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Am J Psychiatry 1993; 150:302-308
Copyright © 1993 by American Psychiatric Association
Body dysmorphic disorder: 30 cases of imagined ugliness
KA Phillips, SL McElroy, PE Keck Jr, HG Pope Jr and JI Hudson
Biological Psychiatry Laboratory, McLean Hospital, Belmont, MA 02178.
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.
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