Hostname: page-component-78c5997874-v9fdk Total loading time: 0 Render date: 2024-11-09T13:40:00.841Z Has data issue: false hasContentIssue false
  • English
  • Français

Obsessive–compulsive disorder and body dysmorphic disorder: a comparison of clinical features

Published online by Cambridge University Press:  16 April 2020

Franco Frare ,
Giulio Perugi ,
Giuseppe Ruffolo  and
Cristina Toni
Franco Frare
Affiliation:
Adults Mental Health Unit, Pistoia Zone, ASL 3, Pistoia, Italy Institute of Behavioural Science “G. De Lisio”, Carrara-Pisa, Italy
Giulio Perugi*
Affiliation:
Department of Psychiatry, University of Pisa, Via Roma 67, 56100, Pisa, Italy Institute of Behavioural Science “G. De Lisio”, Carrara-Pisa, Italy
Giuseppe Ruffolo
Affiliation:
Department of Psychiatry, University of Pisa, Via Roma 67, 56100, Pisa, Italy
Cristina Toni
Affiliation:
Institute of Behavioural Science “G. De Lisio”, Carrara-Pisa, Italy
*
*Corresponding author. E-mail address: [email protected] (G. Perugi).
Get access

Abstract

Body dysmorphic disorder (BDD) is currently classified as a somatoform disorder in DSM-IV, but has been long noted to have some important similarities with obsessive—compulsive disorder (OCD). In addition, BDD and OCD have been often reported to be comorbid with each other. In the present study, we compared demographic characteristics, clinical features and psychiatric comorbidity in patients with OCD, BDD or comorbid BDD—OCD (34 subjects with BDD, 79 with OCD and 24 with BDD—OCD). We also compared the pattern of body dysmorphic concerns and associated behaviors in BDD patients with or without OCD comorbidity. In our sample, BDD and OCD groups showed similar sex ratio. Both groups with BDD and BDD—OCD were significantly younger, and experienced the onset of their disorder at a significantly younger age than subjects with OCD. The two BDD groups were also less likely to be married, and more likely to be unemployed and to have achieved lower level degree, than OCD subjects even when controlling for age. The three groups were significantly different in the presence of comorbid bulimia, alcohol-related and substance-use disorders, BDD—OCD patients showing the highest rate and OCD the lowest. BDD—OCD reported more comorbid bipolar II disorder and social phobia than in the other two groups, while generalized anxiety disorder was observed more frequently in OCD patients. Patients with BDD and BDD—OCD were similar as regards the presence of repetitive BDD-related behaviors, such as mirror-checking or camouflaging. Both groups also did show a similar pattern of distribution as regards the localization of the supposed physical defects in specific areas of the body. The only significant difference concerned the localization in the face, that was more frequent in the BDD group. Our results do not contradict the proposed possible conceptualization of BDD as an OCD spectrum disorder. However, BDD does not appear to be a simple clinical variant of OCD and it seems to be also related to social phobia, mood, eating and impulse control disorders. The co-presence of BDD and OCD features appears to possibly individuate a particularly severe form of the syndrome, with a greater load of psychopathology and functional impairment and a more frequent occurrence of other comorbid mental disorders.

Keywords

Obsessive—compulsive disorder (OCD)Body dysmorphic disorder (BDD)Comorbidity
Type
Original article
Information
European Psychiatry , Volume 19 , Issue 5 , August 2004 , pp. 292 - 298
Copyright
Copyright © 2004 European Psychiatric Association

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

Altamura, CPaluello, MMMundo, EMedda, SMannu, PClinical and subclinical body dysmorphic disorder. Eur Arch Psychiatry Clin Neurosci 2001;251(3):105–8.CrossRefGoogle ScholarPubMed
American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 3rd ed. revised. Washington (DC): APA; 1987.Google Scholar
Andreasen, NCEndicott, JESpitzer, RLWinokur, GThe family history method using diagnostic criteria. Reliability and validity. Arch Gen Psychiatry 1977;34:1229–35.CrossRefGoogle ScholarPubMed
Bienvenu, OJSamuels, JFRiddle, MAHoehn-Saric, RLiang, KYCullen, BAet al.The relationship of obsessive–compulsive disorder to possible spectrum disorders: results from a family study. Biol Psychiatry 2000;48:287–93.CrossRefGoogle ScholarPubMed
Brady, KTAustin, LLydiard, RBBody dysmorphic disorder: the relationship to obsessive–compulsive disorder. J Nerv Ment Dis 1990; 178:538–40.Google ScholarPubMed
Brawman-Minzer, OLydiard, RBPhillips, KAMorton, ACzepowicz, VEmmanuel, Net al.Body dysmorphic disorder in patients with anxiety disorders and major depression: a comorbidity study. Am J Psychiatry 1995;152:1665–7.Google Scholar
Hantouche, EGDemonfaucon, CAngst, JPerugi, GAllilaire, JFAkiskal, HSCyclothymic obsessive–compulsive disorder: clinical characteristics of a neglected and under-recognized entity. Presse Med 2002;31(14):644–8 [in French].Google ScholarPubMed
Hardy, GECotteril, JAA study of depression and obsessionality in dysmorphophobic and psoriatic patients. Br J Psychiatry 1982;140: 19–22.CrossRefGoogle ScholarPubMed
Hay, GGDysmorphophobia. Br J Psychiatry 1970;116:399–406.CrossRefGoogle ScholarPubMed
Hollander, EPhillips, KABody image and experience disorders: body dysmorphic and depersonalization disorders. In: Hollander, E editor. Obsessive–compulsive-related disorders. Washington (DC): American Psychiatric Press; 1992.Google Scholar
Hollander, ECohen, LJSimeon, DBody dysmorphic disorder. Psychiatry Ann 1993;23:359–64.CrossRefGoogle Scholar
Hollander, EAllen, AKwon, JAronowitz, BSchmeidler, JWong, Cet al.Clomipramine vs desipramine crossover trial in body dysmorphic disorder: selective efficacy of a serotonin reuptake inhibitor in imagined ugliness. Arch Gen Psychiatry 1999;56:1033–9.CrossRefGoogle ScholarPubMed
Hollander, ELiebowitz, MRWinchel, RKlumker, AKlein, DFTreatment of body dysmorphic disorder with serotonin reuptake blockers. Am J Psychiatry 1989;146:768–70.Google ScholarPubMed
Janet, PL'obsession de la houte du corps. Les Obsessions et la psycasthenie. Paris: Alcan; 1903. p. 33–50.Google Scholar
Kasahara, YSocial Phobia in Japan. Proceedings of The First Cultural Psychiatry Symposium between Japan and Korea. Social phobia in Japan and Korea. Seoul: East Asian Academy of Cultural Psychiatry; 1987.Google Scholar
Lensi, PCassano, GBCorreddu, GRavagli, SKunovac, JLAkiskal, HSObsessive–compulsive disorder. Familial-developmental history, symptomatology, comorbidity and course with special reference to gender-related differences. Br J Psychiatry 1996;169:101–7.CrossRefGoogle ScholarPubMed
Lepine, JPPelissolo, AComorbidity of social phobia: clinical and epidemiological issues. Int Clin Psychopharmacol 1996;11:35–41.CrossRefGoogle ScholarPubMed
Marks, IMishan, JDysmorphophobic avoidance with disturbed bodily perception. A pilot study of exposure therapy. Br J Psychiatry 1988;152:674–8.Google ScholarPubMed
McKay, DNeziroglu, FYaryura-Tobias, JAComparison of clinical characteristics in OCD and BDD. J Anxiety Disord 1997;11:447–54.CrossRefGoogle Scholar
McKay, DTwo-year follow-up of behavioral treatment and maintenance for body dysmorphic disorder. Behav Modif 1999;23:620–9.CrossRefGoogle ScholarPubMed
Morselli, ESulla dismorfofobia e sulla tafefobia. Boll Accad Sci Med 1886;6:100–19.Google Scholar
Neziroglu, FAYaryura-Tobias, JAExposure, response prevention, and cognitive therapy in the treatment of BBD. Behav Ther 1993;24: 431–8.CrossRefGoogle Scholar
Perugi, GGiannotti, DDi Vaio, SFrare, FSaettoni, MCassano, GBFluvoxamine in the treatment of body dysmorphic disorder (dysmorphophobia). Int Clin Psychopharmacol 1996;11:247–54.CrossRefGoogle Scholar
Perugi, GGiannotti, DDiVaio, SValori, EFrare, FCassano, GBet al.Prevalence, phenomenology and comorbidity of dysmorphophobia (body dysmorphic disorder) in a clinical population. Int J Psych Clin Pract 1997;1:77–82.CrossRefGoogle Scholar
Perugi, GAkiskal, HSGiannotti, DFrare, FDi Vaio, SCassano, GBGender-related differences in body dysmorphic disorder (dysmorphophobia). J Nerv Ment Disord 1997;85:578–82.CrossRefGoogle Scholar
Perugi, GAkiskal, HSPfanner, CPresta, SGemignani, AMilanfranchi, Aet al.Clinical impact of bipolar and unipolar affective comor-bidity on obsessive–compulsive disorder. J Affect Disord 1997;46: 15–23.CrossRefGoogle Scholar
Perugi, GAkiskal, HSGemignani, APfanner, CPresta, SMilanfranchi, Aet al.Episodic course in obsessive–compulsive disorder. Eur Arch Psychiatry Clin Neurosci 1998;248:240–4.CrossRefGoogle ScholarPubMed
Perugi, GFrare, FToni, CMata, BAkiskal, HSBipolar II and unipolar comorbidity in 153 outpatients with social phobia. Compr Psychiatry 2001;42(5):375–81.CrossRefGoogle ScholarPubMed
Perugi, GAkiskal, HSLattanzi, LCecconi, CMastrocinque, CPatronelli, Aet al. The high prevalence of “soft” bipolar (II) features in atypical depression. Compr Psychiatry 1998;39(2):63–71.CrossRefGoogle ScholarPubMed
Perugi, GFrare, FMadaro, DMaremmani, IAkiskal, HSAlcohol abuse in social phobic patients: is there a bipolar connection? J Affect Disord 2002;68:33–9.CrossRefGoogle Scholar
Phillips, KABody dysmorphic disorder: the distress of imagined ugliness. Am J Psychiatry 1991;148:1138–49.Google ScholarPubMed
Phillips, KAThe obsessive–compulsive spectrums. Psychiatr Clin N Am 2002;25:791–809.CrossRefGoogle ScholarPubMed
Phillips, KAMcElroy, SLKeck, PE JrHudson, JIPope, HG JrA comparison of delusional and nondelusional body dysmorphic disorder in 100 cases. Psychophar Bull 1994;30:179–86.Google ScholarPubMed
Phillips, KAMcElroy, SLHudson, JIPope, HG JrBody dysmorphic disorder: an obsessive–compulsive spectrum disorder, a form of affective spectrum disorder, or both? J Clin Psychiatry 1995;56:41–51.Google ScholarPubMed
Phillips, KAKim, JMHudson, JIBody image disturbance in body dysmorphic disorder and eating disorders: obsessions or delusions ? Psychiatr Clin N Am 1995;18:317–34.CrossRefGoogle ScholarPubMed
Phillips, KAGunderson, CGMallya, GMcElroy, SLCarter, WA comparison study of BDD and OCD. J Clin Psychiatry 1998;59:568–75.CrossRefGoogle Scholar
Phillips, KAMcElroy, SLPersonality disorders and traits in patients with body dysmorphic disorder. Compr Psychiatry 2000;41:229–36.CrossRefGoogle ScholarPubMed
Phillips, KAQuality of life for patients with body dysmorphic disorder. J Nerv Ment Dis 2000;188:170–5.CrossRefGoogle ScholarPubMed
Phillips, KADufresne, RGWilkel, CSVittorio, CCRate of body dysmorphic disorder in dermatology patients. J Am Acad Dermatol 2000;42:436–41.CrossRefGoogle ScholarPubMed
Phillips, KAMcElroy, SLDwight, MMEisen, JLRasmussen, SADelusionality and response to open-label fluvoxamine in body dys-morphic disorder. J Clin Psychiatry 2001;62:87–91.CrossRefGoogle Scholar
Simeon, DHollander, EStein, DJCohen, LAronowitz, Body dysmor-phic disorder in the DSM-IV field trial for obsessive–compulsive disorder. Am J Psychiatry 1995;152:1207–9.Google ScholarPubMed
Saxena, SWinograd, ADunkin, JJMaidment, KRosen, RVapnik, Tet al.A retrospective review of clinical characteristics and treatment response in BDD versus OCD. J Clin Psychiatry 2001;62: 67–72.CrossRefGoogle Scholar
Spitzer, RLWilliams, JBWGibbon, MFirst, MBStructured clinical interview for DSM III-R (SCID). Washington (DC): American Psychiatric Press; 1990.Google Scholar
Stekel, WCompulsion and doubt. New York: Liveright; 1949.Google Scholar
Toni, CPerugi, GFrare, FMata, BVitale, BMengali, Fet al.A prospective naturalistic study of 326 panic-agoraphobic patients treated with antidepressants. Pharmacopsychiatry 2000;33:121–31.CrossRefGoogle ScholarPubMed
Tynes, LLWhite, KSteketee, GSToward a new nosology of obsessive–compulsive disorder. Compr Psychiatry 1990;31:465–80.CrossRefGoogle Scholar
Veale, DRiley, SMirror, mirror on the wall, who is the ugliest of them all? The psychopathology of mirror gazing in body dysmorphic disorder. Behav Res Ther 2001;39(12):1381–93.CrossRefGoogle ScholarPubMed
Veale, DGournay, KDryden, WBoocock, AShah, FWillson, Ret al.Body dysmorphic disorder: a cognitive behavioural model and pilot randomised controlled trial. Behav Res Ther 1996;34(9):717–29.Google ScholarPubMed
Veale, DBoocock, AGournay, KDryden, WShah, FWillson, Ret al.Body dysmorphic disorder. A survey of fifty cases. Br J Psychiatry 1996;169(2):196–201.CrossRefGoogle ScholarPubMed
Wilhelm, SKeuthen, NJDeckersbach, TEngelhard, IMForker, AEBaer, Let al.Self-injurious skin picking: clinical characteristics and comorbidity. J Clin Psychiatry 1999;60:454–9.CrossRefGoogle ScholarPubMed
Submit a response

Comments

No Comments have been published for this article.