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PubMedDate not supplied

Axis I comorbidity in body dysmorphic disorder.

Although research on body dysmorphic disorder (BDD) has increased in recent years, this disorder's comorbidity has received little empirical attention. Further work in this area is needed, as it appears that most patients with BDD have at least one comorbid disorder. This study examined axis I comorbidity and clinical correlates of comorbidity in 293 patients with DSM-IV BDD, 175 of whom participated in a phenomenology study and 118 of whom participated in treatment studies of BDD. Subjects were evaluated with the Structured Clinical Interview for DSM-III-R (SCID-P) and a semistructured instrument to obtain information on clinical correlates. Comorbidity was common, with a mean of more than two lifetime comorbid axis I disorders in both the phenomenology and treatment groups. In both groups, the most common lifetime comorbid axis I disorders were major depression, social phobia, obsessive compulsive disorder (OCD), and substance use disorders. Social phobia usually began before onset of BDD, whereas depression and substance use disorders typically developed after onset of BDD. A greater number of comorbid disorders was associated with greater functional impairment and morbidity in a number of domains. Thus, axis I comorbidity is common in BDD patients and associated with significant functional impairment.

Adult↗

PubMed1998

Neuropsychological performance in body dysmorphic disorder.

Fourteen patients with body dysmorphic disorder (BDD) were assessed with neuropsychological measures, including tests of executive, mnestic, and motor functions. Performance in these patients was compared to 10 patients with obsessive-compulsive disorder (OCD), 14 patients with schizophrenia, and 24 normal controls. Findings indicated normal performance of the BDD group on measures of mnestic and motor function, but poor performance of this group on tests of executive function (p < .05). The overall performance of the BDD and OCD groups on the neuropsychological measures was similar, while the schizophrenic groups showed a wider spectrum of neuropsychological deficits to these groups. These findings are discussed in terms of current theories of executive functions and the possible relationship between BDD and OCD.

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↗

PubMed2004

Body dysmorphic disorder: suggestions for detection and treatment in a surgical dermatology practice.

BACKGROUND: Body dysmorphic disorder is a relatively common condition in patients seeking elective surgery. Little has been written, however, in the dermatologic surgery literature about body dysmorphic disorder, where proper recognition and management of this disorder is needed during this time of increased demand for aesthetic dermatologic surgery. OBJECTIVE: The objective was to review the prevalence, demographics, clinical features, treatment approaches, and referral suggestions for patients with body dysmorphic disorder in an attempt to facilitate care of such patients in a general dermatologic surgical practice. METHODS: We reviewed the dermatologic, cosmetic surgical, and psychiatric literature regarding body dysmorphic disorder and related disorders. RESULTS: Body dysmorphic disorder is observed in 6% to 15% of dermatologic and cosmetic surgery patients and in 2% of the general population. Surgical treatment of patients with body dysmorphic disorder typically leads to no change or worsening of symptoms in the majority of patients. The use of screening questionnaires and observation for hallmark features are helpful for clinicians in managing patients with body dysmorphic disorder. Psychiatric referral is desirable, because cognitive behavioral therapy and pharmacologic intervention with selective serotonin reuptake inhibitors are often efficacious. CONCLUSIONS: Body dysmorphic disorder is often underdiagnosed and suboptimal management is common. Effective treatment consists of behavioral and pharmacologic intervention. Use of the Dufresne Body Dysmorphic Disorder Questionnaire appears to be useful as a screening tool in an outpatient setting, and awareness of clinical features of body dysmorphic disorder in the dermatologic surgical setting may spare patients significant morbidity while allowing surgical dermatologists to manage their patients and practices more effectively.

Dermatology↗

PubMed2001

A retrospective review of clinical characteristics and treatment response in body dysmorphic disorder versus obsessive-compulsive disorder.

BACKGROUND: Although body dysmorphic disorder (BDD) has many features in common with obsessive-compulsive disorder (OCD) and is frequently comorbid with OCD, few studies have directly compared the 2 disorders. Although BDD and OCD respond to similar medications and cognitive-behavioral therapy (CBT), their response to treatment has never been directly compared. METHOD: We studied 107 consecutive patients with DSM-III-R OCD (N = 96) or BDD (N = 11) treated openly for 6 weeks with intensive CBT, medication, and psychosocial rehabilitation, in a specialized partial hospitalization program for severely ill OCD patients. All patients were assessed, before and after treatment, with the Yale-Brown Obsessive Compulsive Scale (Y-BOCS), Hamilton Rating Scale for Depression (HAM-D), Hamilton Rating Scale for Anxiety (HAM-A), and Global Assessment Scale (GAS). Retrospectively, we compared the clinical characteristics, symptom severity, and response to treatment of BDD patients with those of OCD patients. RESULTS: BDD patients and OCD patients had similar sex ratio, age, treatment duration, prevalence of comorbid major depression, and pretreatment Y-BOCS and GAS scores. BDD patients had significantly higher pretreatment HAM-D and HAM-A scores. The proportions of patients treated with serotonin reuptake inhibitors and antipsychotics did not differ between groups. Both groups improved with treatment, with significant (p < .001) changes in Y-BOCS, HAM-D, HAM-A, and GAS scores. Change in Y-BOCS did not differ between groups, but changes in HAM-D and HAM-A were significantly greater in BDD patients than in OCD patients. CONCLUSION: While BDD may be associated with greater severity of depressive and anxiety symptoms than OCD, this study suggests that BDD may respond to intensive, multimodal treatment.

Adult↗

PubMed2006

An update on body dysmorphic disorder.

PURPOSE OF REVIEW: The present review provides an update on current research into body dysmorphic disorder. RECENT FINDINGS: Recent findings can be considered under four groupings: the classification of body dysmorphic disorder, its current inclusion under the somatoform disorders, and its relationship to obsessive compulsive disorder and other obsessive compulsive spectrum disorders; the psychotic 'variant' of body dysmorphic disorder, and whether it is simply a more severe form of the nonpsychotic type; the cognitive aspects of body dysmorphic disorder; and the treatment of body dysmorphic disorder, both in terms of pharmacological and psychological parameters. SUMMARY: Body dysmorphic disorder does not sit comfortably in the somatoform disorder category, and there is a good case for it being considered part of the obsessive compulsive spectrum, although it is not merely a subtype of obsessive compulsive disorder. Insight into the illness suggests that it represents a spectrum of disorders, and a categorical delineation of 'psychotic' and 'nonpsychotic' variants cannot be supported. We are beginning to understand more about the neurocognitive aspects of body dysmorphic disorder, but more research is required to assess which deficits/aberrations (if any) are exclusive to body dysmorphic disorder as an entity, and which are a reflection of broader phenomenological manifestations. Finally, the mainstay of treatment for body dysmorphic disorder remains behaviour/cognitive behaviour therapy and serotonin reuptake inhibitors; much more work is required to identify effective interventions for those patients who fail to respond to these treatment modalities.

Cognition Disorders↗

PubMedDate not supplied

Demographic characteristics, phenomenology, comorbidity, and family history in 200 individuals with body dysmorphic disorder.

The authors examined characteristics of body dysmorphic disorder in the largest sample for which a wide range of clinical features has been reported. The authors also compared psychiatrically treated and untreated subjects. Body dysmorphic disorder usually began during adolescence, involved numerous body areas and behaviors, and was characterized by poor insight, high comorbidity rates, and high rates of functional impairment, suicidal ideation, and suicide attempts. There were far more similarities than differences between the currently treated and untreated subjects, although the treated subjects displayed better insight and had more comorbidity.

Adolescent↗

PubMed2002

Body dysmorphic disorder: a guide for primary care physicians.

Body dysmorphic disorder (BDD), a preoccupation with an imagined or slight defect in appearance, is a relatively common psychiatric disorder that often presents to nonpsychiatric physicians. Body dysmorphic disorder is associated with marked impairment in functioning, notably poor quality of life, and a high suicide attempt rate. Most patients seek and receive surgery or nonpsychiatric medical or dermatologic treatment, often with a perceived poor outcome despite an objectively acceptable result. In contrast, psychiatric treatment, serotonin-reuptake inhibitors and cognitive-behavioral therapy, often are effective. This clinically focused review describes the clinical features and prevalence of BDD, the disorder's treatment response, how to recognize and diagnose BDD, and practical suggestions for primary care physicians who encounter these often difficult-to-treat patients.

Adult↗

PubMed2005

Body dysmorphic disorder: more than meets the eye.

Body dysmorphic disorder is a relatively common yet long unrecognized problem affecting mainly adolescents and young adults of both sexes. It is an obsessive disease of such intensity that it interferes with daily activities. Patients typically focus on imagined major defects in the face, nose, skin or hair. Patients often seek multiple physician assessment, but body dysmorphic disorder may be disabling and even life-threatening as a result of depression and suicidal ideation. Treatment with serotonin reuptake inhibitors and cognitive behavioral therapy may be beneficial in many patients.

Adolescent↗

PubMed1999

Clomipramine vs desipramine crossover trial in body dysmorphic disorder: selective efficacy of a serotonin reuptake inhibitor in imagined ugliness.

BACKGROUND: Body dysmorphic disorder (preoccupation with an imagined or slight defect in appearance) is a common and disabling disorder associated with high rates of delusional symptoms and suicide attempts. Although preliminary studies suggest that serotonin reuptake inhibitors may be effective for body dysmorphic disorder, to date no controlled treatment studies have been published. METHODS: Forty patients were enrolled and 29 were randomized into a 16-week, double-blind, crossover-design study of clomipramine, a potent serotonin reuptake inhibitor, and active control desipramine, a selective norepinephrine reuptake inhibitor. Outcome measures included specific ratings of body dysmorphic disorder severity, delusionality, and functional impairment. RESULTS: Clomipramine was superior to desipramine in the acute treatment of body dysmorphic disorder symptoms as measured by assessment of patients' obsessive preoccupation with perceived body defects, repetitive behaviors in response to this preoccupation, and global ratings of symptom severity. Treatment efficacy was independent of the presence or severity of comorbid diagnoses of obsessive-compulsive disorder, depression, or social phobia. Likewise, clomipramine was equally effective regardless of whether the patients had insight or held their dysmorphic misperception with delusional intensity. Clomipramine was also superior to desipramine in improving functional disability. CONCLUSIONS: Clomipramine is more effective than desipramine in the treatment of body dysmorphic disorder and is effective even among those patients who are delusional.

Adrenergic Uptake Inhibitors↗

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

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↗

PubMedDate not supplied

A retrospective follow-up study of body dysmorphic disorder.

BACKGROUND: Although research on body dysmorphic disorder (BDD) is increasing, no follow-up studies of this disorder's course of illness have been published. METHODS: The status of 95 outpatients with BDD treated in a clinical practice was assessed by chart review. Standard scales were used to rate subjects at baseline and the most recent clinic visit (mean duration of follow-up, 1.7 +/- 1.1; range, 0.5-6.4 years). Ratings were also done at 6-month intervals over the first 4 years of follow-up. RESULTS: Allowing for censoring, life table analysis estimated that the proportion of subjects who achieved full remission from BDD at the 6-month and/or 12-month assessment was 24.7%; the proportion who attained partial or full remission at 6 months and/or 12 months was 57.8%. After 4 years of follow-up, 58.2% had experienced full remission, and 83.8% had experienced partial or full remission, at one or more 6-month assessment points. Of those subjects who attained partial or full remission at one or more assessment points, 28.6% subsequently relapsed. Between baseline and the most recent assessment, BDD severity and functioning significantly improved: at the most recent assessment, 16.7% of subjects were in full remission, 37.8% were in partial remission, and 45.6% met full criteria for BDD. Greater severity of BDD symptoms and the presence of major depression or social phobia at baseline were associated with more severe BDD symptoms at study end point. All subjects received at least one medication trial, and 34.3% received some type of therapy during the follow-up period. CONCLUSIONS: A majority of treated patients with BDD improved, although improvement was usually partial. Prospective longitudinal studies are needed to further elucidate the course of BDD.

Adolescent↗

PubMed2002

The importance of aesthetics in body dysmorphic disorder.

It is hypothesized that body dysmorphic disorder (BDD) patients are firstly more "aesthetical," an attribute much like being musical, which varies between different individuals. This results in a greater emotional response to more attractive individuals and placing greater value on the importance of appearance in their identity compared with healthy individuals. Some BDD patients may have greater aesthetic perceptual skills. This is manifested in their education or training in art and design. Secondly, BDD patients may have higher aesthetic standards than the rest of the population. Their failure to achieve an unrealistic aesthetic standard is at the core of BDD, leading to severe distress and handicap.

Journal Article↗

PubMed2003

Body dysmorphic disorder--a fear of imagined ugliness.

BACKGROUND: Body dysmorphic disorder (BDD) is a distressing and impairing illness characterised by an intense time consuming preoccupation with an imagined or slight defect in appearance of a body part or parts. OBJECTIVE: This article outlines the characteristic features and treatment approaches for BDD and suggests screening techniques that can be usefully applied in the general practice setting. DISCUSSION: Body dysmorphic disorder has been shown to be common and chronic yet goes under recognised as the patient is often secretive about their distress. In an endeavour to alleviate the distress, time consuming rituals are performed that are either without effect or paradoxically may exacerbate the distress. Recent treatment studies show that the selective serotonin reuptake inhibitors and cognitive behavioural therapy, used simultaneously or alone, can be beneficial in alleviating the distress and impairment associated with the condition.

Australia↗

PubMed2000

[Diagnosis of body dysmorphic disorder. A pilot study].

The assessment of body dysmorphic disorder (BDD) is complicated by poorly defined diagnostic criteria and a lack of valid instruments. The present pilot study examines the possible benefit of specific instruments in the discrimination of other body image disorders. Thirteen patients with BDD, 13 with disfiguring defects, and 21 with no significant impairment of appearance participated in the study. The participants were recruited from dermatological outpatients on the basis of semistructured diagnostic interviews and clinical ratings of disfigurement. Furthermore, structured interviews were conducted to determine comorbidity with depressive disorders and social phobia and to obtain a clinical rating of obsessive-compulsive symptoms using the modified version of the YBOCS for body dysmorphic disorders. In addition, the Beck depression inventory, the Social Phobia Scale, and the Social Interaction Anxiety Scale were completed. Patients with BDD differed significantly from disfigured and unimpaired patients in obsessive-compulsive symptoms, in particular obsessions, and the discrepancy between personal and clinical rating of disfigurement. However, depression and social phobia scores were only higher in comparison with unimpaired patients. Comorbidity with depressive disorders was significantly increased. Our results support the utility of the specific diagnostic instruments and indicate the particular importance of obsessive-compulsive symptoms in BDD.

Adult↗

PubMed1993

Body dysmorphic disorder: 30 cases of imagined ugliness.

OBJECTIVE: Body dysmorphic disorder, preoccupation with an imagined defect in appearance, is included in DSM-III-R but has received little empirical study. The authors investigated the demographics, phenomenology, course, associated psychopathology, family history, and response to treatment in a series of 30 patients with the disorder. METHOD: The patients (including 12 whose preoccupation was of probable delusional intensity) were assessed with a semistructured interview and the Structural Clinical Interview for DSM-III-R, and their family histories were obtained. RESULTS: The 17 men and 13 women reported a lifetime average of four bodily preoccupations, most commonly "defects" of the hair, nose, and skin. The average age at onset of body dysmorphic disorder was 15 years, and the average duration was 18 years. Seventy-three percent of the patients reported associated ideas or delusions of reference; 73%, excessive mirror checking; and 63%, attempts to camouflage their "deformities." As a result of their symptoms, 97% avoided usual social and occupational activities, 30% had been housebound, and 17% had made suicide attempts. Ninety-three percent of the patients had an associated lifetime diagnosis of a major mood disorder; 33%, a psychotic disorder; and 73%, an anxiety disorder. The patients generally responded poorly to surgical, dermatologic, and dental treatments and to adequate trials of most psychotropic medications, with the exception of fluoxetine and clomipramine (to which more than half had a complete or partial response). CONCLUSIONS: This often secret, chronic disorder can cause considerable distress and impairment, may be related to obsessive-compulsive disorder or mood disorder, and may respond to serotonin reuptake-blocking antidepressants.

Adolescent↗

PubMed2002

A randomized placebo-controlled trial of fluoxetine in body dysmorphic disorder.

BACKGROUND: Research on the pharmacotherapy of body dysmorphic disorder (BDD), a common and often disabling disorder, is limited. Available data suggest that this disorder may respond to serotonin reuptake inhibitors. However, no placebo-controlled treatment studies of BDD have been published. METHODS: Seventy-four patients with DSM-IV BDD or its delusional variant were enrolled and 67 were randomized into a placebo-controlled parallel-group study to evaluate the efficacy and safety of fluoxetine hydrochloride. After 1 week of single-blind placebo treatment, patients were randomized to receive 12 weeks of double-blind treatment with fluoxetine or placebo. Outcome measures included the Yale-Brown Obsessive Compulsive Scale Modified for Body Dysmorphic Disorder (BDD-YBOCS) (the primary outcome measure), the Clinical Global Impressions Scale, the Brown Assessment of Beliefs Scale, and other measures. RESULTS: Results of the BDD-YBOCS indicated that fluoxetine was significantly more effective than placebo for BDD beginning at week 8 and continuing at weeks 10 and 12 (F(1,64) = 16.5; P<.001). The response rate was 18 (53%) of 34 to fluoxetine and 6 (18%) of 33 to the placebo (chi(2)(1) = 8.8; P=.003). The BDD symptoms of delusional patients were as likely as those of nondelusional patients to respond to fluoxetine, and no delusional patients responded to the placebo. In the sample as a whole, treatment response was independent of the duration and severity of BDD and the presence of major depression, obsessive-compulsive disorder, or a personality disorder. Fluoxetine was generally well tolerated. CONCLUSION: Fluoxetine is safe and more effective than placebo in delusional and nondelusional patients with BDD.

Adult↗