Hostname: page-component-cd9895bd7-fscjk Total loading time: 0 Render date: 2024-12-26T14:17:43.520Z Has data issue: false hasContentIssue false

Obsessive-Compulsive Disorder, Body Dysmorphic Disorder, and Hypochondriasis: Three Variations on a Theme

Published online by Cambridge University Press:  07 November 2014

Abstract

Background:

Exaggerated illness and appearance concerns and related compulsive behaviors are seen in the psychiatric disorders of hypochondriasis (HYP), body dysmorphic disorder (BDD), and obsessive-compulsive disorder (OCD). It has been argued that these conditions may cluster in clinical samples and that our current categorical diagnostic policies, which assume independence of these disorders, are arbitrary and fail to capture the dimensional nature of these disorders.

Methods:

We present retrospective clinical data on 21 randomly selected patients who presented with symptoms that involved anxiety about illness and appearance and who were evaluated for cognitive-behavioral treatment or pharmacotherapy. We also review the symptoms, associated features, and response to treatment of three patients from the sample who were each diagnosed with all three of these disorders (HYP, BDD, and OCD).

Results:

Three patients met criteria for HYP, BDD, and OCD, and the other 18 patients met criteria for at least two of the above conditions. The most frequently reported source of anxiety had to do with one's hair. Nine out of the 12 patients treated with behavioral therapy were considered to be responders, and the one treated solely with medication was “very much improved.” Of the eight treated with a combination of behavioral therapy and medication, five were judged to be responders.

Conclusions:

Overlap in phenomenology, associated features, and treatment response suggests that these three disorders may be difficult to distinguish from each other and that a “cluster analysis” model may prove helpful in evaluating clinical samples.

Type
Feature Articles
Copyright
Copyright © Cambridge University Press 1996

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

1.Mayou, R. The nature of bodily symptoms. Br J Psychiatry. 1976;129:5560.Google Scholar
2.American Psychiatric Association. Diagnotic and Statistical Manual of Mental Disrders, 4th ed. Washington, DC: American Psychiatric Association, 1994.Google Scholar
3.Barsky, AJ, Wyshak, G, Merman, GL. Psychiatric co-morbidity in DSM-II1-R hypochondriasis. Arch Gen Psychiatry. 1992;49:101108.Google Scholar
4.Kellner, RJ, Wiggins, RG, Pathak, D. Somatic complaints and anxiety in hypochondriasis. Psychosomatics. 1989;30:5764.CrossRefGoogle Scholar
5.Ladee, GA. Hypochondriacal Syndromes. New York: Elsevier Press; 1966.Google Scholar
6.Phillips, K. BDD: The distress of imagined ugliness. Am J Psychiatry. 1991;148:11381149.Google ScholarPubMed
7.Hollander, E, Liebowitz, MR, Winchel, R, et al. , Treatment of body dysmorphic disorder with serotonin reuptake blockers. Am J Psychiatry. 1989;146:768790.Google Scholar
8.Hollander, E, Neville, D, Frenkel, M, et al. , Body dysmorphic disorder: diagnostic issues and related disorders. Psychosomatics. 1992;33:156165.CrossRefGoogle ScholarPubMed
9.Fallon, BA, Javitch, JA, Hollander, E. Hypochondriasis and obsessive-compulsive disorder: overlap in diagnosis and treatment. J Clin Psychiatry. 1992;52:457460.Google Scholar
10.Rasmussen, SA, Eisen, J. Clinical and epidemiological findings of significance to neuropharmacological trials in OCD. Psychopharmacologcal Bull. 1988;24:466470.Google Scholar
11.Foa, EB, Kozak, MJ. Diagnostic criteria for obsessive-compulsive disorder: DSM IV in progress. Hosp Community Psychiatry. 1991;42:679684.Google Scholar
12.Hollander, D. Serotonergic drugs and the treatment of disorders related to obsessive-compulsive disorder. In: Zohar, J, Pato, M, eds. Current Treatments of Obsessive-Compulsive Disorder. Washington DC: American Psychiatric Press; 1991.Google Scholar
13.Kellner, R, Fava, GA, Lisansky, J. Hypochondriacal fears and beliefs in DSM-III melancholia: changes with amitriptyline. J Affective Disord. 1992;10:2126.CrossRefGoogle Scholar
14.Stein, DJ, Hollander, E. Dermatology and conditions related to obsessive-compulsive disorder. J Am Acad Dermatol. 1992;26:237242.CrossRefGoogle ScholarPubMed
15.Insel, TR, Akiskal, HS. Obsessive compulsive disorder with psychotic features: phenomenologic analysis. Am J Psychiatry. 1986:143:15271533.Google ScholarPubMed
16.Josephson, S, Brondolo, E. Behavioral approaches to the treatment of OCD related disorders. In: Hollander, E, ed. OC Related Disorders. Washington, DC: American Psychiatric Press; 1993.Google Scholar
17.Kellner, R, Fava, GA, Lisansky, J. Hypochondrical fears and beliefs in DSM-III melancholia: changes with amitriptyline. J Affective Disord. 1992;10:2126.Google Scholar
18.Wesur, RB, Noyes, R. Imipramine: an effective treatment for illness phobia. J Affective Disord. 1991;22:4348.Google Scholar
19.Rasmussen, SA, Tsuang, MT. Clinical characteristics and family history in DSM-III obsessive-compulsive disorder. Am J Psychiatry. 1986;143:317322.Google ScholarPubMed
20.Kellner, R. Psychotherapeutic strategies in hypochondriasis: a clinical study. Am J Psychotherapy. 1982;36:146157.Google Scholar
21.Esman, AH. Psychoanalysis and general psychiatry: obsessive-compulsive disorder as paradigm. J Am Psychoanalytic Assoc. 1989:37:319336.CrossRefGoogle ScholarPubMed
22.Philips, KA, MC Elroy, SL, Koch, PE, Pope, HG, Hudson, JI. Body dysmorphic disorder: 30 cases of imagined ugliness. Am J Psychiatry. 1993;150:302308.Google Scholar