Phullips reviews the history and clinical features of body dysmorphic disorder. This disorder has been well described in European psychiatry, but is largely unknown in the United States. The main criteria of the disorder, according to the definition in the revised third edition of the Diagnostic and Statistical Manual of Mental Disorders, include a preoccupation with some imagined defect in physical appearance in a person who actually appears normal or a grossly excessive concern over a slight physical anomaly.
Patients may complain of an excessively large nose or head, small genitals or a "stretched" mouth. They may feel unbearably ugly as a result of the supposed deformity. Persistent preoccupation with the imagined defect can lead to social withdrawal as well as repeated visits to physicians to correct the defect.
Body dysmorphic disorder has been described under various terms for at least a century. Because no prospective or randomized studies have been performed, accurately describing the disorder has been difficult. Clinical features include intense preoccupation with an imagined or grossly exaggerated defect in appearance, regarding it with loathing or extreme shame. The patient may become so preoccupied with the supposed defect that thinking about anything else is difficult. However, patients with this disorder are not delusional. They are often able to tell the physician that they may be exaggerating the extent of the defect or that the defect may not exist.
The incidence of body dysmorphic disorder is not known. One study reported that 28 percent of 258 college students met criteria for the disorder, although these results did not exclude anorexia nervosa or excessive concern with weight. Age of onset is usually from early adolescence through the 20s; most patients wait an average of six years before presenting to a psychiatrist. Most patients are single, and an approximately equal number of men and women are affected.
Most psychiatric disorders can be found in association with the disorder, although no studies have accurately documented the association of an underlying psychiatric disorder. Depression appears to be the most commonly associated disorder.
The natural course of body dysmorphic disorder is unknown, although it appears that the focus of the preoccupation may change over time. Functional impairment may result from the inordinate amount of time that some patients spend worrying about their defect. Other patients can have profoundly disrupted lives, leading to severe social isolation (including being housebound), occupational dysfunction and suicide.
Medical specialists, especially dermatologists and plastic surgeons, are often consulted. Making repeated requests for unnecessary plastic surgery is a complication of the disorder. Surgery rarely meets the patient's expectations, and afterward the patient may become aggressive toward the physician. In addition, the patient may then become preoccupied with another imagined defect.
No clear consensus for treatment of body dysmorphic disorder exists. Avoidance of unnecessary cosmetic surgery is important. Serotonergic antidepressant medications may be useful. The author recommends psychiatric evaluation, although patients are often resistant to this suggestion.
The author believes that this disorder may be more common than previously thought and that physicians should be aware of the disorder to prevent possible serious complications. (American Journal of Psychiatry, September 1991, vol. 148, p. 1138.)
COPYRIGHT 1991 American Academy of Family Physicians
COPYRIGHT 2004 Gale Group
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