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Body dysmorphic disorder: does it have a psychotic subtype?

S L McElroy1, K A Phillips, P E Keck

  • 1Department of Psychiatry, University of Cincinnati College of Medicine, Ohio 45267-0559.

The Journal of Clinical Psychiatry
|October 1, 1993
PubMed
Summary
This summary is machine-generated.

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Body dysmorphic disorder (BDD) may include a psychotic subtype. This study found psychotic BDD patients had more lifetime psychotic disorders but were otherwise similar to nonpsychotic BDD patients, suggesting overlap.

Area of Science:

  • Psychiatry
  • Clinical Psychology

Background:

  • Body dysmorphic disorder (BDD) is classified as nonpsychotic, but its presentation with psychotic features is debated.
  • The potential overlap between BDD with psychotic features and delusional disorder, somatic type, necessitates further investigation.

Purpose of the Study:

  • To investigate differences between patients with nonpsychotic BDD and those with psychotic BDD.
  • To determine if BDD with psychotic features represents a distinct subtype or a variant of delusional disorder, somatic type.

Main Methods:

  • Fifty patients meeting DSM-III-R criteria for BDD were assessed using semistructured interviews and the Structured Clinical Interview for DSM-III-R (SCID).
  • Family psychiatric histories were blindly assessed.
  • Twenty-four nonpsychotic BDD patients were compared with 26 psychotic BDD patients across various clinical and demographic variables.

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Main Results:

  • Patients with psychotic BDD had a significantly higher rate of lifetime psychotic disorder diagnoses compared to nonpsychotic BDD patients.
  • Both groups exhibited significant comorbidity with mood, anxiety, and substance use disorders.
  • Both psychotic and nonpsychotic BDD patients showed a preferential response to serotonin reuptake inhibitors.

Conclusions:

  • Body dysmorphic disorder may encompass a psychotic subtype that closely resembles or is identical to the BDD variant of delusional disorder, somatic type.
  • Future revisions of the Diagnostic and Statistical Manual of Mental Disorders (DSM) should consider including a psychotic subtype for BDD.