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Tijdschrift voor Psychiatrie 44 (2002) 10, 677 - 686

Review article

'The unfaceable mirror'

A.M.E. van de Koolwijk-van Bentum, F.W. Wilmink

background In the literature there has been relatively little attention for body dysmorphic disorder.
aim Review of the history of the concept of body dysmorphic disorder. Review of research regarding its legitimacy as a separate diagnosis in the current DSM-IV classification system, especially in relation to delusional disorder, mood disorders, social phobia and obsessive-compulsive disorder.
method Review of literature by an Embase search over the period 1987-1997 and by a Medline search over the period 1965-2002 (january).
results Epidemiological and pharmacological research reveals many similarities between body dysmorphic disorder and obsessive-compulsive disorder. Epidemiological differences between body dysmorphic disorder and obsessive-compulsive disorder regard marital status, suicidal ideations or attempts, and lifetime rate of depression and social phobia. There are phenomenological differences between body dysmorphic disorder and obsessive-compulsive disorder, like a difference in content of preoccupations and the degree of delusion; however, more research into these matters is needed. The comorbidity of BDD with other axis i and axis II disorders was found to be considerable. Both body dysmorphic disorder and delusional disorder, somatic type, respond preferentially to serotonin re-uptake inhibitors. One case report, however, suggests a pathophysiological difference between body dysmorphic disorder and obsessive-compulsive disorder.
conclusion Current data on similarities and dissimilarities suggest that body dysmorphic disorder could well fit into the obsessive-compulsive spectrum disorder hypothesis. A conclusive answer cannot be given, however, until operational criteria for inclusion of disorders in the obsessive-compulsive spectrum become available. Data on body dysmorphic disorder are scarce, and come from only a few international investigators. Further research into epidemiology, phenomenology, comorbidity, and family history is needed to clarify its classicatory status. To achieve this, genetic, neurobiological and developmental research may prove useful. Body dysmorphic disorder nowadays figures as a separate DSM-IVdiagnosis, but this may well be changed by future research.

keywords body dysmorphic disorder, dysmorphophobia