Summary
Body dysmorphic disorder (BDD) is defined as a preoccupation with an imagined or minimal defect in appearance. Virtually any body part can be the focus of concern, although preoccupations with the hair, nose and skin are particularly common. Associated features include repetitive and often ritualistic behaviours, such as mirror checking and requests for reassurance, as well as ideas or delusions of reference. The degree of impairment associated with the disorder is variable, but most patients experience significant functional impairment as a result of their concerns.
While this often secret disorder has been described for more than a century and reported around the world, it has received little empirical investigation. Nonetheless, emerging data suggest that BDD is frequently a chronic disorder that usually begins during adolescence. Psychiatric hospitalisation and suicide attempts are common in patients with BDD. Disorders that are frequently comorbid include major depression, social phobia and obsessive-compulsive disorder. The prevalence of BDD among patients with other psychiatric disorders, such as atypical depression, obsessive-compulsive disorder and social phobia, appears to be relatively high.
The majority of patients with BDD seek often costly nonpsychiatric therapies, such as surgical or dermatological interventions. These approaches are usually unsuccessful. In contrast, preliminary data from noncomparative studies suggest that serotonin (5-hydroxytryptamine; 5-HT) reuptake inhibitors are often, and perhaps preferentially, effective in the treatment of BDD. Other preliminary data suggest that cognitive-behavioural strategies may also be useful. There are virtually no data on treatment-resistant BDD, but certain pharmacological approaches including augmentation, combination and switching strategies are sometimes effective.
Further investigation of all aspects of this understudied disorder is greatly needed. Aspects that require particular attention are the epidemiology, clinical features, relationship to other psychiatric disorders, biology and, ultimately, aetiology and treatment response.
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References
Morselli E. Sulla dismorfofobia e sulla tafefobia. Bolletinno della R accademia di Genova 1891; 6: 110–9
Yamada M, Kobashi K, Shigemoto T, et al. On dysmorphophobia. Bull Yamaguchi Med School 1978; 25: 47–54
Vallat JN, Leger JM, Destruhaut J, et al. Dysmorphophobie: syndrome ou symptome? Ann Med Psychol (Paris) 1971; 2: 45–65
Bezoari M, Falcinelli D. Immagine del corpo e relazioni oggetuali: note sulla dismorfofobia. Rass Studi Psychiat 1977; 66: 489–510
von Zauner J. Das Krankheitsbild der Dysmorphophobie. Med et Hyg 1979; 37: 329–30
Korkina MB. The syndrome of dysmorphomania (dysmorphophobia) and the development of psychopathic personality. Zh Nevropatol Psikhiatr 1965; 65: 1212–7
Phillips KA. Body dysmorphic disorder: the distress of imagined ugliness. Am J Psychiatry 1991; 148: 1138–49
American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 4th ed. Washington, DC: American Psychiatric Association, 1994
World Health Organization. The 1CD-10 classification of mental and behavioural disorders — clinical descriptions and diagnostic guidelines. Geneva: World Health Organization, 1992
American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 3rd ed. revised. Washington DC: American Psychiatric Association, 1987
Hay GG. Dysmorphophobia. Br J Psychiatry 1970; 116: 399–406
Zaidens SH. Dermatologic hypochondriasis: a form of schizophrenia. Psychosom Med 1950; 12: 250–3
Ladee GA. Hypochondriacal syndromes. Amsterdam: Elsevier, 1966
Andreasen NC, Bardach J. Dysmorphophobia: symptom or disease? Am J Psychiatry 1977; 134: 673–6
Fukuda O. Statistical analysis of dysmorphophobia in outpatient clinic. Jpn J Plast Reconstr Surg 1977; 20: 569–77
Phillips KA, Nierenberg AA, Fava M. Body dysmorphic disorder in atypical depression [abstract]. New research program and abstracts. American Psychiatric Association 147th Annual Meeting; 1994 May 21-26: Philadelphia. Philadelphia: American Psychiatric Association, 1994: 94
Hollander E, Cohen LJ, Simeon D. Body dysmorphic disorder. Psychiatr Ann 1993; 23: 359–64
Brawman-Mintzer O, Lydiard RB, Emmanuel NP, et al. Body dysmorphic disorder: a comorbidity study [abstract]. New research program and abstracts. American Psychiatric Association 147th Annual Meeting; 1994 May 21-26: Philadelphia. Philadelphia: American Psychiatric Association, 1994: 219
Phillips KA, McElroy SL, Keck Jr E, et al. Body dysmorphic disorder: 30 cases of imagined ugliness. Am J Psychiatry 1993; 150: 302–8
Phillips KA, McElroy SL, Keck Jr E, et al. A comparison of delusional and nondelusional body dysmorphic disorder in 100 cases. Psychopharmacol Bull 1994; 30: 179–86
Phillips KA, McElroy SL, Gunderson CG, et al. Body dysmorphic disorder: data on imagined ugliness [abstract]. Continuing medical education (CME) syllabus and proceedings. American Psychiatric Association 147th Annual Meeting; 1994 May 21-26: Philadelphia. Philadelphia: American Psychiatric Association, 1994: 299
McElroy SL, Phillips KA, Keck Jr E, et al. Body dysmorphic disorder: does it have a psychotic subtype? J Clin Psychiatry 1993; 54: 389–95
Phillips KA, McElroy SL. Insight, overvalued ideation, and delusional thinking in body dysmorphic disorder: theoretical and treatment implications. J Nerv Ment Dis 1993; 181: 699–702
Spitzer RL, Williams JBW, Gibbon M, et al. The Structured Clinical Interview for DSM-III-R (SCID): I. History, rationale, and description. Arch Gen Psychiatry 1992; 49: 624–9
Williams JBW, Gibbon M, First MB, et al. The Structured Clinical Interview for DSM-III-R (SCID): II. Multisite test-retest reliability. Arch Gen Psychiatry 1992; 49: 630–6
Phillips KA, McElroy SL, Hudson JI, et al. Body dysmorphic disorders: an OCD-spectrum disorder, a form of affective spectrum disorder, or both? J Clin Psychiatry. In press
Campanella FN, Zuccoli E. In tema di dismorfofobia. Neuropsichiatria 1968; 24: 475–86
Solyom L, DiNicola VF, Phil M, et al. Is there an obsessive psychosis? Aetiological and prognostic factors of an atypical form of obsessive-compulsive neurosis. Can J Psychiatry 1985; 30: 372–80
Jenike MA. A case report of successful treatment of dysmorphophobia with tranylcypromine. Am J Psychiatry 1984; 141: 1463–4
Hollander E, Liebowitz MR, Winchel R, et al. Treatment of body-dysmorphic disorder with serotonin reuptake blockers. Am J Psychiatry 1989; 146: 768–70
Thomas CS. Dysmorphophobia: a question of definition. Br J Psychiatry 1984; 144: 513–6
Braddock LE. Dysmorphophobia in adolescence: a case report. Br J Psychiatry 1982; 140: 199–201
Cotterill JA. Dermatological non-disease: a common and potentially fatal disturbance of cutaneous body image. Br J Dermatol 1981; 104: 611–9
Vitiello B, de Leon J. Dysmorphophobia misdiagnosed as obsessive-compulsive disorder. Psychosomatics 1990; 31: 220–2
Marks I, Mishan J. Dysmorphophobic avoidance with disturbed bodily perception: a pilot study of exposure therapy. Br J Psychiatry 1988; 152: 674–8
Munro A, Chmara J. Monosymptomatic hypochondriacal psychosis: a diagnostic checklist based on 50 cases of the disorder. Can J Psychiatry 1982; 27: 374–6
deLeon J, Bott A, Simpson GM. Dysmorphophobia: body dysmorphic disorder or delusional disorder, somatic subtype? Compr Psychiatry 1989; 30: 457–72
Thomas CS. Dysmorphophobia or monosymptomatic hypochondriasis? [letter], Br J Psychiatry 1985; 146: 672
Brady KT, Austin L, Lydiard RB. Body dysmorphic disorder: the relationship to obsessive-compulsive disorder. J Nerv Ment Dis 1990; 178: 538–40
Goodman WK, Price LH, Rasmussen SA, et al. The Yale Brown Obsessive Compulsive Scale (Y-BOCS): Part I. Development, use, and reliability. Arch Gen Psychiatry 1989; 46: 1006–16
Goodman WK, Price LH, Rasmussen SA, et al. The Yale Brown Obsessive Compulsive Scale (Y-BOCS): Part II. Validity. Arch Gen Psychiatry 1989; 46: 1012–6
Hollander E, Cohen L, Simeon D, et al. Fluvoxamine treatment of body dysmorphic disorder [letter]. J Clin Psychopharmacol 1994; 14: 75–7
McDougle CJ, Goodman WK, Price LH, et al. Neuroleptic addition in fluvoxamine-refractory obsessive-compulsive disorder. Am J Psychiatry 1990; 147: 652–4
Corbella T, Rossi L. La dysmorphophobie: ses aspects cliniques et nosographiques. Acta Neurol Bellg 1967; 67: 691–700
Carroll BJ. Response of major depression with psychosis and body dysmorphic disorder to ECT [letter]. Am J Psychiatry 1994; 151: 288–9
Klages W, Hartwich P. Die Clowndysmorphophobie. Psychother Med Psychol 1982; 32: 183–7
Munjack DJ. The behavioral treatment of dysmorphobia. J Behav Ther Exp Psychiatry 1978; 9: 53–6
Neziroglu FA, Yaryura-Tobias JA. Exposure, response prevention, and cognitive therapy in the treatment of body dysmorphic disorder. Behav Ther 1993; 24: 431–8
Philoppopoulos GS. The analysis of a case of dsymorfophobia. Can J Psychiatry 1979; 24: 397–401
Bloch S, Glue P. Psychotherapy an dysmorphophobia: a case report. Br J Psychiatry 1988; 153: 271–4
Olley PC. Psychiatric aspects of referral. BMJ 1974; 3: 248–9
von Haustein UF, Seikowski K. Dysmorphophobie-Bewahrungsfeld zwischen Dermatologen und Psychotherapeuten. Dermatol Monatsschr 1988; 174: 345–8
Bezoari M, Falcinelli D. Immagine del corpo e relazioni oggetuali: note sulla dismorfofobia. Rass Studi Psychiat 1977; 66: 489–510
Phillips KA, McElroy SL, Lion JR. Body dysmorphic disorder in cosmetic surgery patients [letter]. J Plast Reconstr Surg 1992; 90: 333–4
Phillips KA, Hollander E. Body dysmorphic disorder: DSM-IV source book review. In: Frances A, editor. DSM-IV source book. Washington DC: American Psychiatric Press. In press
Hollander E, Phillips KA. Body image and experience disorders: body dysmorphic and depersonalization disorders. In: Hollander E, editor. Obsessive compulsive-related disorders. Washington DC: American Psychiatric Press, 1992
Phillips KA, McElroy SL. Obsessive-compulsive disorder in relation to body dysmorphic disorder [letter]. Am J Psychiatry 1992; 149: 1284
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Phillips, K.A. Body Dysmorphic Disorder. CNS Drugs 3, 30–40 (1995). https://doi.org/10.2165/00023210-199503010-00004
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DOI: https://doi.org/10.2165/00023210-199503010-00004