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Level of Insight and Clinical Features of Obsessive-Compulsive Disorder with and Without Body Dysmorphic Disorder

Published online by Cambridge University Press:  07 November 2014

Ana Cristina Gargano Nakata ,
Juliana B. Diniz ,
Albina R. Torres ,
Maria Alice de Mathis ,
Victor Fossaluza ,
Carlos Alberto Braganças ,
Ygor Ferrão  and
Euripedes C. Miguel
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Abstract

Introduction: Body dysmorphic disorder (BDD) and obsessive-compulsive disorder (OCD) have several similarities and are included among the obsessive-compulsive spectrum of disorders. However, the content of preoccupations and level of insight of BDD patients differ from OCD patients.

Objective: To compare the level of insight regarding obsessive-compulsive symptoms (OCS) and other clinical features in OCD patients with and without comorbid BDD.

Methods: We evaluated 103 OCD patients (n=25, comorbid BDD), according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria using the Structured Clinical Interview for DSM-IV, the Yale-Brown Obsessive-Compulsive Scale, the University of São Paulo Sensory Phenomena Scale, the Beck Depression and Anxiety Inventories, and the Brown Assessment of Beliefs Scale.

Results: The study groups differed significantly on several clinical features, including level of insight. A worse level of insight regarding OCS was independently associated with the presence of comorbid BDD. Lower educational level, more psychiatric comorbidities, presence of somatic and hoarding obsessions, and presence of intrusive images were associated with BDD comorbidity, even after adjusting for possible confounders.

Conclusion: The presence of BDD in OCD patients is associated with poorer insight into obsessional beliefs and higher morbidity, reflected by lower educational levels and higher number of psychiatric comorbid disorders in general.

Type
Original Research
Information
CNS Spectrums , Volume 12 , Issue 4 , April 2007 , pp. 295 - 303
Copyright
Copyright © Cambridge University Press 2007

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References

REFERENCES

1.Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington, DC: American Psychiatric Association; 1994.Google Scholar
2.Weissman, MM, Bland, RC, Canino, GJ, et al.The cross national epidemiology of obsessive compulsive disorder. The Cross National Collaborative Group. J Clin Psychiatry. 1994;55:5–10.Google ScholarPubMed
3.Torres, AR, Lima, MC. Epidemiology of obsessive-compulsive disorder: a review. Rev Bras Psiquiatr. 2005;27:237–242.CrossRefGoogle ScholarPubMed
4.Rasmussen, SA. Obsessive compulsive spectrum disorders. J Clin Psychiatry. 1994;55:89–91.Google ScholarPubMed
5.McElroy, SL, Phillips, KA, Keck, PE Jr. Obsessive compulsive spectrum disorder. J Clin Psychiatry. 1994;55(suppl):33–51; discussion 52-53.Google ScholarPubMed
6.Hollander, E, Wong, CM. Obsessive-compulsive spectrum disorders. J Clin Psychiatry. 1995;56(suppl 4):3–6.Google ScholarPubMed
7.Phillips, KA, McElroy, SL, Hudson, JI, Pope, HG Jr.Body dysmorphic disorder: an obsessive-compulsive spectrum disorder, a form of affective spectrum disorder, or both? J Clin Psychiatry. 1995;56(suppl 4):41–51.Google ScholarPubMed
8.Torres, AR, Ferrao, YA, Miguel, EC. Body dysmorphic disorder: an alternative expression of obsessive-compulsive disorder? Rev Bras Psiquiatr. 2005;27:95–96.CrossRefGoogle ScholarPubMed
9.Phillips, KA, McElroy, SL, Keck, PE Jr, et al.A comparison of delusional and nondelusional body dysmorphic disorder in 100 cases. Psycopharmacol Bull. 1994;30:179–186.Google ScholarPubMed
10.Phillips, KA. Body dysmorphic disorder: diagnosis and treatment of imagined ugliness. J Clin Psychiatry. 1996;57(suppl 8):61–64; discussion 65.Google ScholarPubMed
11.McElroy, SL, Phillips, KA, et al.Body dysmorphic disorder: does it have a psychotic subtype? J Clin Psychiatry. 1993;54:389–395.Google ScholarPubMed
12.Almeida, OP, Dratcu, L, Laranjeira, R. Manual de Psiquiatria [Portguese]. Rio de Janeiro, Brazil: Ed Guanabara/Koogan; 1996.Google Scholar
13.Stekel, W. In: Gutheil, EA, trans. Compulsion and Doubt [German]. New York, NY: Liveright; 1949.Google Scholar
14.Janet, P. Les obsessions et la psycasthenie [French]. Paris, France: Felix Alcan; 1903.Google Scholar
15.Hollander, E, Liebowitz, MR, Winchel, R, et al.Treatment of body-dysmorphic disorder with serotonin reuptake blockers. Am J Psychiatry. 1989; 46:768–770.Google Scholar
16.Phillips, KA, Dwight, MM, McElroy, SL, Phillips, KA, et al.Efficacy and safety of fluvoxamine in body dysmorphic disorder. J Clin Psychiatry. 1998;59:165–171.CrossRefGoogle ScholarPubMed
17.Gunstad, J, Phillips, KA. Axis I comorbidity in body dysmorphic disorder. Compr Psychiatry. 2003;44:270–276.CrossRefGoogle ScholarPubMed
18.Phillips, KA, Gunderson, CG, Mallya, G, et al.A comparison study of body dysmorphic disorder and obsessive-compulsive disorder. J Clin Psychiatry. 1998;59:568–575.CrossRefGoogle ScholarPubMed
19.Coffey, BJ, Miguel, EC, Biederman, J, et al.Tourette's disorder with and without obsessive-compulsive disorder in adults: are they different? J Nerv Ment Dis. 1998;186:201–206.CrossRefGoogle ScholarPubMed
20.Bienvenu, OJ, Samuels, J, Riddle, MA, et al.The relationship of obsessive- compulsive disorder to possible spectrum disorders: rsesults from a family study. Biol Psychiatry. 2000;48:287–293.CrossRefGoogle ScholarPubMed
21.Eisen, JL, Phillips, KA, Coles, ME, Rasmussen, SA. Insight in obsessive-compulsive disorder and body dysmorphic disorder. Compr Psychiatry. 2004;45:10–15.CrossRefGoogle ScholarPubMed
22.Marazziti, D, Giannotti, D, Catena, MC, Carlini, M, Dell'Osso, B, Presta, S, Pfanner, C, Mungai, F, Dell'Osso, L. Insight in body dysmorphic disorder with and without comorbid obsessive-compulsive disorder. CNS Spectr. 2006;11:494–498.CrossRefGoogle ScholarPubMed
23.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
24.Phillips, KA, Pinto, A, Menard, W, Eisen, JL, Mancebo, M, Rasmussen, SA. Obsessive-compulsive disorder versus body dysmorphic disorder: a comparison study of two possibly related disorders. Depress Anxiety. In press.Google Scholar
25.Leckman, JF, Sholomskas, D, Thompson, WD, Belanger, A, Weissman, MM. Best estimate of lifetime psychiatric diagnosis: a methodological study. Arch Gen Psychiatry. 1982;3:879–883.CrossRefGoogle Scholar
26.First, MB, Spitzer, RL, Gibbon, M, Williams, JBW. Structured clinical interview for DSM-IV axis I disorders-patient edition (SCID-I/P) (2nd version). New York, NY: New York State Psychiatric Institute, Biometrics Research Department; 1995.Google Scholar
27.First, MB, Pincus, HA, Levine, JB. Clinical utility as a criterion for revising psychiatric diagnoses. Am J Psychiatry. 2004;161:946–954.CrossRefGoogle ScholarPubMed
28.Orvaschel, H, Puig-Antich, J. Schedule for affective disorder and schizophrenia for school-age children-epidemiologic (4th version). Ft. Lauderdale, Fla: Nova University, Center for Psychological Study; 1987.Google Scholar
29.Goodman, WK, Price, LH, Rasmussen, SA, et al.The Yale-Brown Obsessive-Compulsive Scale: I. Development, use and reliability. Arch Gen Psychiatry. 1989;46:1006–1011.CrossRefGoogle ScholarPubMed
30.Goodman, WK, Price, LH, Rasmussen, SA, et al.The Yale-Brown Obsessive- Compulsive Scale: II. Validity. Arch Gen Psychiatry. 1989;46:1012–1016.CrossRefGoogle ScholarPubMed
31.Leckman, JF, Riddle, MA, Hardin, MT. The Yale global tic severity scale: initial testing of a clinician-rated scale of tic severity. J Am Acad Child Adolesc Psychiatry. 1989;28:566–573.CrossRefGoogle ScholarPubMed
32.Beck, AT, Ward, CH, Mendelson, M, Mock, J, Erbaugh, J. An inventory for measuring depression. Arch Gen Psychiatry 1961;4:561–571.CrossRefGoogle ScholarPubMed
33.Beck, AT, Epstein, N, Brown, G, Steer, RA. An inventory for measuring clinical anxiety: psychometric properties. J Consult Clin Psychol. 1988;56:893–897.CrossRefGoogle ScholarPubMed
34.Eisen, JL, Phillips, KA. The Brown Assessment of Beliefs Scale: reliability and validity. Am J Psychiatry. 1998;155:102–108.CrossRefGoogle ScholarPubMed
35.Miguel, EC, Coffey, BJ, Baer, L, Savage, CR, Rauch, SL, Jenike, MA. Phenomenology of intentional repetitive behaviors in obsessive-compulsive disorder and Tourette's disorder. J Clin Psychiatry. 1995;56:246–255.Google ScholarPubMed
36.Miguel, EC, Baer, L, Coffey, BJ, et al.Phenomenological differences appearing with repetitive behaviours in obsessive-compulsive disorder and Gilles de la Tourette's syndrome. Br J Psychiatry. 1997;170:140–145.CrossRefGoogle ScholarPubMed
37.Miguel, EC, Rosário-Campos, MC, Prado, HS, et al.Sensory phenomena in obsessive-compulsive disorder and Tourette's disorder. J Clin Psych. 2000;61:150–156.CrossRefGoogle ScholarPubMed
38.Leckman, JF, Walker, DE, Goodman, WK, Pauls, DL, Cohen, DJ. “Just right” perceptions associated with compulsive behavior in Tourette's syndrome. Am J Psych. 1994;151:675–680.Google ScholarPubMed
39.Frare, F, Perugi, G, Ruffolo, G, Toni, C. Obsessive-compulsive disorder and body dysmorphic disorder: a comparison of clinical features. Eur Psychiatry. 2004;19:292–298.CrossRefGoogle ScholarPubMed
40.Kleinknecht, RA, Dinnel, DL, Kleinknecht, EE, Hiruma, N, Harada, N. Cultural factors in social anxiety: a comparison of social phobia symptoms and Taijin kyofusho. J Anxiety Disord. 1997;11:157–177.CrossRefGoogle ScholarPubMed
41.Miguel, EC, Leckman, JF, Rauch, S, et al.Obsessive-compulsive disorder phenotypes: implications for genetic studies. Mol Psychiatry. 2005;10:258–275.CrossRefGoogle ScholarPubMed
42.De Mathis, MA, Diniz, JB, do Rosario, MC, et al.What is the optimal way to subdivide obsessive-compulsive disorder? CNS Spectr. 2006;11:762–779.CrossRefGoogle ScholarPubMed
43.Hasler, G, LaSalle-Ricci, VH, Ronquillo, JG, et al.Obsessive-compulsive disorder symptom dimensions show specific relationships to psychiatric comorbidity. Psychiatry Res. 2005;135:121–132.CrossRefGoogle ScholarPubMed
44.Diniz, JB, Rosario-Campos, MC, Shavitt, RG, et al.Impact of age at onset and duration of illness on the expression of comorbidities in obsessive-compulsive disorder. J Clin Psychiatry. 2004;65:22–27.CrossRefGoogle ScholarPubMed
45.Greenberg, D. Compulsive hoarding. Am J Psychother. 1987;41:409–416.CrossRefGoogle ScholarPubMed
46.Lochner, C, Hemmings, SM, Kinnear, CJ, et al.Cluster analysis of obsessive-compulsive spectrum disorders in patients with obsessive-compulsive disorder: clinical and genetic correlates. Compr Psychiatry. 2005;46:14–19.CrossRefGoogle ScholarPubMed
47.Hoehn-Saric, R, Barksdale, VC. Impulsiveness in obsessive-compulsive patients. Br J Psychiatry. 1983;143:177–182.CrossRefGoogle ScholarPubMed
48.Diniz, JB, Rosario-Campos, MC, Hounie, AG, et al.Chronic tics and Tourette syndrome in patients with obsessive-compulsive disorder. J Psychiatr Res. 2006;40:487–493.CrossRefGoogle ScholarPubMed