Body Dysmorphic Disorder Insights in an Inpatient Psychiatric Setting

Body dysmorphic disorder is a chronic disorder involving imagined or partial appearance defects that lead to significant impairment in everyday life. It is quite prevalent but remains a clinically underdiagnosed psychiatric condition especially in the inpatient psychiatric setting. Onset of body dysmorphic disorder typically begins in adolescence with subclinical symptoms. Over time, symptoms progress to patients meeting the full Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) criteria. Severe cases of the body dysmorphic disorder are often camouflaged by concurrent diseases like major depressive disorder, obsessive-compulsive disorder, substance use disorder, and social anxiety disorder. Further, compounding the complexity of body dysmorphic disorder is a treatment of patients who present with coinciding suicidal ideations. Here, we present a unique case of a 40-year-old female admitted to an inpatient psychiatric unit for treatment of ongoing depression and suicidal symptoms. Early on in her inpatient course, she had symptoms of obsessive-compulsive disorder, social anxiety disorder, and alcohol use disorder. The constellation of symptoms prompted evaluation for body dysmorphic disorder and subsequent targeted treatment. This case report highlights the complexities associated with diagnosing body dysmorphic disorder, the importance of considering it a branch point for other psychiatric conditions, and the treatment for patients who present with coinciding suicidal behavior.