Body Dysmorphic Disorder Is Often Chronic and Undertreated

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BOCA RATON, FLA. -- Most patients with body dysmorphic disorder experience it as a chronic condition and are undertreated, but cause and effect remain unclear, according to the first prospective long-term study in this population.

Body dysmorphic disorder (BDD) is an impairing preoccupation with an imagined or slight defect in one's appearance. Poor functioning and a diminished quality of life are common, Katharine A. Phillips, M.D., said at a meeting of the New Clinical Drug Evaluation Unit sponsored by the National Institute of Mental Health.

Although "unusually distressing," BDD is difficult to study because patients are secretive about their disorder, Dr. Phillips said. "A high proportion of people do not tell their doctors they have BDD symptoms; they are too embarrassed or ashamed. Instead, they say they have anxiety or depression," added Dr. Phillips, professor of psychiatry and human behavior at Brown University, Providence, R.I., and author of "The Broken Mirror: Understanding and Treating Body Dysmorphic Disorder" (New York: Oxford University Press, 1986).

"Body dysmorphic disorder is a relatively common and serious disorder, but we really don't know how they do over time. We are finding that body dysmorphic disorder is an unusually chronic illness," Dr. Phillips explained in an interview at her poster presentation.

After doing a smaller, retrospective analysis at her own institution, Dr. Phillips and her associates recruited and prospectively studied 183 people who met DSM-IV criteria for BDD at base-line. Each week for 3 years, the researchers rated participants' symptoms and assessed the probability of remission. The National Institute of Mental Health sponsored the study.

Full remission was defined as 8 consecutive weeks with minimal or no BDD symptoms. …