen W. Unmasking the face: a guide to recognizing emotions from facial cues. Englewood Cliffs, NJ: Prentice-Hall; 1975 and Ekman P, Friesen W. Pictures of facial affect. Palo Alto: Consulting Psychologists Press, 1976) series and were asked to identify the corresponding emotion. The BDD group was less accurate than the control group, but not the OCD group, in identifying facial expressions of emotion. Relative to the control and OCD groups, the BDD group more often misidentified emotional expressions as angry. In contrast to the findings of Sprengelmeyer et al. [Proc. Royal Soc. London Series B: Biol. Sci. 264 (1997),1767], OCD patients did not show a disgust recognition deficit. Poor insight and ideas of reference, common in BDD, might partly result from an emotion recognition bias for angry expressions. Perceiving others as angry and rejecting might reinforce concerns about one's personal ugliness and social desirability.

Adult↗

PubMed2002

A review of cognitive and behavioral treatment for body dysmorphic disorder.

Until recently, body dysmorphic disorder (BDD) had been vastly ignored in the scientific literature. Despite a recent surge in interest, treatment studies are still surprisingly neglected. Reports from the 1970s-1990s discuss few case descriptions and suggest anecdotal treatment strategies. Since the 1990s, information about the treatment of BDD has increased slightly. The intent of this paper is to review the current state of knowledge regarding cognitive and behavior therapy, which so far has been found to be effective. The current literature suggests that there is no difference between the efficacy of one treatment strategy over another nor the combination of cognitive and behavior therapy over behavior therapy. However, more research is needed in this area before definitive conclusions can be made.

Journal Article↗

PubMed2006

[Body dysmorphic disorder: insufficiently recognized].

Body dysmorphic disorder (BDD) is the current name for a psychiatric disorder that has been known for a long time. Patients are preoccupied with an imagined defect in external appearance and seek non-psychiatric treatment such as surgery, which leaves the underlying BDD unrecognised. Because effective psychiatric treatment is available, i.e. by means of selective serotonin-reuptake inhibitors and cognitive psychotherapy, screening for BDD in medical settings is of great importance.

Cognitive Behavioral Therapy↗

PubMedDate not supplied

Nonpsychiatric medical treatment of body dysmorphic disorder.

Many individuals with body dysmorphic disorder seek nonpsychiatric medical and surgical treatment to improve perceived defects in their physical appearance. However, the types of treatments sought and received, as well as the treatment outcome, have received little investigation. This study describes the frequency, types, and outcomes of treatments sought and received by 200 individuals with body dysmorphic disorder. Treatment was sought by 71.0% and received by 64.0%. Dermatological treatment was most frequently sought and received (most often, topical acne agents), followed by surgery (most often, rhinoplasty). Twelve percent of the subjects received isotretinoin. Such treatment rarely improved body dysmorphic disorder. Thus, nonpsychiatric medical treatments do not appear effective in its treatment.

Acne Vulgaris↗

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↗

PubMed2005

Substance use disorders in individuals with body dysmorphic disorder.

BACKGROUND: Little is known about substance use disorders (SUDs) in individuals with body dysmorphic disorder (BDD). Although studies have examined SUD comorbidity in BDD, no previous studies have examined clinical correlates of SUD comorbidity. METHOD: We examined rates and clinical correlates of comorbid SUDs in 176 consecutive subjects with DSM-IV BDD (71% female; mean +/- SD age = 32.5 +/- 12.3 years). Comorbidity data were obtained with the Structured Clinical Interview for DSM-IV. BDD severity was assessed with the Yale-Brown Obsessive Compulsive Scale Modified for BDD, and delusionality (insight) was assessed with the Brown Assessment of Beliefs Scale. Quality of life and social/occupational functioning were examined using the Social Adjustment Scale, Quality of Life Enjoyment and Satisfaction Questionnaire, Medical Outcomes Study 36-Item Short-Form Health Survey, and Range of Impaired Functioning Tool. All variables were compared in BDD subjects with and without lifetime and current SUDs. Data were collected from January 2001 to June 2003. RESULTS: 48.9% of BDD subjects (N = 86) had a lifetime SUD, 29.5% had lifetime substance abuse, and 35.8% had lifetime substance dependence (most commonly, alcohol dependence [29.0%]). 17% (N = 30) had current substance abuse or dependence (9.1% reported current substance abuse, and 9.7% reported current dependence). 68% of subjects with a lifetime SUD reported that BDD contributed to their SUD. There were far more similarities than differences between subjects with a comorbid SUD and those without an SUD, although those with a lifetime SUD had a significantly higher rate of suicide attempts (p = .004). CONCLUSION: These preliminary results suggest that SUDs are very common in individuals with BDD. Subjects with and without a comorbid SUD were similar in most domains that were examined.

Adaptation, Psychological↗

PubMed2002

Body dysmorphic disorder in patients with anorexia nervosa: prevalence, clinical features, and delusionality of body image.

OBJECTIVE: The prevalence of body dysmorphic disorder in patients with anorexia nervosa is unknown. We hypothesized that body dysmorphic disorder would be underdiagnosed in patients with anorexia nervosa and that comorbidity with body dysmorphic disorder would result in greater overall dysfunction. METHOD: Forty-one patients with DSM-IV anorexia nervosa completed the Body Dysmorphic Disorder Questionnaire, a self-report screen for body dysmorphic disorder. A follow-up interview was conducted using a reliable clinician-administered semistructured diagnostic instrument for DSM-IV body dysmorphic disorder. Delusionality about appearance was assessed using a validated semistructured interview. Comorbid DSM-IV diagnoses, number of hospitalizations and suicide attempts were obtained by means of a detailed diagnostic interview. RESULTS: Sixteen (39%) of the 41 patients with anorexia nervosa were diagnosed with comorbid body dysmorphic disorder unrelated to weight concerns. The anorexia nervosa patients with body dysmorphic disorder had significantly lower overall functioning and higher levels of delusionality than the anorexic patients without body dysmorphic disorder. DISCUSSION: These preliminary results suggest that body dysmorphic disorder may be relatively common among patients with anorexia nervosa. The presence of comorbid body dysmorphic disorder may indicate a more severe form of illness.

Adolescent↗

PubMed1991

Body dysmorphic disorder: the distress of imagined ugliness.

OBJECTIVE: Body dysmorphic disorder, a preoccupation with an imagined defect in physical appearance, has a rich tradition in European psychiatry but has been largely neglected in the United States. Because this little-known disorder is probably more common than is generally realized and can have profound consequences, the author reviews its history, clinical features, and possible relationship to other psychiatric disorders. DATA COLLECTION: Data sources consisted of the MEDLINE database and relevant references in articles obtained from this search. Of 145 articles and books obtained, 100 were selected for inclusion in this review on the basis of how closely they conformed to the concept of body dysmorphic disorder as defined in DSM-III-R and how substantially they contributed to an understanding of the disorder's history, clinical features, or nosologic status. FINDINGS: Body dysmorphic disorder has been colorfully described in the European literature for more than a century. Although its concerns might sound trivial, this disorder can lead to social isolation (including being housebound), occupational dysfunction, unnecessary cosmetic surgery, and suicide. The most commonly associated psychiatric disorder appears to be depression. Although a definitive treatment does not exist, preliminary evidence suggests that serotonergic antidepressant medications may be useful. Whether body dysmorphic disorder is related to other psychiatric disorders, such as psychosis, mood disorder, social phobia, or obsessive-compulsive disorder, is unclear at this time. CONCLUSIONS: More research on the nosology, clinical features, and treatment response of body dysmorphic disorder is important, given the distress and impairment this often secret disorder can cause.

Antidepressive Agents↗

PubMed1995

Body dysmorphic disorder in the DSM-IV field trial for obsessive-compulsive disorder.

OBJECTIVE: This study investigated the prevalence and phenomenology of body dysmorphic disorder in patients with obsessive-compulsive disorder. METHOD: The authors studied 442 patients who participated in the DSM-IV field trial for obsessive-compulsive disorder. RESULTS: Twelve percent (N = 51) of the patients had a lifetime comorbid diagnosis of body dysmorphic disorder. Patients with and without body dysmorphic disorder did not differ in demographic characteristics of obsessive-compulsive symptoms. Patients with obsessive-compulsive disorder and body dysmorphic disorder had more anxious, impulsive, and schizotypal features than patients with obsessive-compulsive disorder alone. Age at onset was similar for the two disorders, and severity correlated. However, insight was significantly more impaired for body dysmorphic disorder than for obsessive-compulsive disorder. CONCLUSIONS: As previously thought, these findings suggest that the two disorders are strongly related but also have differences that require further investigation.

Adult↗

PubMed2003

Body dysmorphic disorder: recognition and treatment.

Body dysmorphic disorder (BDD) is classified as a somatoform disorder in the Diagnostic and Statistical Manual of Mental Disorder-IV-TR (DSM-IV-TR) (American Psychiatric Association, 2000). According to the DSM-IV-R, BDD is characterized as a preoccupation with an imagined defect in appearance. If a slight physical anomaly exists, the person's concern is markedly excessive and this preoccupation causes clinically significant distress or impairment in social, occupational, or other important areas of functioning. This diagnosis is most appropriately used when symptoms associated with this dissatisfaction with the body shape and size are not better explained by an eating disorder (American Psychiatric Association, 2000).

Antipsychotic Agents↗

PubMed1997

Gender differences in body dysmorphic disorder.

Gender differences in body dysmorphic disorder (BDD) have received little investigation. This study assessed gender differences in 188 subjects with BDD who were evaluated with instruments to assess demographic characteristics, clinical features of BDD, treatment history, and comorbid Axis I disorders. Ninety-three (49%) subjects were women, and 95 (51%) were men. Men and women did not significantly differ in terms of most variables examined, including rates of major depression, although women were more likely to be preoccupied with their hips and their weight, pick their skin and camouflage with makeup, and have comorbid bulimia nervosa. Men were more likely to be preoccupied with body build, genitals, and hair thinning, use a hat for camouflage, be unmarried, and have alcohol abuse or dependence. Although men were as likely as women to seek nonpsychiatric medical and surgical treatment, women were more likely to receive such care. Men, however, were as likely as women to have cosmetic surgery. Although the clinical features of BDD appear remarkably similar in women and men, there are some differences, some of which reflect those found in the general population, suggesting that cultural norms and values may influence the content of BDD symptoms.

Alcoholism↗

PubMed1995

Cognitive-behavioral treatment of body dysmorphic disorder: a case report.

Body dysmorphic disorder (BDD) refers to preoccupation with an imagined physical defect or the exaggeration of a slight physical anomaly. Since BDD's inclusion in the DSM-III-R, there have been only a handful of reports of its cognitive-behavioral treatment. We describe one successful short-term cognitive-behavioral therapy treatment of a BDD patient whose presenting concern was small hand size. After nine sessions of therapy, the patient evidenced substantial change on indices measuring affective, cognitive, and behavioral facets of BDD. There was also clinically meaningful improvement in overall levels of depression and anxiety. It is suggested that cognitive-behavioral treatment programs for BDD should take into account comorbid conditions such as social phobia, and avoidant personality disorder.

Adult↗

PubMed2001

Mirror, mirror on the wall, who is the ugliest of them all? The psychopathology of mirror gazing in body dysmorphic disorder.

UNLABELLED: Patients with Body Dysmorphic Disorder (BDD) may spend many hours in front of a mirror but little is known about the psychopathology or the factors that maintain the behaviour. A self-report mirror gazing questionnaire was used to elicit beliefs and behaviours in front of a mirror. Two groups were compared, which consisted of 55 controls and 52 BDD patients. RESULTS: Prior to gazing, BDD patients are driven by the hope that they will look different; the desire to know exactly how they look; a belief that they will feel worse if they resist gazing and the desire to camouflage themselves. They were more likely to focus their attention on an internal impression or feeling (rather than their external reflection in the mirror) and on specific parts of their appearance. They were also more likely to practise showing the best face to pull in public or to use "mental cosmetic surgery" to change their body image than controls. BDD patients invariably felt worse after mirror gazing and were more likely to use ambiguous surfaces such as the backs of CDs or cutlery for a reflection. CONCLUSION: Mirror gazing in BDD consists of a series of complex safety behaviours. It does not follow a simple model of anxiety reduction that occurs in the compulsive checking of obsessive-compulsive disorder. The implications for treatment are discussed.

Adult↗