more likely to affect friendships and dating than
work, school, or other activities. However, other
have reported that impaired social,
familial and occupational functioning is nearly uni-
versal in patients with BDD. As noted, we cannot be
certain how truthful or accurate our respondents
were in acknowledging dysfunction. The high fre-
quency of preoccupation with and worry about
appearance reported by our respondents with BDD
confirms the importance of the DSM-IV decision to
add criteria of distress and/or dysfunction in defin-
ing BDD as a disorder requiring treatment.
If, as our results suggest, BDD has a nation-
wide prevalence of one (interference with func-
tioning) or two (substantial distress) in 10 0
adults, then, given the associated suffering,
impaired functioning and high rate of attempted
suicide, increased efforts to educate the public
and professionals about the disorder, identify
cases early, facilitate access to care and develop
more effective treatments would be desirable.
Future studies to define nationwide prevalence
should utilize a clinically validated, structured
interview instrument, preferably administered
in person by mental health professionals. Such
studies could inform future treatment studies by
carefully documenting BDD onset and course,
the degree to which and ways in which function-
ing has been impaired, rates of seeking treat-
ment from various sources, suicide attempt
rates, and the lifetime and point prevalence of
comorbid conditions. CNS
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CNS Spectr 13:4 © MBL Communications April 2008