Suicidality and Aggressive Behavior in Body Dysmorphic Disorder

Suicide Attempts ◽

Violent Behavior ◽

Clinical Samples ◽

Obsessive Compulsive ◽

Compulsive Disorder ◽

Completed Suicide ◽

Increased Risk

This chapter reviews suicidality and aggressive/violent behavior in body dysmorphic disorder (BDD) and presents clinical cases, which reflect the extreme suffering that BDD often causes. Suicidal ideation and suicide attempts are common in BDD. This has been found in both clinical and epidemiologic samples and in adults as well as youth. More severe BDD symptoms are independently associated with an increased risk of suicidal ideation and suicide attempts. Suicidality appears more common in BDD than in obsessive-compulsive disorder and other clinical samples with which BDD has been directly compared. Although data are limited, the rate of completed suicide appears markedly elevated; indeed, individuals with BDD have many risk factors for completed suicide. Physical aggression and violence are less well studied but appear to commonly occur as a consequence of BDD. Surgeons, dermatologists, and other clinicians who provide cosmetic treatment may be at particular risk. Additional studies designed to investigate these topics are urgently needed.

Increased Risk of Attempted and Completed Suicide in Obsessive Compulsive Disorder: A Systematic Review of Follow-up Studies

Global Psychiatry ◽

10.2478/gp-2018-0009 ◽

2018 ◽

Vol 1 (2) ◽

pp. 61-70

Author(s):

Reinhard Heun

Keyword(s):

High Risk ◽

General Population ◽

Suicide Attempts ◽

Obsessive Compulsive ◽

Compulsive Disorder ◽

Completed Suicide ◽

Increased Risk

AbstractObsessive compulsive disorder (OCD) is a severe, often long-term mental disorder. It may be independent from, or comorbid with other mental disorders, especially depression and anxiety disorders. Suicidal thoughts, ideations and ruminations are prevalent in subjects with OCD, but it is not yet clear if the incidences of attempted and completed suicides have increased in comparison with the general population and with other psychiatric disorders.MethodsWe conducted a systematic literature search on the incidence of suicide attempts and completed suicides in subjects with OCD. Search terms for Pubmed and Medline were OCD and suicide. We selected papers providing follow-up data on the incidence of attempted and completed suicide in OCD.Results404 papers were initially identified. Only 8 papers covering six studies provided prospective data on attempted or completed suicide over a defined period in subjects with OCD, four studies included control subjects. Two studies providing follow-up data were limited to high-risk samples and did not provide enough data on the incidence of suicide in comparison with the general population. The conclusion that there is an increased risk of attempted and completed suicides in OCD can only be based on one large Swedish National Registry sample with an up to 44 year follow up. Psychiatric comorbidity is the most relevant risk factor for suicide.ConclusionsEven though some studies report an increased incidence of attempted and completed suicides in OCD patients from selected high risk samples, the evidence from population based studies is mostly based on one large Swedish study. More long-term studies in the general population with a reduced risk of subject attrition are needed. Using a clear definition and assessment of suicidal behaviour and a common time-frame would improve the comparability of future studies.

Body Dysmorphic Disorder

The British Journal of Psychiatry ◽

10.1192/bjp.169.2.196 ◽

1996 ◽

Vol 169 (2) ◽

pp. 196-201 ◽

Cited By ~ 354

Author(s):

David Veale ◽

Ann Boocock ◽

Kevin Gournay ◽

Windy Dryden ◽

Fozia Shah ◽

...

Keyword(s):

Suicide Attempts ◽

Age At Onset ◽

Obsessive Compulsive ◽

Cross Sectional ◽

Compulsive Disorder ◽

Primary Disorder ◽

The Usa ◽

Axis I ◽

High Degree

BackgroundBody dysmorphic disorder (BDD) consists of a preoccupation with an ‘imagined’ defect in appearance which causes significant distress or impairment in functioning. There has been little previous research into BDD. This study replicates a survey from the USA in a UK population and evaluates specific measures of BDD.MethodCross-sectional interview survey of 50 patients who satisfied DSM–IV criteria for BDD as their primary disorder.ResultsThe average age at onset was late adolescence and a large proportion of patients were either single or divorced. Three-quarters of the sample were female. There was a high degree of comorbidity with the most common additional Axis I diagnosis being either a mood disorder (26%), social phobia (16%) or obsessive–compulsive disorder (6%). Twenty-four per cent had made a suicide attempt in the past. Personality disorders were present in 72% of patients, the most common being paranoid, avoidant and obsessive–compulsive.ConclusionsBDD patients had a high associated comorbidity and previous suicide attempts. BDD is a chronic handicapping disorder and patients are not being adequately identified or treated by health professionals.

Suicide Risk in Obsessive-Compulsive Disorder and Exploration of Risk Factors: A Systematic Review

Current Neuropharmacology ◽

10.2174/1570159x16666180620155941 ◽

2019 ◽

Vol 17 (8) ◽

pp. 681-696 ◽

Cited By ~ 14

Author(s):

Umberto Albert ◽

Diana De Ronchi ◽

Giuseppe Maina ◽

Maurizio Pompili

Keyword(s):

Suicidal Ideation ◽

Suicide Risk ◽

Suicide Attempts ◽

Quantitative Measure ◽

Epidemiological Studies ◽

Clinical Samples ◽

Prevalence Rates ◽

Compulsive Disorder ◽

History Of ◽

Axis I

Background: Historically, OCD has been considered to be associated with a relatively low risk of suicide. Recent studies, on the contrary, revealed a significant association between OCD and suicide attempts and ideation. A huge variation in prevalence rates, however, is reported. Objective: To estimate prevalence rates of suicide attempts and suicidal ideation in individuals with OCD, and to identify predictors of suicide risk among subjects with OCD. Methods: We systematically reviewed the literature on suicide risk (ideation and/or attempts) and OCD. We included studies with appropriate definition of OCD, cross-sectional or prospective design, separating clinical samples from epidemiological studies, that employed a quantitative measure of suicidality and/or reported an outcome measure of the association between suicidality and OCD or examined factors associated with suicidality. Results: In clinical samples, the mean rate of lifetime suicide attempts is 14.2% (31 studies: range 6- 51.7%). Suicidal ideation is referred by 26.3-73.5% of individuals (17 studies, mean 44.1%); current suicidal ideation rate ranges between 6.4 and 75% (13 studies, mean 25.9). Epidemiological studies found that OCD increases significantly the odds of having a lifetime suicidal ideation as compared to the general population (OR: 1.9-10.3) and a history of lifetime suicide attempts (OR: 1.6- 9.9). Predictors of greater suicide risk are severity of OCD, the symptom dimension of unacceptable thoughts, comorbid Axis I disorders, severity of comorbid depressive and anxiety symptoms, past history of suicidality and some emotion-cognitive factors such as alexithymia and hopelessness. Conclusion: Overall, suicidality appears a relevant phenomenon in OCD.

Obsessive-Compulsive Disorder, Body Dysmorphic Disorder, and Hypochondriasis: Three Variations on a Theme

CNS Spectrums ◽

10.1017/s1092852900002613 ◽

1996 ◽

Vol 1 (2) ◽

pp. 24-31 ◽

Cited By ~ 1

Author(s):

Stephen C. Josephson ◽

Eric Hollander ◽

Brian Fallon ◽

Dan J. Stein

Keyword(s):

Behavioral Treatment ◽

Behavioral Therapy ◽

Response To Treatment ◽

Clinical Samples ◽

Cognitive Behavioral Treatment ◽

Analysis Model ◽

Obsessive Compulsive ◽

Compulsive Disorder

AbstractBackground:Exaggerated illness and appearance concerns and related compulsive behaviors are seen in the psychiatric disorders of hypochondriasis (HYP), body dysmorphic disorder (BDD), and obsessive-compulsive disorder (OCD). It has been argued that these conditions may cluster in clinical samples and that our current categorical diagnostic policies, which assume independence of these disorders, are arbitrary and fail to capture the dimensional nature of these disorders.Methods:We present retrospective clinical data on 21 randomly selected patients who presented with symptoms that involved anxiety about illness and appearance and who were evaluated for cognitive-behavioral treatment or pharmacotherapy. We also review the symptoms, associated features, and response to treatment of three patients from the sample who were each diagnosed with all three of these disorders (HYP, BDD, and OCD).Results:Three patients met criteria for HYP, BDD, and OCD, and the other 18 patients met criteria for at least two of the above conditions. The most frequently reported source of anxiety had to do with one's hair. Nine out of the 12 patients treated with behavioral therapy were considered to be responders, and the one treated solely with medication was “very much improved.” Of the eight treated with a combination of behavioral therapy and medication, five were judged to be responders.Conclusions:Overlap in phenomenology, associated features, and treatment response suggests that these three disorders may be difficult to distinguish from each other and that a “cluster analysis” model may prove helpful in evaluating clinical samples.

Variables de riesgo y protección relacionadas con la tentativa de suicidio

Revista de Psicopatología y Psicología Clínica ◽

10.5944/rppc.vol.23.num.3.2018.19106 ◽

2019 ◽

Vol 23 (3) ◽

pp. 221

Author(s):

David Sánchez-Teruel ◽

José Antonio Muela-Martínez ◽

Ana García-León

Keyword(s):

Suicidal Ideation ◽

Suicide Attempts ◽

Public Health Problem ◽

Suicidal Attempt ◽

Important Public Health Problem ◽

Psychological Variables ◽

Completed Suicide ◽

Increased Risk ◽

Predictive Behavior

Abstract: Risk and protection variables related to suicidal attempt. Suicide is an important public health problem, being the suicidal attempt the most predictive behavior of completed suicide. The aim of this study was to detect if there are differences in psychosocial and emotional variables in people with and without suicidal ideation and attempt. The sample consisted of 166 participants (86.36% women), aged between 20 and 77 years (M= 36, SD= 14.12) with and without suicide attempts, which was in turn divided into three groups through the Scale of Suicidal Ideation. The results show that there are important differences between the three groups in the psychological variables measured. We discuss the role of psychosocial variables, which are at the base of the increased risk or protection towards the ideation or suicidal attempt, to promote public suicide prevention policies more focused on those clinical subpopulations with specific risk profiles.Resumen: El suicidio es un importante problema de salud pública, siendo la tentativa de suicidio la conducta más predictiva del suicidio consumado. Mediante el presente estudio se pretende detectar si existen diferencias en variables psicosociales y emocionales en personas con y sin ideación y tentativa suicida. La muestra estuvo constituida por 166 participantes (86.36 % mujeres), con edades comprendidas entre los 20 y 77 años (M= 36; DT= 14.12) con y sin tentativas suicidas, que fue a su vez dividida en tres grupos a través de la Escala de Ideación Suicida. Los resultados muestran que existen importantes diferencias entre los tres grupos en las variables psicológicas medidas. Se discute el papel de las variables psicosociales, que están en la base del incremento del riesgo o protección hacia la ideación o tentativa suicida, para propiciar políticas públicas de prevención del suicidio más centradas en aquellas subpoblaciones clínicas con perfiles de riesgo concretos.

The Pathways of Aggression – Differential Indirect Associations Between Anxiety Sensitivity Cognitive Concerns and Suicidality

Crisis ◽

10.1027/0227-5910/a000725 ◽

2020 ◽

pp. 1-8

Author(s):

Rachel L. Martin ◽

Nicole S. Smith ◽

Nicole M. Caulfield ◽

Daniel W. Capron

Keyword(s):

Suicidal Ideation ◽

Anxiety Sensitivity ◽

Physical Aggression ◽

Indirect Effects ◽

Suicide Risk ◽

Suicide Attempts ◽

Verbal Aggression ◽

Cross Sectional ◽

Increased Risk ◽

Foundational Research

Abstract. Background: Suicide prevention efforts have focused on risk factors that help identify people with an increased risk for suicide. One risk factor related to suicide risk is anxiety sensitivity cognitive concerns (ASCC), which is the "fear of going crazy." The association between ASCC and suicidal ideation is hypothesized to result from the depression–distress amplification model, which postulates that ASCC exacerbates feelings of depression and concurrent distress. Furthermore, there is evidence for associations between ASCC/dysregulated anger and dysregulated anger/suicidal ideation. We hypothesized that aggression may provide pathways from ASCC to suicidality. The current study examined how facets of aggression (described as elevated agitation) meditated the association between ASCC and suicidality. Aims: The current study aimed to extend prior research by examining how different facets of aggression mediate the association between ASCC and suicidality. Method: Participants were 440 adults recruited online, 32.7% of whom endorsed experiencing lifetime suicidal ideation. Results: Our hypotheses were partially supported with two significant indirect effects. Results indicated that physical aggression and hostility provided significant indirect effects; however, verbal aggression and anger did not. Limitations: The study was cross-sectional in nature, limiting causal interpretations about the indirect effects. The sample included primarily White participants. Conclusion: Specific facets of aggression provide pathways through which ASCC is associated with suicidality. Aggression may be a catalyst for individuals to progress to suicidality. The current study provides foundational research for continued examination of physical aggression as a catalyst for suicide attempts.

The Relationship of Body Dysmorphic Disorder to Obsessive-Compulsive Disorder and the Concept of the Obsessive-Compulsive Spectrum

10.1093/med/9780190254131.003.0034 ◽

2017 ◽

Cited By ~ 1

Author(s):

Jessica Simberlund ◽

Eric Hollander

Keyword(s):

Suicide Attempts ◽

Obsessive Compulsive ◽

Major Depressive ◽

Compulsive Disorder ◽

Compulsive Behaviors ◽

Genetic And Environmental Factors ◽

Relationship Of ◽

The Relationship

This chapter describes the relationship of body dysmorphic disorder (BDD) to obsessive-compulsive disorder (OCD) and the concept of the obsessive-compulsive spectrum. BDD is proposed to be part of an obsessive-compulsive spectrum of disorders, given its many similarities to OCD. OCD and BDD are both characterized by obsessions and compulsions, although in BDD individuals focus specifically on body image concerns, whereas in OCD they typically focus on concerns such as contamination, harm, and aggression. Distress that results from obsessions usually generates compulsive behaviors intended to reduce emotional discomfort. Individuals with BDD are more likely to have delusional beliefs and significantly poorer insight. Individuals with BDD report higher rates of major depressive disorder, substance use disorders, suicidal thoughts, and suicide attempts. OCD and BDD demonstrate familiality, indicating that they are likely related conditions. OCD and BDD are thought to be heterogeneous disorders that result from both genetic and environmental factors, some of which appear to be shared; for example, they appear to share some abnormalities involving the basal ganglia and limbic system (specifically the caudate nucleus).

Case Report: Effect of Electroconvulsive Therapy on Obsessive-Compulsive Disorder Comorbid With Body Dysmorphic Disorder

Frontiers in Psychiatry ◽

10.3389/fpsyt.2021.706506 ◽

2021 ◽

Vol 12 ◽

Author(s):

Xiaoyan Ma ◽

Ranli Li

Keyword(s):

Drug Treatment ◽

Electroconvulsive Therapy ◽

Psychiatric Comorbidity ◽

Obsessive Compulsive ◽

Compulsive Disorder ◽

Increased Risk ◽

Modified Electroconvulsive Therapy ◽

Considerable Morbidity

Obsessive-compulsive disorder (OCD) is a chronic psychiatric condition that is associated with considerable morbidity, and ~90% of individuals with OCD have another psychiatric comorbidity. Patients with comorbid OCD and body dysmorphic disorder (BDD) have limited insight and poor psychosocial function, respond poorly to drug treatment, and have an increased risk of suicide. Modified electroconvulsive therapy (ECT) has been attempted to improve symptoms of OCD when drug treatment does not have a satisfactory effect. This report describes a patient who had OCD comorbid with BDD that was successfully treated with modified ECT. Although the mechanism of its effect is unclear, modified ECT may be an alternative treatment for patients with comorbid OCD and BDD. Its efficacy and mechanism of action require further investigation in a large sample of patients with these comorbid disorders.

Suicidal Ideations in Patients With Obsessive-Compulsive Disorder

Caspian Journal of Neurological Sciences ◽

10.32598/cjns.8.28.287.1 ◽

2022 ◽

Vol 8 (1) ◽

pp. 39-48

Author(s):

Mohammadrasoul Khalkhali ◽

◽

Roghaye Zare ◽

Hassan Farrahi ◽

Peyvand Shambayati ◽

...

Keyword(s):

Suicidal Ideation ◽

Rating Scale ◽

Suicide Attempts ◽

Previous History ◽

Obsessive Compulsive ◽

Cross Sectional ◽

Compulsive Disorder ◽

First Degree Relatives ◽

History Of

Background: There are many controversies about the frequency and burden of suicidality in patients with Obsessive-Compulsive Disorder (OCD). Objectives: This study was done to determine the prevalence and risk factors of current suicidal ideations in patients with OCD. Materials & Methods: In this cross-sectional study, 258 outpatients with OCD (Yale-Brawn Obsessive Compulsive Scale, Y-BOCS ≥16) referring to two psychiatry clinics in Guilan, Iran, from March 2018 to September 2019 were evaluated. Suicidality score of the Brief Psychiatric Rating Scale (BPRS) ≥4 was considered for current suicidal ideation at the first visit. Beck Scale for Suicidal Ideation (BSSI) was used to evaluate the intensity of suicidal ideations a week before evaluation. Simple linear and binary logistic regression analyses were used to analyze data by SPSS v. 20. Results: Current suicidal ideation was found in 22.1% of patients. The previous history of suicide attempt (BPRS, P<0.0001 and BSSI, P<0.0001), a history of OCD in first-degree relatives (BPRS: P=0.004 and BSSI: P=0.010), a history of suicide attempts in first-degree relatives (BPRS: P=0.013 and BSSI: P<0.0001), comorbid diagnosis of depressive or body dysmorphic disorder (BPRS, P<0.0001 and BSSI, P<0.0001), and higher Y-BOCS score (BPRS: P=0.043 and BSSI: P<0.0001) were associated with a higher risk of having suicidal ideation. Conclusion: Suicidal thoughts are high in Iranian patients with OCD at their first visit to psychiatry clinics. The previous suicide history, positive history of OCD and suicide attempts in their first-degree relatives, the severity of OCD, and some comorbid psychological disorders are associated with a higher risk of suicidal ideation among OCD patients.