Elsevier

Comprehensive Psychiatry

Volume 44, Issue 4, July–August 2003, Pages 270-276
Comprehensive Psychiatry

Axis I comorbidity in body dysmorphic disorder

https://doi.org/10.1016/S0010-440X(03)00088-9Get rights and content

Abstract

Although research on body dysmorphic disorder (BDD) has increased in recent years, this disorder’s comorbidity has received little empirical attention. Further work in this area is needed, as it appears that most patients with BDD have at least one comorbid disorder. This study examined axis I comorbidity and clinical correlates of comorbidity in 293 patients with DSM-IV BDD, 175 of whom participated in a phenomenology study and 118 of whom participated in treatment studies of BDD. Subjects were evaluated with the Structured Clinical Interview for DSM-III-R (SCID-P) and a semistructured instrument to obtain information on clinical correlates. Comorbidity was common, with a mean of more than two lifetime comorbid axis I disorders in both the phenomenology and treatment groups. In both groups, the most common lifetime comorbid axis I disorders were major depression, social phobia, obsessive compulsive disorder (OCD), and substance use disorders. Social phobia usually began before onset of BDD, whereas depression and substance use disorders typically developed after onset of BDD. A greater number of comorbid disorders was associated with greater functional impairment and morbidity in a number of domains. Thus, axis I comorbidity is common in BDD patients and associated with significant functional impairment.

Section snippets

Method

Subjects were referred from a variety of sources to a BDD research program for evaluation or treatment of BDD. All participants met DSM-IV criteria for BDD or its delusional variant (a type of delusional disorder, somatic type), which may be double-coded with BDD according to DSM-IV. There were 293 participants: 175 participated in a phenomenology study of BDD’s clinical features,3 31 in an open-label study of fluvoxamine for BDD,20 and 87 in placebo-controlled pharmacotherapy studies of BDD.21

Results

Lifetime comorbidity was common (Table 2). Among both phenomenology and treatment study participants, major depression was most frequent, followed by social phobia, OCD, and substance use disorders. Comorbidity rates were generally similar in the phenomenology and treatment groups. The lower rates of bipolar disorder and substance use disorders in the treatment group were expected because of the treatment studies’ exclusion criteria.

Phenomenology study participants had 2.4 ± 1.5 lifetime

Discussion

This study found that comorbidity is common in BDD patients, both in terms of the percentage of patients with at least one comorbid disorder and the mean number of comorbid disorders. Indeed, comorbidity is the rule rather than the exception, as is the case for many psychiatric disorders.25 While the differing comorbidity rates in our phenomenology and treatment studies were expected, these differences underscore that rates may vary in different samples. It is possible, for example, that

References (39)

  • K.A. Phillips et al.

    Body dysmorphic disorder30 cases of imagined ugliness

    Am J Psychiatry

    (1993)
  • L. DeMarco et al.

    Perceived stress in body dysmorphic disorder

    J Nerv Ment Dis

    (1998)
  • D. Veale et al.

    Body dysmorphic disordera survey of fifty cases

    Br J Psychiatry

    (1996)
  • K.A. Phillips

    Quality of life for patients with body dysmorphic disorder

    J Nerv Ment Dis

    (2000)
  • K.A. Phillips et al.

    Gender differences in body dysmorphic disorder

    J Nerv Ment Dis

    (1997)
  • E. Hollander et al.

    Body dysmorphic disorder

    Psychiatr Ann

    (1993)
  • G. Perugi et al.

    Gender-related differences in body dysmorphic disorder (dysmorphophobia)

    J Nerv Ment Dis

    (1997)
  • K.A. Phillips et al.

    A comparison of delusional and nondelusional body dysmorphic disorder in 100 cases

    Psychopharmacol Bull

    (1994)
  • C. Haw et al.

    Deliberate self-harm in patients with alcohol disorderscharacteristics, treatment, and outcome

    Crisis

    (2001)
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