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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