More Aggressive Screening for BDD Is Needed

Persons with body dysmorphic disorder (BDD) have an increased risk of suicidality, according to results of a study reported at the American Psychiatric Association meeting in San Francisco in May. As Eric Hollander, MD and Katherine Phillips, MD reported, the annual rate of suicidal ideation was 57%, and 3% of 183 patients with BDD attempted suicide in the same year. Two patients died by suicide during the study. The patients were followed prospectively for up to 3 years. The annual rate of suicidal ideation was 10 to 25 times higher than in the general U.S. population, and the attempted suicide rate was 4 to 13 times that in the general population, according to the researchers.

Dr. Hollander noted that BDD is often overlooked in clinical settings because of the secretive nature of the disorder. Dr. Phillips recommended that clinicians be alert for and aggressively screen for signs of BDD by asking the patient leading questions such as, “Are you worried about your appearance in any way?” or “Are you unhappy with how you look?” The researchers noted that as other studies have also shown, patients with BDD are prone to comorbidities that can also increase risk of suicidality. Patients with BDD often go first to dermatologists or cosmetic surgeons, in an attempt to correct their imagined or exaggerated physical “flaws.”