A COMPARISON OF DELUSIONAL AND NONDELUSIONAL BODY DYSMORPHIC DISORDERIN 100 CASES

A controversial issue that was debated for DSM-IV is whether body dysm orphic disorder (BDD)-a preoccupation with an imagined defect in appea rance-can be psychotic. BDD is classified separately from its delusion al counterpart (delusional disorder, somatic type) in DSM-IV, but does it have a psychotic variant that overlaps with, and may even be the s ame diagnostic entity as, its delusional disorder variant? One hundred consecutive patients with DSIW-III-R-defined BDD or its delusional va riant were assessed with a semistructured interview, the structured Cl inical Inverview for DSM-III-R, and a modified version of the Yale-Bro wn Obsessive Compulsive Scale (Y-BOCS). The 48 patients with nondelusi onal BDD were compared with the 52 patients with delusional BDD (i.e., delusional disorder, somatic type). The two groups did not differ sig nificantly in terms of most variables examined, including demographics , phenomenology, course, associated features, comorbidity, and treatme nt response. Thus, BDD may have a psychotic subtype that significantly overlaps with, and may even be the same disorder as, its delusional d isorder variant. However, delusional subjects had higher total scores on the modified Y-BOCS, suggesting that the delusional variant of BDD may be a more severe form of the disorder. Although preliminary, these findings have implications for BDD's treatment and classification, su ggesting that inclusion of a delusional (psychotic) subtype of BDD sho uld be considered for future editions of DSM.