Body Dysmorphic Disorder Triggered by Medical Illness?

To the Editor: Little is known about the causes and pathophysiology of body dysmorphic disorder. We report two cases of body dysmorphic disorder that followed a medical illness and suggest that the latter might play an active role as a trigger in the pathogenesis of the disorder.

These cases suggest that a range of physical illnesses may act as a stimulus for the development and/or exacerbation of body dysmorphic disorder. To our knowledge, there is no literature connecting body dysmorphic disorder to a medical condition. However, there is a recent report (1) describing a similar link between a medical illness (malignancies) and obsessive-compulsive disorder (OCD). The latter has many features similar to body dysmorphic disorder, such as obsessive thoughts and repetitive behavior. Moreover, both disorders appear to preferentially respond to selective serotonin reuptake inhibitors, which suggests a common serotonin dysfunction (2). This neurochemical dysfunction might have been triggered by the inflammatory process in our patients. One possible pathophysiological mechanism for a biochemical link between these medical illnesses and the onset of body dysmorphic disorder or OCD may be through cytokines, which have been shown to be activated in inflammatory diseases and cancer and have been suggested to suppress serotonin synthesis (3). This report raises an interesting question about biological factors in the onset of body dysmorphic disorder. Further investigation to illuminate these factors is suggested.