Body dysmorphic disorder, psychosis and insight: a report of four cases

Body dysmorphic disorder is described in the DSM-IV as a single clinical entity, but an additional diagnosis of delusional disorder, somatic type, is allowed when the preoccupation concerning an imaginary defect in appearance is held with delusional intensity. The existence of two clinical forms is implicitly recognized, depending on the presence or absence of psychotic symptoms. Several studies have suggested that these two forms make up a single illness, characterized by different degrees of insight. This supposition is supported by the fact that the symptomatology and the clinical response to the SSRIs are thought to be similar for the two forms. Moreover, certain authors have suggested that categorical nosography (as used by the DSM-IV) should not be the point of reference and that a 'dimensional' point of view is preferable, meaning that the presence of psychotic symptoms would constitute merely a simple phenomenon or state of the same illness.