Body Dysmorphic Disorder: Clinical Aspects and Relationship to Obsessive-Compulsive Disorder

Abstract

Body dysmorphic disorder (BDD) is an obsessive-compulsive and related disorder that is common and usually causes substantial distress and impairment in psychosocial functioning. BDD is associated with markedly poor quality of life and high rates of suicidal ideation and behavior. The first-line pharmacologic approach is a serotonin reuptake inhibitor, often at relatively high doses; serotonin reuptake inhibitors are also recommended for patients with delusional BDD beliefs. The firstline psychosocial treatment is manualized cognitive-behavioral therapy that is tailored to BDD's unique clinical features; it is not recommended that therapists simply apply cognitive-behavioral approaches for other disorders, such as obsessivecompulsive disorder (OCD). Because insight is so often absent or poor in BDD, motivational interviewing techniques are often needed to engage and retain patients in treatment. Cosmetic treatment (e.g., surgery or dermatologic treatment) is not recommended because it appears to only rarely improve BDD symptoms and can even make them worse. BDD has many similarities to OCD and is probably closely related to OCD, but the two disorders also have some important differences. From a clinical perspective, the most important differences are that BDD is characterized by poorer insight, more frequent comorbid major depressive disorder and substance use disorders, and more frequent suicidality. Although treatment approaches have similarities to those for OCD, effective cognitive-behavioral therapy for BDD meaningfully differs from that for OCD.

Prevalence of Body Dysmorphic Disorder among patients seeking orthodontic treatment

“…In our study, BDD-positive patients were concerned about very mild rotations, spacing, midline discrepancy, and tooth size discrepancies which did not require orthodontic treatment. The age group of our patients included in the study was over 18 years since symptoms of BDD usually begin during adolescence [20]. In our study, BDD patients were younger than non-BDD patients, but it was not statistically significant.…”

DSM-5 Obsessive-Compulsive and Related Disorders: Clinical Implications of New Criteria

“…[37] To highlight this relationship, a new Criterion B was added to BDD describing "repetitive behaviors or mental acts in response to preoccupations with perceived defects or flaws in physical appearance." [43] Previously under DSM-IV, BDD individuals with delusional beliefs would have been classified as "delusional disorder, somatic type," in addition to BDD, accounting for approximately 36-39% of individuals with BDD. [41] A notable change in BDD diagnostic criteria is a "with muscle dysmorphia" specifier describing a BDD patient belief that the patients have a small or insufficiently muscular build.…”

“…[40,42] Moreover, BDD patients have been found to have an increased likelihood of being diagnosed with a psychotic disorder due to BDD or OCD-related delusional beliefs. [43] Previously under DSM-IV, BDD individuals with delusional beliefs would have been classified as "delusional disorder, somatic type," in addition to BDD, accounting for approximately 36-39% of individuals with BDD. [41] Interestingly, when the delusional and nondelusional forms of the disorder are compared across a range of domains, more similarities than differences emerge.…”

Body Dysmorphic Disorder in Orthodontic Patients

“…BDD is often present with depressive disorders, social phobias and obsessivecompulsive disorders. [13][14][15][16]…”