Body dysmorphic disorder in patients with obsessive-compulsive disorder: Prevalence and clinical correlates

Projeto Transtornos do Espectro Obsessivo-Compulsivo (PROTOC, Obsessive-Compulsive Spectrum Disorders Project), Department and Institute of Psychiatry, School of Medicine, Universidade de São Paulo (USP), São Paulo, Brazil.
Depression and Anxiety (Impact Factor: 4.41). 11/2012; 29(11). DOI: 10.1002/da.21980
Source: PubMed


The prevalence, sociodemographic aspects, and clinical features of body dysmorphic disorder (BDD) in patients with obsessive–compulsive disorder (OCD) have been previously addressed in primarily relatively small samples.
We performed a cross-sectional demographic and clinical assessment of 901 OCD patients participating in the Brazilian Research Consortium on Obsessive–Compulsive Spectrum Disorders. We used the Structured Clinical Interview for DSM-IV Axis I Disorders; Yale-Brown Obsessive–Compulsive Scale; Dimensional Yale-Brown Obsessive–Compulsive Scale (DY-BOCS); Brown Assessment of Beliefs Scale; Clinical Global Impression Scale; and Beck Depression and Anxiety Inventories.
The lifetime prevalence of BDD was 12.1%. The individuals with comorbid BDD (OCD-BDD; n = 109) were younger than were those without it. In addition, the proportions of single and unemployed patients were greater in the OCD-BDD group. This group of patients also showed higher rates of suicidal behaviors; mood, anxiety, and eating disorders; hypochondriasis; skin picking; Tourette syndrome; and symptoms of the sexual/religious, aggressive, and miscellaneous dimensions. Furthermore, OCD-BDD patients had an earlier onset of OC symptoms; greater severity of OCD, depression, and anxiety symptoms; and poorer insight. After logistic regression, the following features were associated with OCD-BDD: current age; age at OCD onset; severity of the miscellaneous DY-BOCS dimension; severity of depressive symptoms; and comorbid social phobia, dysthymia, anorexia nervosa, bulimia nervosa, and skin picking.
Because OCD patients might not inform clinicians about concerns regarding their appearance, it is essential to investigate symptoms of BDD, especially in young patients with early onset and comorbid social anxiety, chronic depression, skin picking, or eating disorders.

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    • "Like OCD, BDD is characterized by obsessions and repetitive behaviors (e.g., mirror checking, and excessive grooming) (Phillips et al., 1993, Phillips et al., 2010). In addition, BDD and OCD are often comorbid (Conceição Costa et al., 2012; Gunstad & Phillips, 2003). Several BDD–OCD comparison studies (n ¼139 and n ¼295) found more similarities than differences between these disorders; they did not significantly differ in terms of sex ratio; most other demographic, course, and impairment variables; illness severity; or lifetime frequency of most associated disorders in probands or first-degree relatives (Phillips, Gunderson, Mallya, McElroy, & Carter, 1998; Phillips et al., 2007). "
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    ABSTRACT: This is the first study to examine the genetic basis of body dysmorphic disorder (BDD), a common and impairing disorder. Evidence suggests that BDD may be related to obsessive-compulsive disorder (OCD); thus, polymorphisms in nine genes in the serotonin, dopamine, and gamma-aminobutyric acid (GABA) systems were examined, all of which have been implicated previously in OCD. Fifty subjects with DSM-IV BDD were individually matched for ethnicity and gender to 50 healthy controls. Preliminary association was demonstrated for the GABAA-γ2 gene (p=0.012), the A allele occurring more frequently in BDD subjects than in controls; however, it did not survive correction for multiple testing. A trend association was also suggested for serotonin transporter 5-HTTLPR (p=0.064) when considering all three genotypes, with the s/s genotype occurring more frequently in BDD subjects than in controls. This result became more significant when testing for association with the long allele (p=0.041) but did not survive correction for multiple testing. No association was demonstrated for the other examined genes. Genetic analysis of antidepressant response was negative. These results should be considered preliminary, because of the small sample size and limited power. Nonetheless, they provide preliminary support for the role of serotonin and GABA-ergic systems in BDD.
    Journal of Obsessive-Compulsive and Related Disorders 06/2015; 6. DOI:10.1016/j.jocrd.2015.06.004 · 1.18 Impact Factor
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    • "These disorders generally require long-term treatment and share serotonin reuptake inhibitors (SRI) and cognitive behavior therapy (CBT) as their first-line treatment options (Bandelow et al., 2012; Neziroglu and Khemlani-Patel, 2002; Phillips and Hollander, 2008). The combination of OCD and BDD (OCD-BDD) is associated with poorer insight of OCD symptoms (Costa et al., 2012; Eisen et al., 2004; Nakata et al., 2007; Phillips et al., 2012), higher frequency of suicidal behaviors (Costa et al., 2012; Phillips et al., 2007), higher prevalence of hoarding symptoms (Costa et al., 2012; Nakata et al., 2007) and a higher frequency of specific psychiatric comorbidities (Costa et al., 2012; Diniz et al., 2006; Frare et al., 2004; Nakata et al., 2007; Phillips et al., 1998; Veale et al., 1996) in comparison with OCD without comorbid BDD (OCDnon-BDD ). Most of these characteristics were associated with worse prognosis, in previous studies (Belotto-Silva et al., 2012; Catapano et al., 2010; Erzegovesi et al., 2001; Mataix-Cols et al., 1999; Kishore et al., 2004; Shetti et al., 2005); nevertheless, in the only study that systematically investigated the impact of BDD on OCD treatment response, there were similar response patterns observed in OCD patients with and without comorbid BDD (Stewart et al., 2008). "
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    ABSTRACT: Our aim was to investigate the impact of comorbid body dysmorphic disorder (BDD) on the response to sequential pharmacological trials in adult obsessive-compulsive disorder (OCD) patients. The sequential trial initially involved fluoxetine monotherapy followed by one of three randomized, add-on strategies: placebo, clomipramine or quetiapine. We included 138 patients in the initial phase of fluoxetine, up to 80 mg or the maximum tolerated dosage, for 12 weeks. We invited 70 non-responders to participate in the add-on trial; as 54 accepted, we allocated 18 to each treatment group and followed them for an additional 12 weeks. To evaluate the combined effects of sex, age, age at onset, initial severity, type of augmentation and BDD on the response to sequential treatments, we constructed a model using generalized estimating equations (GEE). Of the 39 patients who completed the study (OCD-BDD, n = 13; OCD-non-BDD, n = 26), the OCD-BDD patients were less likely to be classified as responders than the OCD-non-BDD patients (Pearson Chi-Square = 4.4; p = 0.036). In the GEE model, BDD was not significantly associated with a worse response to sequential treatments (z-robust = 1.77; p = 0.07). The predictive potential of BDD regarding sequential treatment strategies for OCD did not survive when the analyses were controlled for other clinical characteristics.
    Journal of Psychopharmacology 11/2013; 28(6). DOI:10.1177/0269881113512042 · 3.59 Impact Factor
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    ABSTRACT: Background: The aim of this study is to compare 3 groups of patients with body dysmorphic disorder (BDD), obsessive-compulsive disorder (OCD), and comorbid BDD and OCD with respect to clinical characteristics and to study their similarities and differences. Methods: Twenty-nine patients diagnosed with BDD, 20 diagnosed with comorbid BDD/OCD and 49 diagnosed with OCD were included in the study. Patients with BDD, comorbid BDD/OCD, and OCD were compared in terms of demographic and clinical variables and scores obtained from various scales. Results: Patients in the comorbid BDD/OCD and OCD groups tended to have higher anxiety scores than in BDD group. Any depressive disorder was more common in the comorbid BDD/OCD and OCD groups than in the BDD group. A significantly higher proportion of patients with BDD/OCD had any anxiety disorder than those with BDD. Subjects with BDD were significantly more likely than subjects with OCD to have narcissistic and avoidant personality disorders and any Axis II personality disorder. Finally, the rate of any cluster B personality disorder was higher in the BDD and BDD/OCD groups than in the OCD group. Conclusions: Despite the similarities between BDD and OCD, these disorders appear to have different aspects especially on psychiatric comorbidity.
    Annals of Clinical Psychiatry 08/2013; 25(3):210-6. · 2.36 Impact Factor
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