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Patients with Body Dysmorphic Disorder

In their article, Phillips & Menard (2006) focus on the phenomenon of suicidality among patients with BDD. Cross-sectional/retrospective data they have obtained shows that individuals with BDD have high rates of suicidal ideation and attempts. Claiming, that there are no previous studies that prospectively examine suicidality in BDD, the authors examined suicidality in 185 subjects for up to 4 years in their first prospective study of BDD’s course. Generally, though the completed suicide rate is preliminary, Phillips & Menard (2006) concluded that individuals with BDD have high rates of suicidal ideation and attempts.

As a result, out of 185 subjects 147 (79.5%) reported having suicidal thoughts; 51 (27.6%) committed a suicide attempt. In general 167 (90.3%) of the subjects passed through mental health therapy at certain point during the observation period. The nine subjects (four men and five women; age: mean = 37.1 years, SD = 11.6) who had suicide attempts during the follow-up period made totally 30 attempts of suicide; having considered all the attempts, it was determined that the level of medical threat was minimal for one subject, moderate for four subjects, severe for one, extreme for one, and resulted in lethal outcomes for two. The study showed that suicidal ideations are reported by a mean of 57.8% of the subjects per year, and a mean of 2.6% attempted suicide per year (Phillips & Menard, 2006).

Phillips & Menard (2006) found in the conducted studies that the incidence of suicide was 45 times higher than in the total U.S. population. This is twice higher than among people with depression, and three times more than in cases of bipolar personality disorder. A link was also suggested between undiagnosed BDD and a higher than in the general population risk of suicide among men who have undergone cosmetic surgery. In cases of gender identity disorder when a patient is not satisfied with his or her biological sex, development of BDD accelerates aimed at the existing sex which is in constant conflict with the sex a patient identifies oneself with. High comorbidity of BDD in patients with gender identity disorder leads to an increased risk of suicide attempts up to 20%, whereas in patients with BDD it is only 15%.

However, the researchers mention their study could have limitations such as the lack of control group or data which is directly comparing the observed subjects having BDD to the individuals with other disorders, as well as the lack of application of instruments different from that of applied in the studies of other disorders, or the conduction of the research in a BDD specialty setting, which could attract more severe cases. On the other hand, the rates of suicide presented by Phillips & Menard (2006) could also be underestimated, because their methods may not have detected all the suicides, as their group size and limited duration of follow-up have limited the stability and precision of the suicidality estimates.
Although further studies are needed over longer follow-up periods and in other BDD samples and settings, the study helps in understanding the situation present in this area and stimulates further research. Thus, for instance, it should also be noted that there is a high degree of comorbidity with other psychiatric disorders which often leads to incorrect diagnoses by clinicians (Claiborne, 2002).

Studies suggest that about 76% of people with BDD are likely to experience major depression at some point in their lives, and this is significantly higher than the expected 10 – 20% of total / general population. About 37% of people with BDD also usually have social phobia, and about 32% experience obsessive-compulsive disorder. In turn, the presence of assident disorders increases the risk of suicidal thinking (Phillips, 2009; Phillips et al, 2005). For example, depression increases the risk of suicide by 15-20 times, and almost 4% of people who suffered from this disorder committed suicide. Among the patients with manic-depressive illness around 10-15% commit suicide (National Center for Injury Prevention and Control, 2003). Also 5% among patients with schizophrenia commit suicides, while dysmorphophobia is most commonly observed in cases of schizophrenia, especially in its obliterate forms and boundary conditions (Harris & Barraclough, 1997).

On a whole, long-term dynamic study (according to the observations of experts with many years of experience) of patients with pathologic thoughts about one of another physical defect has shown that, first of all, the patients at clinics (not only those of psychiatrists) are mostly persons with not obtrusive, but overvalued ideas or delusions, and, secondly, that these pathology is most often represented by not a single symptom, but a characteristic syndrome (Claiborne, 2002; Phillips, 2009).

The study of syndromological structure and nosologistic nature of the given pathology is extremely important primarily because the disorders of this type are often the content of the earliest, initial manifestations of mental illnesses, developing for a long time silent and invisible to others, while it is obviously a morbid condition with all the ensuing consequences. In addition to the possibility of development of diagnostic and prognostic criteria, the need for careful study of patients with disorders described is dictated by the requirements of direct clinical practice: the searches for the most appropriate therapeutic interventions for patients with this kind of pathology which is difficult to treat.

References:
Claiborne, J. (2002). The BDD Workbook: Overcome Body Dysmorphic Disorder and End Body Image Obsessions. New Harbinger Publications.
Harris, E.C., & Barraclough B. (1997). Suicide as an outcome for mental disorders: a meta-analysis. British Journal of Psychiatry, 170, pp. 205–228.
National Center for Injury Prevention and Control: WISQARS Injury Mortality Reports, 1999-2003. webappa.cdc.gov/sasweb/ncipc/mortrate10_sy.html
Phillips, K.A. (2009). Understanding Body Dysmorphic Disorder. Oxford University Press.
Phillips, K.A., Coles, M. E., Menard, W., Yen, S., Fay, C., & Weisberg, R.B. (2005). Suicidal ideation and suicide attempts in body dysmorphic disorder. Journal of Clinical Psychiatry, 66, pp.717–725.
Phillips, K.A., & Menard, W.B.A. (2006). Suicidality in Body Dysmorphic Disorder: A Prospective Study. American Journal of Psychiatry, 163, pp. 1280-1282.