Body Image Disturbances
in Psychotic Disorders
This chapter describes body image disturbances in psychotic disorders, including schizophrenia, somatic delusions, and the psychotic variant of body dysmorphic disorder (BDD). Many challenges exist in reviewing psychotic forms of body experience. The admonition of the Diagnostic and Statistical Manual of Mental Disorders–IV—Text Revision (DSM-IV-TR) that the term psychotic "has historically received a number of different definitions, none of which has achieved universal acceptance" (p. 827) addresses a central challenge. Relatively little is known about psychotic aspects of body image. This lacuna is partially due to the lack of body image measures developed specifically for psychotic populations and infrequent use of available measures to assess these individuals.
Historically, body image distortion often has been viewed as a central feature of schizophrenia. Psychodynamic theorists, in particular, have presented clinical observations and theories propounding the central role of body image in schizophrenic etiology and phenomenology. Guimón comprehensively reviews the body image disturbances described in schizophrenia, including experiences of body deterioration, depersonalization, body boundary disintegration, and transmuted feelings of masculinity and femininity. He describes a range of body image perceptions and beliefs pertaining to missing or misshapen body parts, perceptions of the body as unusually weak or strong, changes in body size or consistency (e.g., turning into