Dysmorphophobia

Of the obsessive-compulsive spectrum disorders, body dysmorphophobia (BD) attracts special attention. The main symptom of body dysmorphophobia is concern about an imaginary or minor defect in appearance. In studies conducted in accordance with the DSM-IV criteria, BDD was detected in 12% of patients with OCD. The manifestations of body dysmorphophobia and OCD are similar in many respects. Both conditions are characterized by recurring, disturbing obsessive thoughts. In OCD, their content includes a variety of topics (for example, fear of infection or committing an unwanted impulsive action). In body dysmorphophobia, by definition, these concerns are always associated with a minor or imaginary physical defect. Most often, this excessive concern is associated with the face and head (for example, the size of the nose, the shape of the face, the properties of the skin, the presence of wrinkles or pigment spots); less often, the patient's attention is focused on other parts of the body (for example, breast asymmetry or the size of the feet). In body dysmorphic disorder, repeated checking (such as looking at an imaginary defect in a mirror) or touching are common - actions that are also commonly seen in classic OCD. However, some people with body dysmorphic disorder do not have checking rituals - instead, they try to avoid any reminder of their defect by removing all mirrors or covering all reflective surfaces in the home.

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Diagnostic criteria for body dysmorphic disorder

• A. Preoccupation with an imagined defect in appearance or excessive concern about an existing minor physical defect
• B. The concern causes clinically significant discomfort or disrupts the patient's functioning in social, professional or other important areas
• B. The preoccupation cannot be better explained by another mental disorder (e.g., dissatisfaction with body image in anorexia nervosa)

In contrast to patients with OCD, patients with dysmorphophobia usually believe that their irrational concerns are justified. However, when presented with evidence to the contrary (e.g., a nomogram showing that the head size is within normal limits), the patient may still admit that their concerns lack an objective basis. Thus, the overvalued ideas of patients with dysmorphophobia can be placed between obsessions and delusional ideas, depending on the extent to which the patients' false ideas can be changed. In clinical practice, it is not always possible to draw a clear line between dysmorphophobia and somatic delusions.

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Treatment of body dysmorphic disorder

There are no controlled studies evaluating the effectiveness of treatment for BDD. However, several open studies have shown that SSRIs and clomipramine are effective in many patients with BDD and even in some patients with delusions. A retrospective analysis of the treatment of 50 patients with BDD found that clomipramine, fluoxetine, and fluvoxamine were more effective than tricyclic antidepressants. The researchers conducted an open trial of fluvoxamine (at a dose of up to 300 mg/day) in 20 patients with BDD. According to fairly strict criteria, treatment was considered effective in 14 of 20 (70%) patients. The authors noted that "in patients with delusions, treatment was no less effective than in patients without delusions, and the level of criticism improved significantly as a result of treatment." However, these authors' experience suggests that BDD is less responsive to pharmacotherapy than OCD.