Acne May Be Sign of Body Dysmorphic Disorder
Boschert, Sherry, Clinical Psychiatry News
LOS ANGELES -- Significant numbers of patients with acne have debilitating symptoms normally associated with body dysmorphic disorder, Dr. Whitney P. Bowe said at the annual meeting of the Society for Investigational Dermatology
In her screening study, 14%-21% of the 128 patients met objective and subjective criteria for a diagnosis of body dysmorphic disorder. The range varied depending on the definition of acne severity.
Body dysmorphic disorder, a preoccupation with a slight or imagined defect in appearance, causes significant disruption in daily functioning. In the general population, 0.7%-3.0% of people are thought to have body dysmorphic disorder, which usually begins in adolescence. The preoccupation typically leads to behaviors such as skin picking and mirror checking.
Patients with body dysmorphic disorder are among the toughest patients to treat, said Dr. Bowe, who conducted the study with associates at the University of Pennsylvania, Philadelphia, while she was a medical student there. She is now an intern at Albert Einstein College of Medicine, New York. Patients with body dysmorphic disorder commonly respond poorly to treatments that do not include psychiatric medications, she explained. They are at increased risk for suicide and are more likely to threaten health care providers both legally and physically, previous reports suggest.
In the current study, the investigators categorized physician assessments of acne severity as clinically significant (which automatically precluded a diagnosis of body dysmorphic disorder) or as clinically insignificant using a stringent or less stringent set of criteria. All patients completed the Body Dysmorphic Disorder Questionnaire-Dermatology Version (BDDQ-DV), which has 100% sensitivity and 92% specificity in surgical settings for detecting preoccupation with defects and at least moderate distress or impairment in functioning.
Only patients with clinically insignificant acne and a positive BDDQ-DV were considered to have body dysmorphic disorder, Dr. Bowe noted.
A total of 49 patients met stringent objective criteria for "minimal or nonexistent acne" (defined as zero or only a few scattered comedones or papules, five or fewer postinflammatory macules, and no scars). …