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Body dysmorphic disorder

Body dysmorphic disorder (BDD) is a mental disorder which involves a disturbed body image. The central feature of BDD is that persons who are afflicted with it are excessively dissatisfied with their body because of a perceived physical defect. An example would be a woman who is extremely worried that her nose is too big, although other people don't notice anything unusual about it. more...

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Diagnostic criteria (DSM-IV-TR)

The DSM-IV-TR, the latest version of the diagnostic manual of the American Psychiatric Association (see also: DSM cautionary statement), lists three (3) necessary criteria for a diagnosis of body dysmorphic disorder:

  1. Preoccupation with an imagined defect in appearance. If a slight physical anomaly is present, the person's concern is markedly excessive.
  2. The preoccupation causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
  3. The preoccupation is not better accounted for by another mental disorder (e.g., dissatisfaction with body shape and size in anorexia nervosa).

BDD and other disorders

Note that, according to the DSM criteria, a BDD diagnosis cannot be made if another disorder accounts for the preoccupation with a perceived defect. For instance, people who worry excessively about their weight are not considered to have BDD if this preoccupation is accounted for by an eating disorder. Body dysmorphic disorder is also considered to be different from gender identity disorder and transsexualism, even though the desire to modify one's body is also reflected in people who are judged to have these disorders. Some paraphilias also involve a wish to modify one's body. For example, people with apotemnophilia are convinced that a part of their body needs to be amputated.

In the medical community, some make links between BDD and obsessive-compulsive disorder because there are some similarities between these disorders. For instance, obsessive thoughts and compulsive behaviors are common symptoms of both disorders.

Read more at Wikipedia.org


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Body dysmorphic disorder in anorexic patients - Eating Disorders
From Nutrition Research Newsletter, 10/1/02

Body dysmorphic disorder, an often secret preoccupation with an imagined or slight defect in appearance, is a relatively common yet under recognized psychiatric disorder. The prevalence and clinical features of body dysmorphic disorder in patients with anorexia nervosa (AN) are of particular interest because both body dysmorphic disorder and AN have at their core a distortion of body image and a preoccupation with bodily appearance. Studies have shown that patients with AN tend to focus more on body weight, while those with body dysmorphic disorder focus on specific body parts.

The prevalence of body dysmorphic disorder in patients with AN is unknown. Grant et al. hypothesized that body dysmorphic disorder would be under-diagnosed in patients with AN and that comorbidity with body dysmorphic disorder would result in greater overall dysfunction, meaning more severe body-image distortions, poorer occupational and social function and more severe global illness.

Forty-one females meeting the DSM-IV criteria for AN were included in this study. All subjects completed the Body Dysmorphic Disorder Questionnaire, a self-report measure that screens for body dysmorphic disorder. For those subjects who screened positive for body dysmorphic disorder on the questionnaire, a follow-up interview was conducted using a reliable clinician-administered semi-structured diagnostic instrument for DSM-IV body dysmorphic disorder. Co-morbid DSM-IV diagnoses, number of hospitalizations and suicide attempts were also obtained through a detailed diagnostic interview.

Sixteen (39%) of the 41 subjects with AN were diagnosed with comorbid body dysmorphic disorder. Patients diagnosed with body dysmorphic disorder were preoccupied with an imagined or slight defect in appearance unrelated to their concerns about weight. The onset of body dysmorphic disorder preceded AN symptoms in 15 of the anorexic patients with body dysmorphic disorder. The patients with both of these disorders also reported an earlier age of onset of AN compared to the patients without body dysmorphic disorder. The 16 subjects also suffered from a variety of other Axis 1 disorders. Nine suffered from major depressive disorder, four had social phobia, and three had obsessive-compulsive disorder. The anorexic patients with body dysmorphic disorder had significantly lower overall functioning and higher levels of delusionality than the anorexic patients without body dysmorphic disorder.

Body dysmorphic disorder has a relatively high prevalence among patients with anorexia nervosa and is not a rare disorder in this population. There was an instance of under diagnosis since none of the patients were diagnosed with body dysmorphic disorder during their hospitalization. However, since the subjects were drawn from a hospitalized sample of patients with AN this may reflect a possible selection bias. Also, given the severity of the patient sample, the findings may not be fully generalizable to other patients with anorexia. Therefore, further research is needed to confirm these findings that the comorbidity of body dysmorphic disorder appears to result in more severe impairment in overall functioning, more delusionality regarding appearance and in a greater likelihood to attempt suicide.

Jon E. Grant, Suck Won Kim and Elke D. Eckert, Body dysmorphic disorder in patients with anorexia nervosa: prevalence, clinical features, and delusionality in body image, Int d Eat Disord 32: 291-300 (2002) [Correspondence to: Jon E. Grant, Department of Psychiatry, University, of Minnesota School of Medicine, 2450 Riverside Avenue, Minneapolis, Minnesota 55454-1495. E-mail: grant045@umn.edu]

COPYRIGHT 2002 Frost & Sullivan
COPYRIGHT 2002 Gale Group

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