Comorbidity of body dysmorphic disorder and eating disorders: severity of psychopathology and body image disturbance.

OBJECTIVE The current study examined comorbidity and clinical correlates of eating disorders in a large sample of individuals with body dysmorphic disorder (BDD). METHOD Two hundred individuals with DSM-IV (4th ed. of the Diagnostic and Statistical Manual of Mental Disorders. Washington, DC: American Psychiatric Association; 1994) BDD completed reliable interviewer-administered and self-report measures, including diagnostic assessments and measures of body image, symptom severity, delusionality, psychosocial functioning, quality of life (QOL), and history of psychiatric treatment. RESULTS A total of 32.5% of BDD subjects had a comorbid lifetime eating disorder: 9.0% had anorexia nervosa, 6.5% had bulimia nervosa, and 17.5% had an eating disorder not otherwise specified. Comparisons of subjects with a comorbid lifetime eating disorder (n = 65) and subjects without an eating disorder (n = 135) indicated that the comorbid group was more likely to be female, less likely to be African American, had more comorbidity, and had significantly greater body image disturbance and dissatisfaction. There were no significant group differences in BDD symptom severity, degree of delusionality, or suicidal ideation or attempts. Functioning and QOL were notably poor in both groups, with no significant between-group differences. However, a higher proportion of the comorbid eating disorder group had been hospitalized for psychiatric problems. This group had also received a greater number of psychotherapy sessions and psychotropic medications. CONCLUSION Eating disorders appear relatively common in individuals with BDD. BDD subjects with a comorbid eating disorder differed on several demographic variables, had greater comorbidity and body image disturbance, and had received more mental health treatment than subjects without a comorbid eating disorder. These findings have important implications for the assessment and treatment of these comorbid body image disorders.

[1]  K. Lynch,et al.  Inter-rater reliability of the SCID alcohol and substance use disorders section among adolescents. , 2000, Drug and alcohol dependence.

[2]  Suck-Won Kim,et al.  Body dysmorphic disorder in patients with anorexia nervosa: prevalence, clinical features, and delusionality of body image. , 2002, The International journal of eating disorders.

[3]  E. Hollander,et al.  A severity rating scale for body dysmorphic disorder: development, reliability, and validity of a modified version of the Yale-Brown Obsessive Compulsive Scale. , 1997, Psychopharmacology bulletin.

[4]  J. Rosen,et al.  A comparison of eating disorders and body dysmorphic disorder on body image and psychological adjustment. , 1998, Journal of psychosomatic research.

[5]  Y. Lecrubier.  The influence of comorbidity on the prevalence of suicidal behaviour , 2000, European Psychiatry.

[6]  K. Phillips,et al.  The Brown Assessment of Beliefs Scale: reliability and validity. , 1998, The American journal of psychiatry.

[7]  R. Judge,et al.  Patient perspectives on once-weekly fluoxetine. , 2001, The Journal of clinical psychiatry.

[8]  P. Santonastaso,et al.  A case of dysmorphophobia following recovery from anorexia nervosa , 1989 .

[9]  J. Rosen,et al.  Development of the body dysmorphic disorder examination. , 1996, Behaviour research and therapy.

[10]  C. Mazure,et al.  The Yale-Brown-Cornell Eating Disorder Scale: development, use, reliability and validity. , 1994, Journal of psychiatric research.

[11]  Christopher S. Thomas.  Anorexia nervosa and dysmorphophobia. , 1987, The British journal of psychiatry : the journal of mental science.

[12]  T N Robinson,et al.  Pursuit of thinness and onset of eating disorder symptoms in a community sample of adolescent girls: a three-year prospective analysis. , 1994, The International journal of eating disorders.

[13]  M. Weissman,et al.  SOCIAL ADJUSTMENT BY SELF‐REPORT IN A COMMUNITY SAMPLE AND IN PSYCHIATRIC OUTPATIENTS , 1978, The Journal of nervous and mental disease.

[14]  K. Phillips,et al.  Axis I comorbidity in body dysmorphic disorder. , 2003, Comprehensive psychiatry.

[15]  E. Struening,et al.  Obsessive-compulsive disorder and comorbid anxiety problems in a national anxiety screening sample. , 2000, Journal of anxiety disorders.

[16]  K. Phillips,et al.  A comparison study of body dysmorphic disorder and obsessive-compulsive disorder. , 1998, The Journal of clinical psychiatry.

[17]  Nonweight-related body image concerns among female eating-disordered patients and nonclinical controls: some preliminary observations. , 2000, The International journal of eating disorders.

[18]  P. Keck,et al.  Topiramate in the treatment of binge eating disorder associated with obesity: a randomized, placebo-controlled trial. , 2003, The American journal of psychiatry.

[19]  E. Hollander,et al.  Obsessive compulsive spectrum disorders. , 1994, The Journal of clinical psychiatry.

[20]  K. Phillips.  The broken mirror : understanding and treating body dysmorphic disorder , 1996 .

[21]  S. Strakowski,et al.  Phenomenology of adolescent and adult mania in hospitalized patients with bipolar disorder. , 1997, The American journal of psychiatry.

[22]  H. Kraemer,et al.  Eating disorders in white and black women. , 2003, The American journal of psychiatry.

[23]  K. Hawton,et al.  Deliberate self-harm patients with alcohol disorders: characteristics, treatment, and outcome. , 2001, Crisis.

[24]  J. Endicott,et al.  Quality of Life Enjoyment and Satisfaction Questionnaire: a new measure. , 1993, Psychopharmacology bulletin.

[25]  J. Endicott,et al.  Quality-of-life impairment in depressive and anxiety disorders. , 2005, The American journal of psychiatry.

[26]  K. Gournay,et al.  Body Dysmorphic Disorder , 1996, British Journal of Psychiatry.

[27]  D. Gleaves,et al.  Body dysmorphic disorder: a review of conceptualizations, assessment, and treatment strategies. , 2001, Clinical psychology review.

[28]  J. Rosen,et al.  Assessment of body image in eating disorders with the body dysmorphic disorder examination. , 1995, Behaviour research and therapy.

[29]  J. Endicott,et al.  The Range of Impaired Functioning Tool (LIFE–RIFT): a brief measure of functional impairment , 1999, Psychological Medicine.

[30]  J. Jolanta,et al.  The links between body dysmorphic disorder and eating disorders , 2000 .

[31]  H. Akiskal,et al.  Gender-related differences in body dysmorphic disorder (dysmorphophobia). , 1997, The Journal of nervous and mental disease.

[32]  K. Phillips,et al.  Body image disturbance in body dysmorphic disorder and eating disorders. Obsessions or delusions? , 1995, The Psychiatric clinics of North America.

[33]  M. Fava,et al.  Body dysmorphic disorder in outpatients with major depression. , 2002, Journal of affective disorders.

[34]  Is Anorexia Nervosa a Subtype of Body Dysmorphic Disorder? Probably Not, but Read On… , 2004, Harvard review of psychiatry.

[35]  R. Bland,et al.  Psychiatric Comorbidity and Treatment Seeking: Sources of Selection Bias in the Study of Clinical Populations , 1993, The Journal of nervous and mental disease.

[36]  K. Phillips,et al.  Body dysmorphic disorder: an obsessive-compulsive spectrum disorder, a form of affective spectrum disorder, or both? , 1995, The Journal of clinical psychiatry.

[37]  D. Stein,et al.  Consensus statement on generalized anxiety disorder from the International Consensus Group on Depression and Anxiety. , 2001, The Journal of clinical psychiatry.

[38]  M. Otto,et al.  Prevalence of body dysmorphic disorder in a community sample of women. , 2001, The American journal of psychiatry.

[39]  K. Phillips.  Quality of life for patients with body dysmorphic disorder. , 2000, The Journal of nervous and mental disease.

[40]  M. Liebowitz,et al.  Disability and quality of life in pure and comorbid social phobia. Findings from a controlled study , 1999, European Psychiatry.

[41]  K. Phillips,et al.  Perceived stress in body dysmorphic disorder. , 1998, The Journal of nervous and mental disease.

[42]  M. Zimmerman,et al.  Body dysmorphic disorder in psychiatric outpatients: recognition, prevalence, comorbidity, demographic, and clinical correlates. , 1998, Comprehensive psychiatry.

[43]  McKnight Investigators.  Risk factors for the onset of eating disorders in adolescent girls: results of the McKnight longitudinal risk factor study. , 2003, The American journal of psychiatry.

[44]  K. Phillips,et al.  Gender differences in body dysmorphic disorder. , 1997, The Journal of nervous and mental disease.

[45]  K. Phillips,et al.  Body dysmorphic disorder: 30 cases of imagined ugliness. , 1993, The American journal of psychiatry.

[46]  A. Nierenberg,et al.  Prevalence and clinical features of body dysmorphic disorder in atypical major depression. , 1996, The Journal of nervous and mental disease.

[47]  R. Hoehn-Saric,et al.  The relationship of obsessive–compulsive disorder to possible spectrum disorders: results from a family study , 2000, Biological Psychiatry.