Psychiatric Quarterly

, Volume 70, Issue 4, pp 313–331

Body Dysmorphic Disorder and Depression: Theoretical Considerations and Treatment Strategies

  • Katharine A. Phillips


Body dysmorphic disorder (BDD), also known as dysmorphophobia, consists of a distressing and impairing preoccupation with an imagined or slight defect in appearance. BDD is an underrecognized and relatively common disorder that is associated with high rates of occupational and social impairment, hospitalization, and suicide attempts. BDD is unlikely to simply be a symptom of depression, although it often coexists with depression and may be related to depression. It is important to recognize BDD in depressed patients, because missing the diagnosis can result in refractory BDD and depressive symptoms. Available data indicate that BDD may not respond to all treatments for depression and may instead respond preferentially to serotonin-reuptake inhibitors. In addition, lengthier treatment trials than those required for depression may be needed to successfully treat BDD and comorbid depression. It can be difficult and challenging to diagnose BDD in depressed patients because the symptoms are often concealed due to embarrassment and shame. This paper discusses the relationship between BDD and depression and discusses practical strategies for recognizing and treating BDD and depressive symptoms in patients with depression.


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  1. 1.
    Morselli E: Sulla dismorfofobia e sulla tafefobia. Bolletinno della R accademia di Genova 6:110–119, 1891.Google Scholar
  2. 2.
    Phillips KA: Body dysmorphic disorder: the distress of imagined ugliness. American Journal of Psychiatry 148:1138–1149, 1991.Google Scholar
  3. 3.
    Phillips KA, McElroy SL, Keck PE Jr, et al: Body dysmorphic disorder: 30 cases of imagined ugliness. American Journal of Psychiatry 150:302–308, 1993.Google Scholar
  4. 4.
    Phillips KA: The Broken Mirror: Understanding and Treating Body Dysmorphic Disorder. New York, Oxford University Press, 1996.Google Scholar
  5. 5.
    Veale D, Boocock A, Gournay K, et al: Body dysmorphic disorder: a survey of fiftycases. British Journal of Psychiatry 169:196–201, 1996.Google Scholar
  6. 6.
    Hollander E, Cohen LJ, Simeon D: Body dysmorphic disorder. Psychiatric Annals 23: 359–364, 1993.Google Scholar
  7. 7.
    Perugi G, Akiskal HS, Giannotti D, et al: Gender-related differences in body dysmorphic disorder (dysmorphophobia). Journal of Nervous and Mental Disease 185:578–582, 1997.Google Scholar
  8. 8.
    Pope HG Jr, Gruber AJ, Choi P, et al: Muscle dysmorphia: an underrecognized form of body dysmorphic disorder. Psychosomatics 38:548–557, 1997.Google Scholar
  9. 9.
    Phillips KA, McElroy SL, Keck PE Jr, et al: A comparison of delusional and nondelusional body dysmorphic disorder in 100 cases. Psychopharmacology Bulletin 30: 179–186, 1994.Google Scholar
  10. 10.
    O'Sullivan RL, Phillips KA, Keuthen NJ, et al: Near fatal skin picking from delusional body dysmorphic disorder responsive to fluvoxamine. Psychosomatics 40:79–81, 1999.Google Scholar
  11. 11.
    DeMarco LM, Li LC, Phillips KA, et al: Perceived stress in body dysmorphic disorder. Journal of Nervous and Mental Disease 186:724–726, 1998.Google Scholar
  12. 12.
    Phillips KA, Diaz S: Gender differences in body dysmorphic disorder. Journal of Nervous and Mental Disease 185:570–577, 1997.Google Scholar
  13. 13.
    Albertini RS, Phillips KA: 33 cases of body dysmorphic disorder in children and adolescents. Journal of the American Academy of Child and Adolescent Psychiatry 38:453–459, 1999.Google Scholar
  14. 14.
    Cotterill JA, Cunliffe WJ: Suicide in dermatological patients. British Journal of Dermatology 137:246–250, 1997.Google Scholar
  15. 15.
    Hay GG: Dysmorphophobia. British Journal of Psychiatry 116:399–406, 1970.Google Scholar
  16. 16.
    Cotterill JA: Dermatological non-disease: a common and potentially fatal disturbance of cutaneous body image. British Journal of Dermatology 104:611–619, 1981.Google Scholar
  17. 17.
    Hardy GE, Cotterill JA: A study of depression and obsessionality in dysmorphophobic and psoriatic patients. British Journal of Psychiatry 140:19–22, 1987.Google Scholar
  18. 18.
    Du Fort GG, Newman SC, Bland RC: Psychiatric comorbidity and treatment seeking: sources of selection bias in the study of clinical populations. Journal of Nervous and Mental Disease 181:467–474, 1993Google Scholar
  19. 19.
    Brawman-Mintzer O, Lydiard RB, Phillips KA, et al: Body dysmorphic disorder in patients with anxiety disorders and major depression: a comorbidity study. American Journal of Psychiatry 152:1665–1667, 1995.Google Scholar
  20. 20.
    Phillips KA, Atala KD, Pope HG: Diagnostic instruments for body dysmorphic disorder. New Research Program and Abstracts, American Psychiatric Association 148th Annual Meeting. Miami: American Psychiatric Association, 1995:157.Google Scholar
  21. 21.
    Nierenberg AA, Phillips KA, Kaji J, et al: Body dysmorphic disorder is comorbid with major depression. New Research Program and Abstracts, American Psychiatric Association 148th Annual Meeting. Miami: American Psychiatric Association, 1995:154.Google Scholar
  22. 22.
    Phillips KA, Nierenberg AA, Brendel G, et al: Prevalence and clinical features of body dysmorphic disorder in atypical major depression. Journal of Nervous and Mental Disease 184:125–129, 1996.Google Scholar
  23. 23.
    Perugi G, Akiskal HS, Lattanzi L, et al: The high prevalence of “soft” bipolar (II) features in atypical depression. Comprehensive Psychiatry 39:63–71, 1998.Google Scholar
  24. 24.
    Soriano JL, O'Sullivan RL, Baer L, et al: Trichotillomania and self-esteem: a survey of 62 female hair pullers. Journal of Clinical Psychiatry 57:77–82, 1996.Google Scholar
  25. 25.
    Rosen JC, Ramirez E: A comparison of eating disorders and body dysmorphic disorder on body image and psychological adjustment. Journal of Psychosomatic Research 44:441–449, 1998.Google Scholar
  26. 26.
    Phillips KA, Dwight MM, McElroy SL: Efficacy and safety of fluvoxamine in body dysmorphic disorder. Journal of Clinical Psychiatry 59:165–171, 1998.Google Scholar
  27. 27.
    Lyons MJ, Tyrer, P, Gunderson J, et al: Heuristic models of comorbidity of axis I and axis II disorders. Journal of Personality Disorders 11:260–269, 1997.Google Scholar
  28. 28.
    Phillips KA, McElroy SL, Hudson JI, et al: Body dysmorphic disorder: an obsessive compulsive spectrum disorder, a form of affective spectrum disorder, or both? Journal of Clinical Psychiatry 56(S):41–52, 1995.Google Scholar
  29. 29.
    Hudson JI, Pope HG Jr: Affective spectrum disorder: does antidepressant response identify a family disorders with a common pathophysiology? American Journal of Psychiatry 147:553–564, 1990.Google Scholar
  30. 30.
    Phillips KA, Gunderson CG, Mallya G, et al: A comparison study of body dysmorphic disorder and obsessive compulsive disorder. Journal of Clinical Psychiatry 59:568–575, 1998.Google Scholar
  31. 31.
    Hollander E, Phillips KA: Body image and experience disorders: body dysmorphic and depersonalization disorders, in Obsessive Compulsive-Related Disorders. Edited by Hollander E. Washington, DC, American Psychiatric Press Inc, 1992.Google Scholar
  32. 32.
    Fukuda O: Statistical analysis of dysmorphophobia in out-patient clinic. Japanese Journal of Plastic and Reconstructive Surgery 20:569–577, 1997.Google Scholar
  33. 33.
    Munro A. Delusional Hypochondriasis. Toronto, Clarke Institute of Psychiatry Monograph Series #5, 1982.Google Scholar
  34. 34.
    Hollander E, Liebowitz MR, Winchel R, et al: Treatment of body-dysmorphic disorder with serotonin reuptake blockers. American Journal of Psychiatry 146:768–770, 1989.Google Scholar
  35. 35.
    Phillips KA: Body dysmorphic disorder: diagnosis and treatment of imagined ugliness. Journal of Clinical Psychiatry 57(S):61–64, 1996.Google Scholar
  36. 36.
    Perugi G, Giannotti D, Di Vaio S, et al: Fluvoxamine in the treatment of body dysmorphic disorder (dysmorphobia). International Clinical Psychopharmacology 11:247–254, 1996.Google Scholar
  37. 37.
    Hollander E, Cohen L, Simeon D, et al: Fluvoxamine treatment of body dysmorphic disorder (letter). Journal of Clinical Psychopharmacology 14:75–77, 1994.Google Scholar
  38. 38.
    Neziroglu FA, Yaryura-Tobias JA: Exposure, response prevention, and cognitive therapy in the treatment of body dysmorphic disorder. Behavior Therapy 24:431–438, 1993.Google Scholar
  39. 39.
    Wilhelm S, Otto MW, Lohr B, et al: Cognitive behavior group therapy for body dysmorphic disorder: a case series. Behaviour Research and Therapy 37:71–75, 1999.Google Scholar
  40. 40.
    Rosen JC, Reiter J, Orosan P: Cognitive-behavioral body image therapy for body dysmorphic disorder. Journal of Consulting and Clinical Psychology 63:263–269, 1995.Google Scholar
  41. 41.
    Veale D, Gournay K, Dryden W, et al: Body dysmorphic disorder: a cognitive behavioural model and pilot randomized controlled trial. Behavior Research and Therapeutics 34:717–729, 1996.Google Scholar
  42. 42.
    McKay D, Todaro J, Neziroglu F, et al: Body dysmorphic disorder: a preliminary evaluation of treatment and maintenance using exposure and response prevention. Behaviour Research and Therapy 35:67–70, 1997.Google Scholar
  43. 43.
    Phillips KA, McElroy SL: Treatment response of depression in patients with body dysmorphic disorder. New Clinical Drug Evaluation Unit Program (NCDEU) 38th Annual Meeting Abstracts of Poster Presentations. Boca Raton: National Institute of Mental Health, 1998:146.Google Scholar
  44. 44.
    Phillips KA: An open study of buspirone augmentation of serotonin-reuptake inhibitors in body dysmorphic disorder. Psychopharmacology Bulletin 2:175–180, 1996.Google Scholar
  45. 45.
    Zimmerman M, Mattia JI: Body dysmorphic disorder in psychiatric outpatients: recognition, prevalence, comorbidity, demographic, and clinical correlates. Comprehensive Psychiatry 39:265–270, 1998.Google Scholar

Copyright information

© Human Sciences Press, Inc. 1999

Authors and Affiliations

  • Katharine A. Phillips
    • 1
  1. 1.Associate Medical Director of Ambulatory Services, Butler Hospital, and Associate Professor, Department of Psychiatry and Human BehaviorBrown University School of MedicineProvidence

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