Delusional versus nondelusional body dysmorphic disorder: recommendations for DSM-5

Area of Science:

• Psychiatry
• Clinical Psychology
• Mental Health Research

Background:

• Body dysmorphic disorder (BDD) involves preoccupation with perceived flaws in appearance.
• Previous diagnostic manuals (DSM-III-R, DSM-IV) separated BDD into delusional and nondelusional forms, with limited evidence.
• These classifications had limitations due to a lack of empirical data at the time of publication.

Purpose of the Study:

• To review the historical classification of BDD variants in DSM editions.
• To examine empirical evidence on the similarities and differences between delusional and nondelusional BDD.
• To propose a revised classification for BDD based on current evidence.

Main Methods:

• Review of earlier editions of the Diagnostic and Statistical Manual of Mental Disorders (DSM).
• Analysis of empirical evidence published since the development of DSM-IV.
• Comparison of BDD variants across multiple validators, including treatment response.

Main Results:

• Empirical evidence reveals significant similarities between delusional and nondelusional BDD variants across various validators.
• Similarities extend to treatment response, particularly pharmacotherapy.
• The differences between the variants are fewer than previously assumed by diagnostic classifications.

Conclusions:

• BDD's delusional and nondelusional forms should be classified as a single disorder.
• An insight specifier, encompassing a range from good insight to absent insight/delusional beliefs, should be included in diagnostic criteria.
• This revised classification aims to improve the care of individuals with BDD and inform understanding of related disorders.