Body Dysmorphic Disorder: Chronic, Unremitting

People with body dysmorphic disorder, or BDD, have a distressing and often harmful preoccupation with an imagined or slight defect in their appearance. Their distress can lead to thoughts of suicide (70% of patients) or suicidal attempts (22%-24% of patients) (Br J Psychiatry 1996; 169:196; J Nerv Ment Dis 1997;185:570).

Despite its seriousness, until recently no prospective follow-up studies of the course of the disease had been done. Katherine A. Phillips, MD, and colleagues at Brown University and Decision Science Institute at Butler Hospital, Providence, RI, obtained data with the Longitudinal Interval Follow-up Evaluation on weekly BDD symptom status for 183 subjects diagnosed with BDD. The 183 patients were followed for one year (Am J Psychiatry 2006;163:907).

Most had long-term symptoms. Two-thirds of those with BDD were female; most were single; and most cases of BDD symptoms were moderate to severe. The mean duration of BDD symptoms was 16.0 years, and 148 subjects reported a continuous lifetime course of BDD.

The chronic and unremitting course of disease was apparent: during the year of follow-up–only 9% of the patients experienced full remission of symptoms and only 21% had partial remission. To underscore the seriousness of BDD, 15% of the subjects who had full remissions subsequently relapsed.