Hostname: page-component-cd9895bd7-gvvz8 Total loading time: 0 Render date: 2025-01-05T00:32:21.707Z Has data issue: false hasContentIssue false
  • English
  • Français

A 4-year prospective observational follow-up study of course and predictors of course in body dysmorphic disorder

Published online by Cambridge University Press:  29 August 2012

K. A. Phillips ,
W. Menard ,
E. Quinn ,
E. R. Didie  and
R. L. Stout
K. A. Phillips*
Affiliation:
Rhode Island Hospital, Providence, RI, USA Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
W. Menard
Affiliation:
Rhode Island Hospital, Providence, RI, USA
E. Quinn
Affiliation:
Stonehill College, Easton, MA, USA
E. R. Didie
Affiliation:
Rhode Island Hospital, Providence, RI, USA Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
R. L. Stout
Affiliation:
Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA Pacific Institute for Research and Evaluation, Calverton, MD, USA
*
*Address for correspondence: K. A. Phillips, M.D., Rhode Island Hospital, Coro Center West, Suite 2.030, 1 Hoppin Street, Providence, RI 02903, USA. (Email: [email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

This report prospectively examines the 4-year course, and predictors of course, of body dysmorphic disorder (BDD), a common and often severe disorder. No prior studies have prospectively examined the course of BDD in individuals ascertained for BDD.

Method

The Longitudinal Interval Follow-Up Evaluation (LIFE) assessed weekly BDD symptoms and treatment received over 4 years for 166 broadly ascertained adults and adolescents with current BDD at intake. Kaplan–Meier life tables were constructed for time to remission and relapse. Full remission was defined as minimal or no BDD symptoms, and partial remission as less than full DSM-IV criteria, for at least 8 consecutive weeks. Full relapse and partial relapse were defined as meeting full BDD criteria for at least 2 consecutive weeks after attaining full or partial remission respectively. Cox proportional hazards regression examined predictors of remission and relapse.

Results

Over 4 years, the cumulative probability was 0.20 for full remission and 0.55 for full or partial remission from BDD. A lower likelihood of full or partial remission was predicted by more severe BDD symptoms at intake, longer lifetime duration of BDD, and being an adult. Among partially or fully remitted subjects, the cumulative probability was 0.42 for subsequent full relapse and 0.63 for subsequent full or partial relapse. More severe BDD at intake and earlier age at BDD onset predicted full or partial relapse. Eighty-eight percent of subjects received mental health treatment during the follow-up period.

Conclusions

In this observational study, BDD tended to be chronic. Several intake variables predicted greater chronicity of BDD.

Keywords

Body dysmorphic disordercoursepredictorsrelapseremission
Type
Original Articles
Information
Psychological Medicine , Volume 43 , Issue 5 , May 2013 , pp. 1109 - 1117
Copyright
Copyright © Cambridge University Press 2012

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Bjornsson, AS, Dyck, I, Moitra, E, Stout, RL, Weisberg, RB, Keller, MB, Phillips, KA (2011). The clinical course of body dysmorphic disorder in the Harvard/Brown Anxiety Research Project (HARP). Journal of Nervous and Mental Disease 199, 55–57.CrossRefGoogle ScholarPubMed
Bruce, SE, Yonkers, KA, Otto, MW, Eisen, JL, Weisberg, RB, Pagano, M, Shea, MT, Keller, MB (2005). Influence of psychiatric comorbidity on recovery and recurrence in generalized anxiety disorder, social phobia, and panic disorder: a 12-year prospective study. American Journal of Psychiatry 162, 1179–1187.CrossRefGoogle ScholarPubMed
Buhlmann, U, Glaesmer, H, Mewes, R, Fama, JM, Wilhelm, S, Brahler, E, Rief, W (2010). Updates on the prevalence of body dysmorphic disorder: a population-based survey. Psychiatry Research 178, 171–175.CrossRefGoogle ScholarPubMed
Buhlmann, U, McNally, RJ, Etcoff, NL, Tuschen-Caffier, B, Wilhelm, S (2004). Emotion recognition deficits in body dysmorphic disorder. Journal of Psychiatric Research 38, 201–206.CrossRefGoogle ScholarPubMed
Coryell, W, Leon, A, Winokur, G, Endicott, J, Keller, M, Akiskal, H, Solomon, D (1996). Importance of psychotic features to long-term course in major depressive disorder. American Journal of Psychiatry 153, 483–489.Google ScholarPubMed
Cox, DR (1972). Regression models and life-tables. Journal of the Royal Statistical Society, Series B 34, 187–220.Google Scholar
Eisen, JL, Phillips, KA, Baer, L, Beer, DA, Atala, KD, Rasmussen, SA (1998). The Brown Assessment of Beliefs Scale: reliability and validity. American Journal of Psychiatry 155, 102–108.CrossRefGoogle ScholarPubMed
Eisen, JL, Pinto, A, Mancebo, MC, Dyck, IR, Orlando, ME, Rasmussen, SA (2010). A 2-year prospective follow-up study of the course of obsessive-compulsive disorder. Journal of Clinical Psychiatry 71, 1033–1039.CrossRefGoogle ScholarPubMed
First, MB, Spitzer, RL, Gibbon, M, Williams, JBW (1996). Structured Clinical Interview for DSM-IV Axis I Disorders: Non-Patient Edition (SCID-N/P). New York State Psychiatric Institute: New York.Google Scholar
Flint, AJ, Rifat, SL (1998). Two-year outcome of psychotic depression in late life. American Journal of Psychiatry 155, 178–183.CrossRefGoogle ScholarPubMed
Goisman, RM, Warshaw, MG, Peterson, LG, Rogers, MP, Cuneo, P, Hunt, MF, Tomlin-Albanese, JM, Kazim, A, Gollan, JK, Epstein-Kaye, T, Reich, JH, Keller, MB (1994). Panic, agoraphobia, and panic disorder with agoraphobia. Data from a multicenter anxiety disorders study. Journal of Nervous and Mental Disease 182, 72–79.CrossRefGoogle ScholarPubMed
Gunderson, JG, Stout, RL, McGlashan, TH, Shea, MT, Morey, LC, Grilo, CM, Zanarini, MC, Yen, S, Markowitz, JC, Sanislow, C, Ansell, E, Pinto, A, Skodol, AE (2011). Ten-year course of borderline personality disorder: psychopathology and function from the Collaborative Longitudinal Personality Disorders study. Archives of General Psychiatry 68, 827–837.CrossRefGoogle Scholar
Gunstad, J, Phillips, KA (2003). Axis I comorbidity in body dysmorphic disorder. Comprehensive Psychiatry 44, 270–276.CrossRefGoogle ScholarPubMed
Ipser, J, Sander, C, Stein, D (2009). Pharmacotherapy and psychotherapy for body dysmorphic disorder. Cochrane Database of Systematic Reviews (Online) 21, CD005332.Google Scholar
Keller, MB (2006). Social anxiety disorder clinical course and outcome: review of Harvard/Brown Anxiety Research Project (HARP) findings. Journal of Clinical Psychiatry 67 (Suppl. 12), 14–19.Google ScholarPubMed
Keller, MB, Lavori, PW, Coryell, W, Endicott, J, Meuller, TI (1998). Bipolar I: a five-year perspective follow-up. Journal of Nervous and Mental Disease 181, 238–245.CrossRefGoogle Scholar
Keller, MB, Lavori, PW, Friedman, B, Nielsen, E (1987). The Longitudinal Interval Follow-up Evaluation: a comprehensive method for assessing outcome in prospective longitudinal studies. Archives of General Psychiatry 44, 540–548.CrossRefGoogle ScholarPubMed
Koran, LM, Abujaoude, E, Large, MD, Serpe, RT (2008). The prevalence of body dysmorphic disorder in the United States adult population. CNS Spectrums 13, 316–322.CrossRefGoogle ScholarPubMed
Mancuso, S, Knoesen, N, Castle, DJ (2010). Delusional vs nondelusional body dysmorphic disorder. Comprehensive Psychiatry 51, 177–182.CrossRefGoogle Scholar
Nagy, LM, Krystal, JH, Woods, SW, Charney, DS (1989). Clinical and medication outcome after short-term alprazolam and behavioral group treatment in panic disorder. 2.5 year naturalistic follow-up study. Archives of General Psychiatry 46, 993–999.CrossRefGoogle ScholarPubMed
NICE (2006). Core Interventions in the Treatment of Obsessive Compulsive Disorder and Body Dysmorphic Disorder. National Institute for Health and Clinical Excellence (NICE) Clinical Guideline CG31 (www.nice.org.uk/page.aspx?o=289817). Accessed June 2011.Google Scholar
Noyes, R Jr., Reich, J, Christiansen, J, Suelzer, M, Pfohl, B, Coryell, WA (1990). Outcome of panic disorder. Relationship to diagnostic subtypes and comorbidity. Archives of General Psychiatry 47, 809–818.CrossRefGoogle ScholarPubMed
Phillips, KA (2011). Body image and body dysmorphic disorder. In Body Image: A Handbook of Science, Practice, and Prevention, 2nd edn (ed. Cash, T. F. and Smolak, L.), pp. 305–313. Guilford Press: New York.Google Scholar
Phillips, KA, Albertini, RS, Siniscalchi, JM, Khan, A, Robinson, M (2001). Effectiveness of pharmacotherapy for body dysmorphic disorder: a chart-review study. Journal of Clinical Psychiatry 62, 721–727.CrossRefGoogle ScholarPubMed
Phillips, KA, Diaz, SF (1997). Gender differences in body dysmorphic disorder. Journal of Nervous and Mental Disease 185, 570–577.CrossRefGoogle ScholarPubMed
Phillips, KA, Didie, ER, Feusner, J, Wilhelm, S (2008). Body dysmorphic disorder: treating an underrecognized disorder. American Journal of Psychiatry 165, 1111–1118.CrossRefGoogle ScholarPubMed
Phillips, KA, Grant, JE, Siniscalchi, JM, Stout, R, Price, LH (2005 a). A retrospective follow-up study of body dysmorphic disorder. Comprehensive Psychiatry 46, 315–321.CrossRefGoogle ScholarPubMed
Phillips, KA, Hollander, E, Rasmussen, SA, Aronowitz, BR, DeCaria, C, Goodman, WK (1997). A severity rating scale for body dysmorphic disorder: development, reliability, and validity of a modified version of the Yale-Brown Obsessive Compulsive Scale. Psychopharmacology Bulletin 33, 17–22.Google ScholarPubMed
Phillips, KA, McElroy, SL, Keck, PE, Pope, HG, Hudson, JI (1994). A comparison of delusional and nondelusional body dysmorphic disorder in 100 cases. Psychopharmacology Bulletin 30, 179–186.Google ScholarPubMed
Phillips, KA, Menard, W (2006). Suicidality in body dysmorphic disorder: a prospective study. American Journal of Psychiatry 163, 1280–1282.CrossRefGoogle ScholarPubMed
Phillips, KA, Menard, W, Fay, C, Pagano, ME (2005 b). Psychosocial functioning and quality of life in body dysmorphic disorder. Comprehensive Psychiatry 46, 254–260.CrossRefGoogle ScholarPubMed
Phillips, KA, Menard, W, Fay, C, Weisberg, R (2005 c). Demographic characteristics, phenomenology, comorbidity, and family history in 200 individuals with body dysmorphic disorder. Psychosomatics 46, 317–325.CrossRefGoogle ScholarPubMed
Phillips, KA, Menard, W, Pagano, ME, Fay, C, Stout, RL (2006 a). Delusional versus nondelusional body dysmorphic disorder: clinical features and course of illness. Journal of Psychiatric Research 40, 95–104.CrossRefGoogle ScholarPubMed
Phillips, KA, Pagano, ME, Menard, W, Fay, C, Stout, RL (2005 d). Predictors of remission from body dysmorphic disorder: a prospective study. Journal of Nervous and Mental Disease 193, 564–567.CrossRefGoogle ScholarPubMed
Phillips, KA, Pagano, ME, Menard, W, Stout, RL (2006 b). A 12-month follow-up study of the course of body dysmorphic disorder. American Journal of Psychiatry 163, 907–912.CrossRefGoogle ScholarPubMed
Phillips, KA, Wilhelm, S, Koran, LM, Didie, ER, Fallon, B, Fuesner, J, Stein, DJ (2010). Body dysmorphic disorder: some key issues for DSM-V. Depression and Anxiety 27, 573–591.CrossRefGoogle ScholarPubMed
Rief, W, Buhlmann, U, Wilhelm, S, Borkenhagen, A, Brahler, E (2006). The prevalence of body dysmorphic disorder: a population-based survey. Psychological Medicine 36, 877–885.CrossRefGoogle ScholarPubMed
Schwartz, RC, Cohen, BN, Grubaugh, A (1997). Does insight affect long-term inpatient treatment outcome in chronic schizophrenia? Comprehensive Psychiatry 38, 283–288.CrossRefGoogle ScholarPubMed
Shea, MT, Stout, RL, Yen, S, Pagano, ME, Skodol, AE, Morey, LC, Gunderson, JG, McGlashan, TH, Grilo, CM, Sanislow, CA, Bender, DS, Zanarini, MC (2004). Associations in the course of personality disorders and Axis I disorders over time. Journal of Abnormal Psychology 113, 499–508.CrossRefGoogle ScholarPubMed
Shea, MT, Yen, S (2003). Stability as a distinction between Axis I and Axis II disorders. Journal of Personality Disorders 17, 373–386.CrossRefGoogle ScholarPubMed
Soskis, DA, Bowers, MB (1969). The schizophrenic experience. A follow-up study of attitude and posthospital adjustment. Journal of Nervous and Mental Disease 149, 443–449.CrossRefGoogle ScholarPubMed
Steketee, G, Perry, JC, Goisman, RM, Warshaw, MG, Massion, AO, Peterson, LG, Langford, L, Weinshenker, N, Farreras, IG, Keller, MB (1997). The Psychosocial Treatment Interview for anxiety disorders: a method for assessing psychotherapeutic procedures in anxiety disorders. Journal of Psychotherapy Practice and Research 6, 194–210.Google ScholarPubMed
Warshaw, MG, Keller, MB, Stout, RL (1994). Reliability and validity of the Longitudinal Interval Follow-up Evaluation for assessing outcome of anxiety disorders. Journal of Psychiatric Research 28, 531–545.CrossRefGoogle ScholarPubMed
Wilhelm, S, Otto, MW, Lohr, B, Deckersbach, T (1999). Cognitive behavior group therapy for body dysmorphic disorder: a case series. Behaviour Research and Therapy 37, 71–75.CrossRefGoogle ScholarPubMed
Wilhelm, S, Phillips, KA, Fama, JM, Greenberg, JL, Steketee, G (2011). Modular cognitive-behavioral therapy for body dysmorphic disorder. Behavior Therapy 42, 624–633.CrossRefGoogle ScholarPubMed
Yonkers, KA, Bruce, SE, Dyck, IR, Keller, MB (2003). Chronicity, relapse, and illness – course of panic disorder, social phobia, and generalized anxiety disorder: findings in men and women from 8 years of follow-up. Depression and Anxiety 17, 173–179.CrossRefGoogle ScholarPubMed