By Katharine A. Phillips, M.D.
Professor of Psychiatry, Weill Cornell Medical College
Attending Psychiatrist, New York-Presbyterian/Weill Cornell Medical Center
New York, NY, USA
Editor: Dr. Phillips (Bio) is one of the leading experts, not only in the US but in the entire world, on the topic of body dysmorphic disorder (BDD). She is also a member of the Editorial Board of Simple and Practical Medical Education.
She is the author or co-author of the leading books on body dysmorphic disorder for clinicians and for patients and their families. Please see: BEST books about Body Dysmorphic Disorder.
Body dysmorphic disorder (BDD) is common
Clinicians are often surprised to hear that BDD is more common than obsessive-compulsive disorder (OCD), anorexia nervosa, and schizophrenia.
How common is it?
– BDD currently affects about 2.5% of the general population (Hartmann and Buhlmann, 2017).
– And, it is far more common than this in certain clinical settings (Veale et al., 2016). These settings include psychiatric; dermatology and general cosmetic surgery (Peeters et al., 2021); rhinoplasty; orthodontic and orthognathic treatment (Dons et al., 2021); and other surgery settings (Dey et al., 2015).
BDD Is often very distressing and impairing
BDD is one of the most distressing disorders I’ve seen in more than 30 years of practice.
– Patients with more severe BDD are tortured by their belief that they look ugly, abnormal, or deformed.
– Psychosocial functioning and quality of life are usually very poor (Phillips et al., 2005b).
Suicidality is common in persons with BDD
Independent risk of suicidality
In acute psychiatric settings, BDD has been found to be associated with increased suicidal risk independently of comorbid psychiatric disorders (Snorrason et al., 2020).
Stronger association with suicidality than other psychiatric disorders
BDD has been found to be more strongly associated with suicidal ideation and suicidal behaviors than any other psychiatric disorder examined, including major depressive disorder, bipolar depression, OCD, and PTSD (Snorranson et al., 2019).
Compared to other groups (e.g., OCD, eating disorders, any anxiety disorder, healthy controls), patients with BDD are (Angelakis et al., 2016):
– Nearly four times more likely to have had suicidal ideation, and
– Nearly three times more likely to have attempted suicide.
Treatment for BDD works
Even though more, randomized, double-blind clinical trials need to be done, research evidence and clinical experience find that both pharmacotherapy and cognitive-behavior therapy (CBT) that is tailored to BDD are effective for most patients with BDD (Castle et al., 2021; Krebs et al., 2017).
Next, please see the following articles on this website:
Angelakis I, Gooding PA, Panagioti M. Suicidality in body dysmorphic disorder (BDD): A systematic review with meta-analysis. Clin Psychol Rev. 2016 Nov;49:55-66. doi: 10.1016/j.cpr.2016.08.002. Epub 2016 Aug 28. PMID: 27607741.
Castle D, Beilharz F, Phillips KA, Brakoulias V, Drummond LM, Hollander E, Ioannidis K, Pallanti S, Chamberlain SR, Rossell SL, Veale D, Wilhelm S, Van Ameringen M, Dell’Osso B, Menchon JM, Fineberg NA. Body dysmorphic disorder: a treatment synthesis and consensus on behalf of the International College of Obsessive-Compulsive Spectrum Disorders and the Obsessive Compulsive and Related Disorders Network of the European College of Neuropsychopharmacology. Int Clin Psychopharmacol. 2021 Mar 1;36(2):61-75. doi: 10.1097/YIC.0000000000000342. PMID: 33230025; PMCID: PMC7846290.
Dey JK, Ishii M, Phillis M, Byrne PJ, Boahene KD, Ishii LE. Body dysmorphic disorder in a facial plastic and reconstructive surgery clinic: measuring prevalence, assessing comorbidities, and validating a feasible screening instrument. JAMA Facial Plast Surg. 2015 Mar-Apr;17(2):137-43. doi: 10.1001/jamafacial.2014.1492. PMID: 25654334.
Dons F, Mulier D, Maleux O, Shaheen E, Politis C. Body dysmorphic disorder (BDD) in the orthodontic and orthognathic setting: A systematic review. J Stomatol Oral Maxillofac Surg. 2021 Oct 30:S2468-7855(21)00239-1. doi: 10.1016/j.jormas.2021.10.015. Epub ahead of print. PMID: 34728407.
Hartmann AS, Buhlmann U. Prevalence and underrecognition of body dysmorphic disorder. In Phillips, ed. Body Dysmorphic Disorder: Advances in Research and Clinical Practice. New York, NY: Oxford University Press, 2017.
Krebs G, Fernández de la Cruz L, Mataix-Cols D. Recent advances in understanding and managing body dysmorphic disorder. Evid Based Ment Health. 2017 Aug;20(3):71-75. doi: 10.1136/eb-2017-102702. Epub 2017 Jul 20. PMID: 28729345; PMCID: PMC5566091.
Peeters V, Janmohamed SR, Baharlou S, Gutermuth J, Willemsen R. Screening for Body Dysmorphic Disorder among Patients Seeking Dermatological and Cosmetic Care: A Cross-sectional Study. Acta Derm Venereol. 2021 Oct 19;101(10):adv00572. doi: 10.2340/actadv.v101.279. PMID: 34595537.
Phillips KA, Menard W, Fay C, Pagano ME. Psychosocial functioning and quality of life in body dysmorphic disorder. Compr Psychiatry. 2005b Jul-Aug;46(4):254-60. doi: 10.1016/j.comppsych.2004.10.004. PMID: 16175755; PMCID: PMC1351256.
Snorrason I, Beard C, Christensen K, Bjornsson AS, Björgvinsson T. Body dysmorphic disorder and major depressive episode have comorbidity-independent associations with suicidality in an acute psychiatric setting. J Affect Disord. 2019 Dec 1;259:266-270. doi: 10.1016/j.jad.2019.08.059. Epub 2019 Aug 19. PMID: 31450136.
Snorrason I, Beard C, Christensen K, Bjornsson AS, Björgvinsson T. Body dysmorphic disorder is associated with risk for suicidality and inpatient hospitalization: A replication study. Psychiatry Res. 2020 Nov;293:113478. doi: 10.1016/j.psychres.2020.113478. Epub 2020 Sep 24. PMID: 33198049.
Veale D, Neziroglu F. Body Dysmorphic Disorder: A Treatment Manual. West Sussex, UK: Wiley-Blackwell, 2010.
References not used in this article
AlAwadh I, Bogari A, Azhar T, AlTaylouni N, AlSughier N, AlKarzae M, AlQuniabut I, AlDosari B. Prevalence of Body Dysmorphic Disorder Among Rhinoplasty Candidates: A Systematic Review. Ear Nose Throat J. 2021 Nov 18:1455613211056543. doi: 10.1177/01455613211056543. Epub ahead of print. PMID: 34789021.
De La Vega D, Giner L, Courtet P. Suicidality in Subjects With Anxiety or Obsessive-Compulsive and Related Disorders: Recent Advances. Curr Psychiatry Rep. 2018 Mar 28;20(4):26. doi: 10.1007/s11920-018-0885-z. PMID: 29594718.
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