Delusional versus nondelusional body dysmorphic disorder: Clinical features and course of illness

DSM-IV’s classification of body dysmorphic disorder (BDD) is controversial. Whereas BDD is classified as a somatoform disorder, its delusional variant is classified as a psychotic disorder. However, the relationship between these BDD variants has received little investigation. In this study, we comp...

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Bibliographic Details
Published in:Journal of psychiatric research 2006-03, Vol.40 (2), p.95-104
Main Authors: Phillips, K.A., Menard, W., Pagano, M.E., Fay, C., Stout, R.L.
Format: Article
Language:English
Subjects:
Adolescent
Adult
Adult and adolescent clinical studies
Biological and medical sciences
Body dysmorphic disorder
Culture
Delusional disorder
Delusions - epidemiology
Depression - diagnosis
Depression - epidemiology
Depression - etiology
Diagnostic and Statistical Manual of Mental Disorders
Disease Progression
Dysmorphophobia
Female
Humans
Male
Medical sciences
Middle Aged
Prospective Studies
Psychology. Psychoanalysis. Psychiatry
Psychopathology. Psychiatry
Psychotic disorder
Severity of Illness Index
Somatoform disorder
Somatoform Disorders - diagnosis
Somatoform Disorders - epidemiology
Somatoform Disorders - psychology
Somatoform disorders. Psychosomatics
Surveys and Questionnaires
Citations: Items that cite this one
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Summary:DSM-IV’s classification of body dysmorphic disorder (BDD) is controversial. Whereas BDD is classified as a somatoform disorder, its delusional variant is classified as a psychotic disorder. However, the relationship between these BDD variants has received little investigation. In this study, we compared BDD’s delusional and nondelusional variants in 191 subjects using reliable and valid measures that assessed a variety of domains. Subjects with delusional BDD were similar to those with nondelusional BDD in terms of most variables, including most demographic features, BDD characteristics, most measures of functional impairment and quality of life, comorbidity, and family history. Delusional and nondelusional subjects also had a similar probability of remitting from BDD over 1 year of prospective follow-up. However, delusional subjects had significantly lower educational attainment, were more likely to have attempted suicide, had poorer social functioning on several measures, were more likely to have drug abuse or dependence, were less likely to currently be receiving mental health treatment, and had more severe BDD symptoms. However, when controlling for BDD symptom severity, the two groups differed only in terms of educational attainment. These findings indicate that BDD’s delusional and nondelusional forms have many more similarities than differences, although on several measures delusional subjects evidenced greater morbidity, which appeared accounted for by their more severe BDD symptoms. Thus, these findings offer some support for the hypothesis that these two BDD variants may constitute the same disorder. Additional studies are needed to examine this issue, which may have relevance for other disorders with both delusional and nondelusional variants in DSM.
ISSN:0022-3956
1879-1379
DOI:10.1016/j.jpsychires.2005.08.005