Reprinted from Eating Disorders Review
September/October 2008 Volume 19, Number 5
©2008 Gürze Books
People with body dysmorphic disorder are extremely distressed and often impaired by imagined or slight physical defects. This could be a slightly deformed nose or small facial scar or a “defect” other people can’t even see. They may seek care for their perceived defects from a long list of specialties, including dermatology, cosmetic surgery, dentistry, psychiatry, and family medicine. The table, below right, shows rates of BDD in selected populations.
The results of a recent study of adult inpatients showed that BDD may be more common than suspected and is often underdiagnosed among psychiatric inpatients, who are often embarrassed to admit they have this disorder (General Hospital Psychiatry 2008; 30:67).
Michelle Conroy, MD, and colleagues at the Warren Alpert Medical School of Brown University and the Body Dysmorphic Disorder and Body Image program at Butler Hospital, Providence, RI, report that 16% of 100 consecutively admitted psychiatric inpatients they studied had current or past diagnoses of BDD. Among those with BDD, a fourth reported that BDD was a major reason or had affected the decision for their hospitalization. All reported having suicidal thoughts, and 93% reported a history of suicide attempts.
The patients had previously revealed their BDD symptoms only to a small number of health care professionals. The most common reasons given were embarrassment, fear of being judged negatively, and fear that no one would understand. A fourth of the patients felt that their primary care physicians would not understand.
According to Dr. Conroy and colleagues, it is important to screen psychiatric inpatients for underlying BDD because these patients have severe depressive symptoms and have a high risk of suicide.
An interesting pattern of differences in prevalence of BDD between men and women appeared as an incidental finding during a recent multi-site study. Dr. John F. Samuels, of Johns Hopkins University School of Medicine, Baltimore, and physicians at UCLA, Harvard University and Brown University investigated obsessive-compulsive disorder (OCD) and hoarding among 151 men and 358 women diagnosed with OCD who were examined during the OCD Collaborative Genetics Study (Behav Res Ther, 2008; June 27, Epub ahead of print).
The researchers found that among men, but not among women, hoarding was associated with aggressive, sexual, and religious obsessions and checking compulsions. In contrast, women who were hoarders more often had BDD, social phobia, and post-traumatic stress syndrome. In women but not in men, hoarding was associated with schizotypal and dependent personality disorders.