Hostname: page-component-cd9895bd7-gxg78 Total loading time: 0 Render date: 2024-12-25T02:04:18.108Z Has data issue: false hasContentIssue false
  • English
  • Français

Body dysmorphic disorder in patients with borderline personality disorder: prevalence, clinical characteristics, and role of childhood trauma

Published online by Cambridge University Press:  24 June 2014

Umit Semiz ,
Cengiz Basoglu ,
Mesut Cetin ,
Servet Ebrinc ,
Ozcan Uzun  and
Berk Ergun
Umit Semiz*
Affiliation:
GATA Haydarpasa Training Hospital, Psychiatry, Uskudar 34668, Istanbul, Turkey
Cengiz Basoglu
Affiliation:
GATA Haydarpasa Training Hospital, Psychiatry, Uskudar 34668, Istanbul, Turkey
Mesut Cetin
Affiliation:
GATA Haydarpasa Training Hospital, Psychiatry, Uskudar 34668, Istanbul, Turkey
Servet Ebrinc
Affiliation:
GATA Haydarpasa Training Hospital, Psychiatry, Uskudar 34668, Istanbul, Turkey
Ozcan Uzun
Affiliation:
GATA Haydarpasa Training Hospital, Psychiatry, Uskudar 34668, Istanbul, Turkey
Berk Ergun
Affiliation:
GATA Haydarpasa Training Hospital, Psychiatry, Uskudar 34668, Istanbul, Turkey
*
Dr Umit Semiz, GATA Haydarpasa Training Hospital, Psychiatry, Uskudar, 34668 Istanbul, Turkey. Tel: +90 216 5422020-3755; Fax: +90 216 3493517; E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

The prevalence of body dysmorphic disorder (BDD) in patients with borderline personality disorder (BPD) is unidentified. We hypothesised that BDD would be more common than realised in patients with BPD and comorbidity with BDD would result in a more severe clinical profile. Also, childhood trauma may play a predictive role in this association.

Methods:

The study included 70 BPD in-patients and 70 matched healthy controls. The subjects were evaluated with a comprehensive assessment battery using Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I), Structured Clinical Interview for DSM-III-R Personality Disorders (SCID-II) diagnostic tool for BDD, Global Assessment of Functioning, Traumatic Experiences Checklist and Hamilton Depression Rating Scale.

Results:

The prevalence of BDD was 54.3% in the borderline sample. The BPD patients with BDD had significantly lower overall functioning and higher levels of BPD pathology, childhood traumatic experiences, suicide attempts, substance abuse and self-mutilation than those without BDD. Traumatic experiences were significant predictor of comorbid BDD diagnosis in BPD patients.

Conclusions:

Our results suggest a relatively high prevalence of BDD among patients with BPD, and co-occurrence of BDD and BPD remains to be clarified. The additional diagnosis of BDD in patients with BPD may cause a more severe global illness, and these two disorders may share, at least partly, a common psychopathologic mechanism.

Keywords

anxietybody dysmorphic disorderborderline personality disorderchildhood traumaclinical trialscomorbiditypsychiatric disorders
Type
Research Article
Information
Acta Neuropsychiatrica , Volume 20 , Issue 1 , February 2008 , pp. 33 - 40
Copyright
Copyright © 2007 Blackwell Munksgaard

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th edn. Washington, DC: American Psychiatric Association, 1994. Google Scholar
Grant, JE, Kim, SW, Crow, SJ. Prevalence and clinical features of body dysmorphic disorder in adolescent and adult psychiatric inpatients. J Clin Psychiatry 2001;62:517–522. CrossRefGoogle ScholarPubMed
Phillips, KA, Nierenberg, AA, Brendel, G, Fava, M. Prevalence and clinical features of body dysmorphic disorder in atypical major depression. J Nerv Ment Dis 1996;184:125–129. Google ScholarPubMed
Phillips, KA. Body dysmorphic disorder: the distress of imagined ugliness. Am J Psychiatry 1991;148:1138–1149. Google ScholarPubMed
Neziroglu, F, Yaryura-Tobias, JA. A review of cognitive behavioural and pharmacological treatment of body dysmorphic disorder. Behav Modif 1997;21:324–340. CrossRefGoogle ScholarPubMed
Zimmerman, M, Mattia, JI. Body dysmorphic disorder in psychiatric outpatients: recognition, prevalence, comorbidity, demographic, and clinical correlates. Compr Psychiatry 1998;39:265–270. CrossRefGoogle ScholarPubMed
Perugi, G, Akiskal, HS, Giannotti, D, Frare, F, Di Vaio, S, Cassano, GB. Gender-related differences in body dysmorphic disorder (dysmorphophobia). J Nerv Ment Dis 1997;185:578–582. CrossRefGoogle ScholarPubMed
Brawman-Mintzer, O, Lydiard, RB, Phillips, KAet al. Body dysmorphic disorder in patients with anxiety disorders and major depression: a comorbidity study. Am J Psychiatry 1995;152:1665–1667. Google ScholarPubMed
Wilhelm, S, Otto, MW, Zucker, BG, Pollack, MH. Prevalence of body dysmorphic disorder in patients with anxiety disorders. J Anxiety Disord 1997;11:499–502. CrossRefGoogle ScholarPubMed
Nierenberg, AA, Phillips, KA, Petersen, TJet al. Body dysmorphic disorder in outpatients with major depression. J Affect Disord 2002;69:141–148. CrossRefGoogle ScholarPubMed
Simeon, D, Hollander, E, Stein, DJ, Cohen, L, Aronowitz, B. Body dysmorphic disorder in the DSM-IV field trial for obsessive-compulsive disorder. Am J Psychiatry 1995;152:1207–1209. Google ScholarPubMed
Ruffolo, JS, Phillips, KA, Menard, W, Fay, C, Weisberg, RB. Comorbidity of body dysmorphic disorder and eating disorders: severity of psychopathology and body image disturbance. Int J Eat Disord 2006;39:11–19. CrossRefGoogle ScholarPubMed
Phillips, KA, McElroy, SL. Personality disorders and traits in patients with body dysmorphic disorder. Compr Psychiatry 2000;41:229–236. CrossRefGoogle ScholarPubMed
Phillips, KA, McElroy, SL, Keck, PE Jr, Pope, HG Jr, Hudson, JI. Body dysmorphic disorder: 30 cases of imagined ugliness. Am J Psychiatry 1993;150:302–308. Google ScholarPubMed
Skodol, AE, Gunderson, JG, McGlashan, THet al. Functional impairment in patients with schizotypal, borderline, avoidant, or obsessive-compulsive personality disorder. Am J Psychiatry 2002;159:276–283. CrossRefGoogle ScholarPubMed
Phillips, KA, Coles, M, Menard, W, Yen, S, Fay, C, Weisberg, RB. Suicidal ideation and suicide attempts in body dysmorphic disorder. J Clin Psychiatry 2005;66:717–725. CrossRefGoogle ScholarPubMed
Work Group on Borderline Personality Disorder. Practice guideline for the treatment of patients with borderline personality disorder. Am J Psychiatry 2001;158 (Suppl.):1–52. Google Scholar
Phillips, KA. Body dysmorphic disorder: clinical aspects and treatment strategies. Bull Menninger Clin 1998;62 (Suppl. A):33–48. Google ScholarPubMed
Zanarini, MC, Frankenburg, FR, Hennen, J, Reich, DB, Silk, KR. Axis I comorbidity in patients with borderline personality disorder: 6-year follow-up and prediction of time to remission. Am J Psychiatry 2004;161:2108–2114. CrossRefGoogle ScholarPubMed
Neziroglu, F, McKay, D, Todaro, J, Yaryura-Tobias, JA. Effect of cognitive behaviour therapy on persons with body dysmorphic disorder and comorbid axis II diagnoses. Behav Ther 1996;27:67–77. CrossRefGoogle Scholar
Veale, D, Boocock, A, Gournay, Ket al. Body dysmorphic disorder. A survey of fifty cases. Br J Psychiatry 1996;169:196–201. CrossRefGoogle ScholarPubMed
Veale, D. Body dysmorphic disorder. Postgrad Med J 2004;80:67–71. CrossRefGoogle ScholarPubMed
Haaf, B, Pohl, U, Deusinger, IM, Bohus, M. Examination of body concept of female patients with borderline personality disorder. Psychother Psychosom Med Psychol 2001;51:246–254. CrossRefGoogle ScholarPubMed
van den Bosch, LM, Verheul, R, Langeland, W, van den Brink, W. Trauma, dissociation, and posttraumatic stress disorder in female borderline patients with and without substance abuse problems. Aust N Z J Psychiatry 2003;37:549–555. CrossRefGoogle ScholarPubMed
Fallon, P, Ackard, D. Sexual abuse and body image. In: Cash, TF, Pruzinsky, T, eds. Body image: a handbook of theory, research, & clinical practice. New York: Guilford Press, 2002:117–126. Google Scholar
Cororve, MB, Gleaves, DH. Body dysmorphic disorder: a review of conceptualizations, assessment, and treatment strategies. Clin Psychol Rev 2001;21:949–970. CrossRefGoogle ScholarPubMed
Coskunol, H, Bagdiken, I, Sorias, S, Saygili, R. The reliability and validity of the SCID-II Turkish version. Turk J Psychol 1994;9:26–29. Google Scholar
Spitzer, RL, Williams, JBW, Gibbon, M. Structured clinical interview for DSM-III-R personality disorders (SCID-II). New York: Biometrics Research, 1987. Google Scholar
Uzun, O, Basoglu, C, Akar, Aet al. Body dysmorphic disorder in patients with acne. Compr Psychiatry 2003;44:415–419. CrossRefGoogle ScholarPubMed
Corapcioglu, A, Aydemir, O, Yildiz, M, Esen, A, Koroglu, E. Structured clinical interview for DSM-IV (SCID), Turkish version. Ankara: Hekimler Yayin Birligi, 1999. Google Scholar
First, MB, Spitzer, RL, Williams, JBW. Structured clinical interview for DSM-IV (SCID). Washington, DC: American Psychiatric Association, 1997. Google Scholar
Nijenhuis, ERS, van der Hart, O, Kruger, K. The psychometric characteristics of the Traumatic Experiences Questionnaire (TEC): first findings among psychiatric outpatients. Clin Psychol Psychother 2002;9:200–210. CrossRefGoogle Scholar
Hamilton, M. A rating scale for depression. J Neurol Neurosurg Psychiatr 1960;23:56–62. CrossRefGoogle ScholarPubMed
Napoleon, A. The presentation of personalities in plastic surgery. Ann Plast Surg 1993;31:193–208. CrossRefGoogle ScholarPubMed
Groenman, NH, Sauer, HC. Personality characteristics of the cosmetic surgical insatiable patient. Psychother Psychosom 1983;40:241–245. CrossRefGoogle ScholarPubMed
Becker, DF, McGlashan, TH, Grilo, CM. Exploratory factor analysis of borderline personality disorder criteria in hospitalized adolescents. Compr Psychiatry 2006;47:99–105. CrossRefGoogle ScholarPubMed
Sansone, RA, Wiederman, MW, Monteith, D. Obesity, borderline personality symptomatology, and body image among women in a psychiatric outpatient setting. Int J Eat Disord 2001;29:76–79. 3.0.CO;2-O>CrossRefGoogle Scholar
Hollander, E, Cohen, LJ, Simoen, D. Body dysmorphic disorder. Psychiatr Ann 1993;23:359–364. CrossRefGoogle Scholar
American Psychiatric Association. Practice guideline for the treatment of patients with borderline personality disorder-introduction. Am J Psychiatry 2001;158:2. Google Scholar
Phillips, KA. The broken mirror: understanding and treating body dysmorphic disorder. New York: Oxford University Press, 1996. Google Scholar
Zanarini, MC, Frankenburg, FR, Dubo, EDet al. Axis I comorbidity of borderline personality disorder. Am J Psychiatry 1998;155:1733–1739. CrossRefGoogle ScholarPubMed
Zimmerman, M, Mattia, JI. Axis I diagnostic comorbidity and borderline personality disorder. Compr Psychiatry 1999;40:245–252. CrossRefGoogle ScholarPubMed
Herman, JL, Perry, JC, van der Kolk, BA. Childhood trauma in borderline personality disorder. Am J Psychiatry 1989;146:490–495. Google ScholarPubMed
Veale, D, Kinderman, P, Riley, S, Lambrou, C. Self-discrepancy in body dysmorphic disorder. Br J Clin Psychol 2003;42:157–169. CrossRefGoogle ScholarPubMed
Rinne, T, van den Brink, W, Wouters, L, van Dyck, R. SSRI treatment of borderline personality disorder: a randomized, placebo-controlled clinical trial for female patients with borderline personality disorder. Am J Psychiatry 2002;159:2048–2054. CrossRefGoogle ScholarPubMed
Phillips, KA, Dwight, MM, McElroy, SL. Efficacy and safety of fluvoxamine in body dysmorphic disorder. J Clin Psychiatry 1998;59:165–171. CrossRefGoogle ScholarPubMed
Didie, ER, Tortolani, CC, Pope, CG, Menard, W, Fay, C, Phillips, KA. Childhood abuse and neglect in body dysmorphic disorder. Child Abuse Negl 2006;30:1105–1115. CrossRefGoogle ScholarPubMed
Orbach, I, Stein, D, Shan-Sela, M, Har-Even, D. Body attitudes and body experiences in suicidal adolescents. Suicide Life Threat Behav 2001;31:237–249. CrossRefGoogle ScholarPubMed
Phillips, KA, Grant, J, Siniscalchi, J, Albertini, RS. Surgical and nonpsychiatric medical treatment of patients with body dysmorphic disorder. Psychosomatics 2001;42:504–510. CrossRefGoogle ScholarPubMed
Phillips, KA. The presentation of body dysmorphic disorder in medical settings. Prim Psychiatry 2006;13:51–59. Google ScholarPubMed