Body Dysmorphic Disorder Underdiagnosed

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NEW ORLEANS -- Body dysmorphic disorder appears to be frequently comorbid with other psychiatric disorders but is regularly undiagnosed, Dr. Jon E. Grant said at the annual meeting of the American Psychiatric Association.

In one series of patients hospitalized for diverse psychiatric conditions, 13% met criteria for body dysmorphic disorder (BDD). None had been diagnosed as such by their treating physicians, either at admission or during the hospital stay, said Dr. Grant of the University of Minnesota, Minneapolis.

Body dysmorphic disorder--a distressing and impairing preoccupation with slight or imagined defects in appearance--is associated with substantial social, occupational, and academic deficits, as well as high rates of suicidality. Shame and humiliation often lead those with the disorder to keep it secret--even from their physicians.

More aggressive investigation finds a high prevalence of BDD in the presence of other mental disorders: typical rates are 14% among those with atypical major depressive disorder, 7% with anxiety disorder, and 12% with obsessive-compulsive disorder, he said.

Dr. Grant reported a study of 101 consecutive adult and 21 adolescent admissions to a psychiatric hospital. Using a self-report questionnaire for screening and a semistructured diagnostic interview for follow-up, 13 adults and 3 adolescents of the 122 patients (13.1%) met the criteria for BDD, including 15% of the 65 female patients, and 11% of the 57 males.

In the group of 122 admissions, 21% of those with major depressive disorder, 10% of those with bipolar disorder, 50% of those with alcohol use disorders, 33% of those with panic, and 16% of those with anorexia met criteria for BDD, he said. One of the patients had delusional BDD, and one had muscle dysmorphia--a preoccupation with muscle building, Dr. …