A comparison study of body dysmorphic disorder and obsessive-compulsive disorder

Background: Body dysmorphic disorder, a preoccupation with an imagined or s light defect in appearance, is classified as a somatoform disorder, but has been hypothesized to be related to obsessive-compulsive disorder. A reflec tion of this hypothesis, body dysmorphic disorder is included in the Yale-B rown Obsessive Compulsive Scale symptom checklist, and its transfer to the anxiety disorders' section was considered for DSM-IV. However, the similari ties and differences between body dysmorphic disorder and obsessive-compuls ive disorder have received little investigation. Method: We compared patients with DSM-IV body dysmorphic disorder (N = 53), obsessive-compulsive disorder (N = 53), or both disorders (N = 33) in term s of demographic features, clinical features, comorbidity, and family histo ry. We also assessed the rate of body dysmorphic disorder among 62 of these subjects initially diagnosed with obsessive-compulsive disorder. Results: 14.5% (9 of 62) of subjects initially diagnosed with obsessive-com pulsive disorder had comorbid body dysmorphic disorder. The 2 disorders did not differ significantly in terms of sex ratio; most other demographic, co urse, and impairment variables; illness severity; or lifetime frequency of most associated disorders in probands or first-degree relatives. However, s ubjects with body dysmorphic disorder were less likely to be married and mo re likely to have had suicidal ideation or made a suicide attempt because o f their disorder. They also had an earlier onset of major depression and hi gher lifetime rates of major depression, social phobia, and psychotic disor der diagnoses, as well as higher rates of substance use disorders in first- degree relatives. Conclusion: Body dysmorphic disorder appears to be relatively common among patients with obsessive-compulsive disorder. While the 2 disorders have man y similarities, they also have some differences and should be differentiate d in clinical and research settings.