Prevalence and Clinical Features of Body Dysmorphic Disorder in Adolescent and Adult Psychiatric Inpatients

Background: The rate of body dysmorphic disorder (BDD) in inpatient psychiatric settings and the nature of the presenting complaints are unknown. Because of the shame and humiliation that BDD patients suffer, we hypothesized that, unless specifically screened for at the time of admission, BDD would be underdiagnosed in psychiatric inpatients.

Method: 101 consecutive adult patients and 21 consecutive adolescent patients presenting for psychiatric inpatient admission to a university teaching hospital participated in the study. Subjects completed the Body Dysmorphic Disorder Questionnaire, a brief self-report measure that screens for BDD, and a follow-up interview was conducted using a reliable clinician-administered semistructured diagnostic instrument for DSM-IV BDD. Data concerning current diagnoses, number of hospitalizations, number of suicide attempts, and current level of functioning were also obtained.

Results: Sixteen (13.1%) of the 122 subjects were diagnosed with BDD. None of the subjects with BDD had been diagnosed with BDD by their treating physician during hospitalization. All 16 subjects reported that they would not raise the issue with their physician unless specifically asked due to feelings of shame.

Conclusion: These preliminary results suggest that BDD, an underrecognized and often severe psychiatric disorder, may be relatively common in the psychiatric inpatient setting. It is important that clinicians specifically inquire about BDD because patients will not voluntarily raise these concerns. The comorbidity of this disorder with other psychiatric illnesses may have treatment implications.