Chapter 39. Body Dysmorphic Disorder

Katharine A. Phillips, M.D.
DOI: 10.1176/appi.books.9781585622986.260403



Body dysmorphic disorder (BDD), also known as dysmorphophobia, is a severe and relatively common somatoform disorder (Phillips 2005a). DSM-IV-TR (American Psychiatric Association 2000) defines BDD as a preoccupation with an imagined defect in appearance; if a slight physical anomaly is present, the person's concern is markedly excessive. The preoccupation causes clinically significant distress or impairment in social, occupational, or other important areas of functioning, and it must not be better accounted for by another mental disorder (e.g., dissatisfaction with body shape and size in anorexia nervosa). According to DSM-IV-TR, patients with delusional BDD (i.e., those who are completely convinced that their view of their appearance is accurate and undistorted) may be diagnosed with both BDD and a psychotic disorder (delusional disorder, somatic type). This "double coding" implies that BDD's delusional and nondelusional variants may constitute the same disorder rather than being distinct subtypes, which is consistent with available data (Phillips 2004). Patients with BDD—both delusional and nondelusional patients—have high levels of distress, markedly poor functioning and quality of life, and high rates of suicidality (Cotterill and Cunliffe 1997; Phillips 2001; Phillips et al. 2005a, 2005b; Veale et al. 1996a). Thus, it is important to recognize BDD, accurately diagnose it, and provide effective treatment.

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Albertini RS, Phillips KA: Thirty-three cases of body dysmorphic disorder in children and adolescents. J Am Acad Child Adolesc Psychiatry 38:453–459, 1999
Allen A, Hollander E: Body dysmorphic disorder. Psychiatr Clin North Am 23:617–628, 2000
Allen A, Hadley SJ, Kaplan A, et al: An open-label trial of venlafaxine in body dysmorphic disorder. Abstracts of the Sixth International Obsessive Compulsive Disorder Conference, Lanzarote, Spain, November 2003
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision. Washington, DC, American Psychiatric Association, 2000
Brady KT, Austin L, Lydiard RB: Body dysmorphic disorder: the relationship to obsessive-compulsive disorder. J Nerv Ment Dis 178:538–540, 1990
Cotterill JA: Body dysmorphic disorder. Dermatol Clin 14:457–463, 1996
Cotterill JA, Cunliffe WJ: Suicide in dermatological patients. Br J Dermatol 137:246–250, 1997
Crerand C, Phillips KA, Menard W, et al: Nonpsychiatric medical treatment of body dysmorphic disorder. Psychosomatics 46:549–555, 2005
Cromarty P, Marks I: Does rational role-play enhance the outcome of exposure therapy in dysmorphophobia? A case study. Br J Psychiatry 167:399–402, 1995
Eisen JL, Phillips KA, Baer L, et al: The Brown Assessment of Beliefs Scale: reliability and validity. Am J Psychiatry 155:102–108, 1998
Fukuda O: Statistical analysis of dysmorphophobia in an outpatient clinic. Japan J Plast Reconstruct Surg 20:569–577, 1977
Gomez-Perez JC, Marks IM, Gutierrez-Fisac JL: Dysmorphophobia: clinical features and outcome with behavior therapy. Eur Psychiatry 9:229–235, 1994
Grant JE, Kim SW, Crow SJ: Prevalence and clinical features of body dysmorphic disorder in adolescent and adult psychiatric inpatients. J Clin Psychiatry 62:517–522, 2001
Hollander E, Liebowitz MR, Winchel R, et al: Treatment of body-dysmorphic disorder with serotonin reuptake blockers. Am J Psychiatry 146:768–770, 1989
Hollander E, Cohen L, Simeon D, et al: Fluvoxamine treatment of body dysmorphic disorder (letter). J Clin Psychopharmacol 14:75–77, 1994
Hollander E, Allen A, Kwon J, et al: Clomipramine vs desipramine crossover trial in body dysmorphic disorder: selective efficacy of a serotonin reuptake inhibitor in imagined ugliness. Arch Gen Psychiatry 56:1033–1039, 1999
Jain S, Grant JE, Menard W, et al: A chart-review study of SRI continuation treatment versus discontinuation in body dysmorphic disorder. Abstracts from the National Institute of Mental Health NCDEU 44th Annual Meeting, Phoenix, AZ, June 2004
Koblenzer CS: The dysmorphic syndrome. Arch Dermatol 121:780–784, 1985
Koblenzer CS: The broken mirror: dysmorphic syndrome in the dermatologist's practice. Fitzpatrick's Journal of Clinical Dermatology March/April:14–19, 1994
Ladee GA: Hypochondriacal Syndromes. Amsterdam, Holland, Elsevier, 1966
March JS, Frances A, Carpenter D, et al: The expert consensus guideline series: treatment of obsessive-compulsive disorder. J Clin Psychiatry 58:1–72, 1997
Marks I, Mishan J: Dysmorphophobic avoidance with disturbed bodily perception: a pilot study of exposure therapy. Br J Psychiatry 152:674–678, 1988
McDougle CJ, Goodman WK, Price LH, et al: Neuroleptic addition in fluvoxamine-refractory obsessive-compulsive disorder. Am J Psychiatry 147:652–654, 1990
McDougle CJ, Goodman WK, Leckman JF, et al: Haloperidol addition in fluvoxamine-refractory obsessive-compulsive disorder. Arch Gen Psychiatry 51:302–308, 1994
McKay D: Two-year follow-up of behavioral treatment and maintenance for body dysmorphic disorder. Behav Modif 23:620–629, 1999
Munro A, Chmara J: Monosymptomatic hypochondriacal psychosis: a diagnostic checklist based on 50 cases of the disorder. Can J Psychiatry 27:374–376, 1982
Newell R, Schrubb S: Attitude change and behaviour therapy in body dysmorphic disorder: two case reports. Behav Cog Psychother 22:163–169, 1994
Neziroglu F, Khemlani-Patel S: A review of cognitive and behavioral treatment for body dysmorphic disorder. CNS Spectr 7:464–471, 2002
Neziroglu FA, Yaryura-Tobias JA: Exposure, response prevention, and cognitive therapy in the treatment of body dysmorphic disorder. Behav Ther 24:431–438, 1993
Pallanti S, Koran LM: Intravenous, pulse-loaded clomipramine in body dysmorphic disorder: two case reports. CNS Spectr 1:54–57, 1996
Perugi G, Giannotti D, Di Vaio S, et al: Fluvoxamine in the treatment of body dysmorphic disorder (dysmorphophobia). Int Clin Psychopharmacol 11:247–254, 1996
Phillips KA: Body dysmorphic disorder, in Somatoform and Factitious Disorders (Review of Psychiatry Series, Vol 20, No 3; Oldham JM and Riba MB, series eds). Edited by Phillips KA. Washington, DC, American Psychiatric Publishing, 2001, pp 67–94
Phillips KA: Pharmacological treatment of body dysmorphic disorder: review of the evidence and a recommended treatment approach. CNS Spectr 7:453–460, 2002
Phillips KA: Psychosis in body dysmorphic disorder. J Psychiatr Res 38:63–72, 2004
Phillips KA: The Broken Mirror: Understanding and Treating Body Dysmorphic Disorder, Revised and Expanded Edition. New York, Oxford University Press, 2005a
Phillips KA: Olanzapine augmentation of fluoxetine in body dysmorphic disorder (letter). Am J Psychiatry 162:1022–1023, 2005b
Phillips KA: An open-label trial of escitalopram in body dysmorphic disorder. Int Clin Psychopharmacol 21:177–179, 2006
Phillips KA: Placebo-controlled study of pimozide augmentation of fluoxetine in body dysmorphic disorder. Am J Psychiatry 162:377–379, 2005d
Phillips KA, Najjar F: An open-label study of citalopram in body dysmorphic disorder. J Clin Psychiatry 64:715–720, 2003
Phillips KA, McElroy SL, Lion JR: Body dysmorphic disorder in cosmetic surgery patients (letter). Plas Reconstr Surg 90:333–334, 1992
Phillips KA, McElroy SL, Keck PE Jr, et al: Body dysmorphic disorder: 30 cases of imagined ugliness. Am J Psychiatry 150:302–308, 1993
Phillips KA, McElroy SL, Keck PE Jr, et al: A comparison of delusional and nondelusional body dysmorphic disorder in 100 cases. Psychopharmacol Bull 30:179–186, 1994
Phillips KA, Nierenberg AA, Brendel G, et al: Prevalence and clinical features of body dysmorphic disorder in atypical major depression. J Nerv Ment Dis 184:125–129, 1996
Phillips KA, Dwight MM, McElroy SL: Efficacy and safety of fluvoxamine in body dysmorphic disorder. J Clin Psychiatry 59:165–171, 1998
Phillips KA, Albertini RS, Siniscalchi JM, et al: Effectiveness of pharmacotherapy for body dysmorphic disorder: a chart-review study. J Clin Psychiatry 62:721–727, 2001a
Phillips KA, Grant JD, Siniscalchi J, et al: Surgical and nonpsychiatric medical treatment of patients with body dysmorphic disorder. Psychosomatics 42:504–510, 2001b
Phillips KA, McElroy SL, Dwight MM, et al: Delusionality and response to open-label fluvoxamine in body dysmorphic disorder. J Clin Psychiatry 62:87–91, 2001c
Phillips KA, Albertini RS, Rasmussen SA: A randomized placebo-controlled trial of fluoxetine in body dysmorphic disorder. Arch Gen Psychiatry 59:381–388, 2002
Phillips KA, Coles M, Menard W, et al: Suicidal ideation and suicide attempts in body dysmorphic disorder. J Clin Psychiatry 66:717–725, 2005a
Phillips KA, Menard W, Fay C, et al: Psychosocial functioning and quality of life in body dysmorphic disorder. Compr Psychiatry 45:438–444, 2005b
Phillips KA, Pagano ME, Menard W, et al: Predictors of remission from body dysmorphic disorder: a prospective study. J Nerv Ment Dis 193:564–567, 2005c
Phillips KA, Pagano ME, Menard W: Pharmacotherapy for body dysmorphic disorder: treatment received and illness severity. Ann Clin Psychiatry, in press
Riding J, Munro A: Pimozide in the treatment of monosymptomatic hypochondriacal psychosis. Acta Psychiatr Scand 52:23–30, 1975
Rosen JC, Reiter J, Orosan P: Cognitive-behavioral body image therapy for body dysmorphic disorder. J Consult Clin Psychol 63:263–269, 1995
Sarwer DB: Awareness and identification of body dysmorphic disorder by aesthetic surgeons: results of a survey of American Society for Aesthetic Plastic Surgery members. Aesthet Surg J 22:531–535, 2002
Schmidt NB, Harrington P: Cognitive-behavioral treatment of body dysmorphic disorder: a case report. J Behav Ther Exp Psychiatr 26:161–167, 1995
Sondheimer A: Clomipramine treatment of delusional disorder, somatic type. J Am Acad Child Adolesc Psychiatry 27:188–192, 1988
Veale D: Outcome of cosmetic surgery and "DIY" surgery in patients with body dysmorphic disorder. Psychiatr Bull 24:218–221, 2000
Veale D, Boocock A, Gournay K, et al: Body dysmorphic disorder: a survey of fifty cases. Br J Psychiatry 169:196–201, 1996a
Veale D, Gournay K, Dryden W, et al: Body dysmorphic disorder: a cognitive behavioural model and pilot randomized controlled trial. Behav Res Ther 34:717–729, 1996b
Wilhelm S: Cruel Reflections: Treatment of Body Dysmorphic Disorder With Cognitive-Behavioral Therapy. New York, Guilford, 2006
Wilhelm S, Otto MW, Lohr B, et al: Cognitive behavior group therapy for body dysmorphic disorder: a case series. Behav Res Ther 37:71–75, 1999
Zimmerman M, Mattia JI: Body dysmorphic disorder in psychiatric outpatients: recognition, prevalence, comorbidity, demographic, and clinical correlates. Compr Psychiatry 39:265–270, 1998
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