Dysmorphophobia

Of the disorders of the obsessive-compulsive spectrum, attention is drawn to dysmorphophobia (DMF). The main symptom of dysmorphophobia is concern about an imaginary or insignificant defect in the exterior. In studies conducted in accordance with the DSM-IV criteria, DMP was detected in 12% of patients with OCD. The manifestations of dysmorphophobia and OCD are similar in many respects. Both states are characterized by repetitive disturbing patients with obsessive thoughts. In OCD, their content includes a variety of topics (for example, fear of contracting or undesired impulsive action). In the case of dysmorphophobia, by definition, these fears are always associated with a minor or imagined physical disability. 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 attention of the patient is concentrated on other parts of the body (for example, the asymmetry of the chest or the size of the feet). When dysmorphophobia is often observed repeated checks (for example, viewing an imaginary defect in the mirror) or touching - that is, the actions that are usually noted in the classical ROC. However, in some patients with dysmorphophobia, there are no test rituals - on the contrary, they try to avoid any reminder of their lack, removing all mirrors or covering all the reflecting surfaces in the house.

[1], [2], [3], [4],

Diagnostic criteria of dysmorphophobia

• A. Concerns about an imaginary appearance defect or excessive concern about an easy physical disability
• B. Concern is caused by clinically significant discomfort or disrupts the life activity of a patient in social, professional or other important areas
• B. Concern can not be better explained by another mental disorder (for example, dissatisfaction with a figure in anorexia nervosa)

In contrast to patients with OCD, patients with dysmorphophobia usually believe that their irrational concern is fully justified. However, when evidence is presented to the contrary (for example, a nomogram certifying that the size of the head is within the normal range), the patient can still recognize that his concern is devoid of an objective basis. Thus, the overvalued ideas of patients with dysmorphophobia can be located between obsessions and delusions, depending on the extent to which false representations of patients are susceptible to reassurance. In clinical practice, it is not always possible to draw a clear line between dysmorphophobia and somatic delirium.

[5], [6], [7]

Treatment of dysmorphophobia

Controlled studies evaluating the effectiveness of dysmorphophobia treatment were not conducted. But in several open studies it has been shown that SSRIs and clomipramine are effective in many patients with dysmorphophobia and even in some patients with delusional ideas. A retrospective analysis of the treatment of 5O patients with dysmorphophobia showed that clomipramine, fluoxetine and fluvoxamine proved to be more effective than tricyclic antidepressants. Scientists conducted an open study of fluvoxamine (at a dose of up to 300 mg / day) in 20 patients with dysmorphophobia. In accordance with rather strict criteria, treatment in 14 out of 20 (70%) patients was found to be effective. The authors noted that "in patients with delirium, treatment was no less effective than in patients without delirium, and as a result of treatment, the level of criticism improved significantly." Nevertheless, the experience of these authors shows that dysmorphophobia is less reactive to pharmacotherapy than OCD.