Comorbid personality impairment in body dysmorphic disorder

Personality impairment was evaluated in 17 body dysmorphic disorder (BDD) p atients undergoing a treatment study of clomipramine versus desipramine. Se mistructured interviews were administered using both categorical (Structure d Clinical Interview for DSM [SCID II]) and dimensional (Dimensional Assess ment of Personality Impairment [DAPI]) methods. Personality measures were a lso correlated with a range of clinical variables (severity of BDD and depr essive symptoms, age, duration of illness, and response to treatment). A se condary aim of the study was to provide preliminary validation for the DAPI . Consistent with previous studies, BDD patients showed considerable person ality pathology. By SCID II, patients met criteria for a mean of 2.53 perso nality disorder diagnoses; 87% of patients met criteria for at least 1 diag nosis and 53% for more than 1. Cluster C diagnoses were the most common. Me an scores for the DAPI were 2.63 (3 = mild impairment) to 6.41 (7 = severe impairment), averaging 5.26 (5 = moderate). With regard to the DAPI, the re sults provided preliminary evidence of good reliability and validity. Moreo ver, both personality measures were highly intercorrelated. Although SCID I I diagnoses correlated with baseline depression (Hamilton Rating Scale for Depression [HRSD]) scores, there were few other significant correlations be tween personality and other clinical variables. Of note, however, treatment responders demonstrated less personality impairment than nonresponders. Th e finding that personality measures were highly intercorrelated but, on the whole, not well correlated with other clinical measures supports the disti nct and dissociable nature of personality phenomena in BDD. Despite the sma ll sample size, these results suggest that personality impairment appears t o be significant factor in BDD and may even play a role in treatment respon se. Copyright (C) 2000 by W.B. Saunders Company.