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Body dysmorphic disorder: An in-depth view
6 December 2010
There are many disorders that are becoming more and more prevalent in this day and age. In addition to this, these disorders defined by the DSM-IV are constantly being redefined and re-categorized. Among these is body dysmorphic disorder (BDD). This is a disorder, previously known as dysmorphophobia, is “defined as a preoccupation with an ‘‘imagined’’ defect in one’s appearance” (Veale, 2004). According to the DSM-IV it is a somatoform disorder and is marked by excessive occupation with one’s appearance, body image, and weight. In addition, to be diagnosed with this disorder one’s condition must have a severe effect on his social, occupational and even educational functioning in daily life. Furthermore, according to Veale, 2004, many subjects with the disorder are marked by having a “preoccupation is associated with many time consuming rituals such as mirror gazing or constant comparing”. From this information it opens the question to if is closely related to any other disorder and if so, in what way. Although there is limited information on what exactly the disorder entails, and new information is being discovered frequently, there have still been multiple studies that lead reason for some to speculate a close relationship with BDD and obsessive-compulsive disorder (OCD). There are many similarities between the two including symptoms and behaviors that those diagnosed with the disorders have in common. This is an in-depth look at various studies that have found similarities between the two and how treatments can be found that may be able to treat both disorders.
One review article done a few years ago by Hollander et al. helps identify the relationship between BDD and OCD. In this review it is mentioned that those with BDD often have persistent or repetitive thoughts about their perceived body images, similar to those diagnosed with OCD who have obsession that are defined as repetitive as well which could be one of the first steps in linking OCD patients to BDD patients. Below is a chart found in the Hollander et al. review and although these criterions are from the DSM-III R the chart still shows the similar characteristics of those with OCD and those with BDD.
BDD, OCD, and Genes
Following this review, one of the studies that helps further define the relationship between OCD and BDD is one that looks at family ties and how the prevalence of the disorders in one’s family may be linked to the relationship and comorbidity of the two disorders. Bienvenu et al. performed a family study for the Biological Psychiatry journal. The goal of the psychologists was to find possible relationships between OCD and somatoform disorders, such as body dysmorphia, eating disorders and etc. In the study, there was quite an extensive process that went into picking the experimental and control groups for this study. First there was a group of 99 randomly selected participants from 5 OCD treatment centers in the Boston area. Interviews were then conducted for 80 case probands or patients who are the first in their families to be diagnosed with a condition, or disorder, and a group of 343 of the first-degree relatives of the 80 probands. From this point, a set control probands were found over the phone by a researcher to match the case probands. Finally, the ending results landed the psychologists with 80 case probands and 73 control probands as well as 343 case first-degree relatives and 300 control first-degree relatives. After obtaining all of the participants in the study, the majority of the research and study was conducted through in-depth interviews. The study, which proves to be a very valid source in the quest of defining the relationship of OCD and BDD, used various diagnostic instruments to explore the relationships of the disorders. These diagnostic instruments used by Bienvenu et al. included the Schedule for Affective Disorders and Schizophrenia—Lifetime Anxiety version, adapted from another study conducted in 1989; the Yale–Brown Obsessive Compulsive Scale, and other such scales to measure the degree which the subjects did or did not have a disorder. The results yielded many different findings. Among these was the result that the trace of BDD, hypochondriasis, skin-picking or other disorders were more prevalent in case probands with OCD. Also, the majority of these spectrum disorders were more common in the case relatives than the control relatives. The researchers concluded that somatoform disorders, especially body dysmorphia, as well as pathologic grooming behaviors, which can be symptoms of BDD, are more prevalent in patients with OCD than any other disorders. Furthermore, these disorders are more likely to be “passed down” between family members. Overall, the study was very organized and yielded informative results as a whole however, there is still more research to be done on the subject. The main goal was to identify if there are relationships between OCD and BDD however the control and case study groups may have needed to be more even and possibly slightly smaller. In addition, it is hard to find that all the results have little error due to the fact that so many different types of disorders were being measured. If the researchers were to simply hone in on a few disorders in relation to OCD maybe more clear results could have been noticed. As stated before there is still much more that can be found of the familial relationships between OCD and BDD patients however this study did show that BDD is probably the most common disorder that can stem from or be derived from OCD and vice versa. In order to further asses this conclusion, a few more studies can be looked at.
When completing research, two more studies were found in which scientists compared and contrasted obsessive-compulsive disorder and body dysmorphic disorder. The first was performed by researchers for the European Psychiatry scholarly journal. The goal of their study was to compare the clinical features, characteristics, and behaviors of those with BDD, OCD, or both. Frare, Perugi, Ruffolo, and Toni (2004) took 137 patients from the Institute of Psychiatry of the University of Pisa and compared their conditions to a diagnosis of body dysmorphia, a diagnosis of obsessive-compulsive disorder, and a diagnosis of the comorbidity of the two. The researchers then collected information about the characteristics of their conditions through interviews using sections of the DSM-III-R criteria for the conditions. As a side note, the interviews were conducted by psychiatrists, all with 4 years of experience in mood and anxiety disorders. Family histories of anxiety and personal histories were explored as well. Resulting from this study, the researchers found that there were many similarities between the subjects. To abbreviate, the patients measured with just body dysmorphia are BDD, those with just obsessive-compulsive disorder are OCD, and those with both are BDD-OCD. Frare et al. (2004) found that the BDD and BDD-OCD subjects had similar sex ratios. Additionally, the BDD and BDD-OCD subjects were “similar as regards the presence of mirror-checking or camouflaging” (p.295). Also, in conclusion, the researchers found that “OCD and BDD might frequently coexist in clinical samples and have several similarities” and they concluded that “results do not contradict the often-proposed conceptualization of BDD as an OCD spectrum disorder”(p. 296-297). I feel that this study was very thorough and the hypothesis was thorough and the tests of the study were valid, however I do feel that maybe a little more research could have been done in order to be certain of the results. Although maybe this could be to lack of information about BDD but there seemed to be uncertainty in the researchers’ conclusions from the study. Perhaps more information was needed.
In one final study, the similarities and differences between OCD and BDD were researched. At Brown Medical School in Rhode Island, researchers Eisen, Phillips, Coles, and Rasmussen (2004) looked at different insights of subjects with OCD and BDD, instead of clinical presentation, comorbidity rates, and treatment response as has been done in previous studies. They hypothesized that “we hypothesized that BDD subjects would have poorer global insight than OCD subjects and that a higher percentage of BDD subjects would be classified as delusional” (p. 11).The researchers took 64 subjects with OCD according to the DSM-III R and DSM-IV and 85 subjects with BDD according to the same criterion and an important note is that patients were not excluded if they were delusional as well. The subjects’ insight was assessed using a BABS test. This type of test, according to Eisen et al. (2004) is where “seven-item clinician-administered scale designed to assess degree of insight (delusionality) during the past week in a variety of psychiatric disorders” (p. 11). These seven items include, conviction, perception of how others are viewed, explanation of differing views, fixity, attempt to disprove beliefs, insight, and finally referential thinking. Using the BABS test, the researchers found that both disorders yielded the same results in symptom severity however, as hypothesized, the BDD subjects had higher BABS scores, or in other words, lower insight. From these results, one can conclude that BDD subjects as a whole may be slightly more delusional, or have more delusions than those with OCD. This means that, although the two disorders may be related, BDD may involve more complexities of the mind than OCD, however further researcher may be needed before coming to this conclusion. I feel that from this study, one can benefit from the information that is provided. The use of the BABS test and the different approach that the researchers used gives new dimension to the concept of BDD and OCD being related.
From the studies that were looked at it is clear that there may very well be a close correlation between BDD patients and OCD patients. It is also evident that there are some key differences between the disorders including how the mind functions in one with the disorders. There have been many proposals that say that both disorders can be treated similarly and this may be possible but once again more information is needed. In conclusion, yes, the two disorders are related in some way, that is true, however, to what degree and in what ways they are related is still being debated. Furthermore, the need for more information and studies is necessary for any scientist or researcher to proceed and succeed in finding possible treatments. If the disorders are more closely related than what is known now, perhaps from this one can discover what more can be done to treat both BDD and OCD.
Bienvenu, O.J., Samuels, F.J., Riddle, M.A., Hoehn-Saric, R., & Liang, K., Cullen B.A.M., Grados, A.M., Nestadt, G. (2000). The relationship of obsessive–compulsive disorder to possible spectrum disorders: results from a family study. Biological Psychiatry, 45(4), 287-293.
Eisen, J.L., Phillips, K.A., Coles, M.E., & Rasmussen, S.A. (2004). Insight in obsessive compulsive disorder and body dysmorphic disorder. Comprehensive Psychiatry, 45(1), 10-15.
Frare, F., Perugi, G., Ruffolo, G., & Toni, C. (2004). Obsessive-compulsive disorder and body dysmorphic disorder: a comparison of clinical features. European Psychiatry, 19(5), 292-298.
Hollander, E, Neville, D, Frenkel, M, Josehpson, S, & Liebowitz, MR. (1992). Body dysmorphic disorder. diagnostic issues and related disorders. Psychosomatics, 33, 156-165.
Veale, D. (2004). Body dysmorphic disorder. Post Graduate Medical Journal, 80(940), doi: 10.1136
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