Differentiating Body Dysmorphic Disorder from Normal Appearance Concerns and Other Mental Disorders

2017 ◽  
Author(s):  
Katharine A. Phillips
Keyword(s):  
Anxiety Disorder ◽  
Social Anxiety ◽  
Psychotic Disorders ◽  
Body Dysmorphic Disorder ◽  
Obsessive Compulsive ◽  
Normal Appearance ◽  
Compulsive Disorder ◽  
Illness Anxiety ◽  
Hair Pulling Disorder ◽  
Skin Picking Disorder

This chapter discusses differentiation of body dysmorphic disorder (BDD) from disorders that may be misdiagnosed as BDD or that present differential diagnosis challenges: eating disorders, major depressive disorder, obsessive-compulsive disorder, trichotillomania (hair-pulling disorder), excoriation (skin-picking) disorder, illness anxiety disorder, social anxiety disorder, agoraphobia, panic disorder, generalized anxiety disorder, schizophrenia and other psychotic disorders, gender dysphoria, avoidant personality disorder, olfactory reference syndrome, and several other constructs. This chapter also discusses how to differentiate BDD from normal appearance concerns and from problematic preoccupation with obvious physical defects.BDD is commonly misdiagnosed as another mental disorder. Sometimes misdiagnosis occurs because patients are too embarrassed and ashamed to reveal their appearance concerns; in such cases, BDD symptoms that are more readily observable (such as social anxiety) may be assigned an incorrect diagnosis while BDD goes undetected. In other cases, BDD symptoms are recognized but are misdiagnosed as another disorder. BDD must be differentiated from other conditions so appropriate treatment can be instituted.

scholarly journals Body Dysmorphic Disorder Insights in an Inpatient Psychiatric Setting

2021 ◽  
Vol 2021 ◽  
pp. 1-4
Author(s):  
Zachary A. Koenig ◽  
Sarah Callaham ◽  
Brittany Waltz ◽  
Julie Bosley ◽  
Raja Mogallapu ◽  
...  
Keyword(s):  
Anxiety Disorder ◽  
Social Anxiety ◽  
Obsessive Compulsive Disorder ◽  
Social Anxiety Disorder ◽  
Body Dysmorphic Disorder ◽  
The Body ◽  
Obsessive Compulsive ◽  
Compulsive Disorder ◽  
Psychiatric Setting ◽  
Significant Impairment

Body dysmorphic disorder is a chronic disorder involving imagined or partial appearance defects that lead to significant impairment in everyday life. It is quite prevalent but remains a clinically underdiagnosed psychiatric condition especially in the inpatient psychiatric setting. Onset of body dysmorphic disorder typically begins in adolescence with subclinical symptoms. Over time, symptoms progress to patients meeting the full Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) criteria. Severe cases of the body dysmorphic disorder are often camouflaged by concurrent diseases like major depressive disorder, obsessive-compulsive disorder, substance use disorder, and social anxiety disorder. Further, compounding the complexity of body dysmorphic disorder is a treatment of patients who present with coinciding suicidal ideations. Here, we present a unique case of a 40-year-old female admitted to an inpatient psychiatric unit for treatment of ongoing depression and suicidal symptoms. Early on in her inpatient course, she had symptoms of obsessive-compulsive disorder, social anxiety disorder, and alcohol use disorder. The constellation of symptoms prompted evaluation for body dysmorphic disorder and subsequent targeted treatment. This case report highlights the complexities associated with diagnosing body dysmorphic disorder, the importance of considering it a branch point for other psychiatric conditions, and the treatment for patients who present with coinciding suicidal behavior.

scholarly journals Long-Term Effectiveness and Cost-Effectiveness of Videoconference-Delivered Cognitive Behavioral Therapy for Obsessive-Compulsive Disorder, Panic Disorder, and Social Anxiety Disorder in Japan: One-Year Follow-Up of a Single-Arm Trial (Preprint)

2019 ◽  
Author(s):  
Kazuki Matsumoto ◽  
Sayo Hamatani ◽  
Kazue Nagai ◽  
Chihiro Sutoh ◽  
Akiko Nakagawa ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Anxiety Disorder ◽  
Social Anxiety ◽  
Panic Disorder ◽  
Social Anxiety Disorder ◽  
Behavioral Therapy ◽  
Obsessive Compulsive ◽  
Compulsive Disorder

BACKGROUND Face-to-face individual cognitive behavioral therapy (CBT) and internet-based CBT (ICBT) without videoconferencing are known to have long-term effectiveness for obsessive-compulsive disorder (OCD), panic disorder (PD), and social anxiety disorder (SAD). However, videoconference-delivered CBT (VCBT) has not been investigated regarding its long-term effectiveness and cost-effectiveness. OBJECTIVE The purpose of this study was to investigate the long-term effectiveness and cost-effectiveness of VCBT for patients with OCD, PD, or SAD in Japan via a 1-year follow-up to our previous 16-week single-arm study. METHODS Written informed consent was obtained from 25 of 29 eligible patients with OCD, PD, and SAD who had completed VCBT in our clinical trial. Participants were assessed at baseline, end of treatment, and at the follow-up end points of 3, 6, and 12 months. Outcomes were the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), Panic Disorder Severity Scale (PDSS), Liebowitz Social Anxiety Scale (LSAS), Patient Health Questionnaire–9 (PHQ-9), General Anxiety Disorder–7 (GAD-7), and EuroQol-5D-5L (EQ-5D-5L). To analyze long-term effectiveness, we used mixed-model analysis of variance. To analyze cost-effectiveness, we employed relevant public data and derived data on VCBT implementation costs from Japanese national health insurance data. RESULTS Four males and 21 females with an average age of 35.1 (SD 8.6) years participated in the 1-year follow-up study. Principal diagnoses were OCD (n=10), PD (n=7), and SAD (n=8). The change at 12 months on the Y-BOCS was −4.1 (<i>F</i><sub>1</sub>=4.45, <i>P</i>=.04), the change in PDSS was −4.4 (<i>F</i><sub>1</sub>=6.83, <i>P</i>=.001), and the change in LSAS was −30.9 (<i>F</i><sub>1</sub>=6.73, <i>P</i>=.01). The change in the PHQ-9 at 12 months was −2.7 (<i>F</i><sub>1</sub>=7.72, <i>P</i>=.007), and the change in the GAD-7 was −3.0 (<i>F</i><sub>1</sub>=7.09, <i>P</i>=.009). QALY at 12 months was 0.7469 (SE 0.0353, 95% Cl 0.6728-0.821), and the change was a significant increase of 0.0379 (<i>P</i>=.01). Total costs to provide the VCBT were ¥60,800 to ¥81,960 per patient. The set threshold was ¥189,500 ($1723, €1579, and £1354) calculated based on willingness to pay in Japan. CONCLUSIONS VCBT was a cost-effective way to effectively treat Japanese patients with OCD, PD, or SAD. CLINICALTRIAL University Hospital Medical Information Network Clinical Trials Registry UMIN000026609; https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000030495

Clinical Management of Obsessive-Compulsive and Related Disorders

2017 ◽  
Author(s):  
Samuel R Chamberlain
Keyword(s):  
Body Dysmorphic Disorder ◽  
Current Knowledge ◽  
Assessment Tools ◽  
Future Research ◽  
Obsessive Compulsive ◽  
Compulsive Disorder ◽  
Medical Issues ◽  
Evidence Based Treatments ◽  
Current Knowledge Base ◽  
Hair Pulling Disorder

Obsessive-compulsive and related disorders (OCRDs) now have their own category in the Diagnostic and Statistical Manual of Mental Disorders, fifth edition. Disorders currently classified as OCRDs are obsessive-compulsive disorder, trichotillomania (hair pulling disorder), excoriation (skin picking) disorder, hoarding disorder, and body dysmorphic disorder. Collectively, the OCRDs are prevalent, cause considerable functional impairment, and are often overlooked by clinicians. This review surveys current definitions and diagnosis of OCRDs, highlighting recommended assessment tools, differential diagnoses, and medical issues. The heritability of OCRDs is examined, based on available twin data, along with implicated genetic factors. Neurobiological understanding of OCRDs is outlined, focusing on dysregulation of habit generation and top-down response control corticostriatal pathways. The review then highlights evidence-based treatments for OCRDs, which differ considerably between individual disorders. Treatment guidance includes descriptions of target medication doses and therapy content. Lastly, limitations in the current knowledge base for OCRDs are reviewed, with implications for future research directions. This review contains 1 figure, 7 tables, and 40 references. Key words: compulsivity, dopamine, glutamate, impulsivity, screening for OCD, serotonin 

scholarly journals Psychopharmacotherapy of Obsessive-Compulsive Symptoms within the Framework of Tourette Syndrome

2019 ◽  
Vol 17 (8) ◽  
pp. 703-709 ◽  
Author(s):  
Aribert Rothenberger ◽  
Veit Roessner
Keyword(s):  
Drug Treatment ◽  
Tourette Syndrome ◽  
Clinical Symptoms ◽  
Behavioral Therapy ◽  
Stress Sensitivity ◽  
Obsessive Compulsive ◽  
Obsessive Compulsive Symptoms ◽  
Compulsive Disorder ◽  
Hair Pulling Disorder ◽  
Skin Picking Disorder

: While Behavioral Therapy (BT) should be recommended as the first step in the treatment of OCD as well as TS, medication can be added for augmentation and in certain situations (e.g. family preference, BT not available or feasible) the priority may even reverse. This narrative review is given on the complexity of drug treatment in patients comorbid with obsessive-compulsive disorder (OCD) and Tourette syndrome (TS) and other tic problems. OCD with TS is a co-occurring combination of the two generally delimitable, but in detail, also overlapping disorders which wax and wane with time but have different courses as well as necessities and options of treatment. Distinct subtypes like “tic-related OCD” are questionable. Obsessive-compulsive symptoms (OCS) and tics are frequently associated (OCS in TS up to 90%, tics in OCD up to 37%). Sensory-motor phenomena like urges and just-right feelings reflect some behavioral overlap. The main additional psychopathologies are attention-deficit hyperactivity disorder (ADHD), mood problems and anxiety. Also, hair pulling disorder and skin picking disorder are related to OCD with TS. Hence, the assessment and drug treatment of its many psychopathological problems need high clinical experience, careful planning, and ongoing evaluation/adaptation. Drugs are able to reduce clinical symptoms but cannot cure the disorders, which should be treated in parallel in their own right; i.e. for OCD serotonin reuptake inhibitors (SSRI) and for TS (tics), certain antipsychotics can be successfully prescribed. In cases of OCD with tics, when OCS responds only partially, an augmentation with antipsychotics (recommended: risperidone and aripiprazole) may improve OCS as well as tics. Also, the benzamide sulpiride, an atypical antipsychotics, may be beneficial in treating the combination of OCS, tics and anxious-depressive problems. : Probably, any additional psychopathologies of OCD might attenuate the effectiveness of SSRI on OCS; on the other hand, in cases of OCD with tics, SSRI may reduce not only OCS but also stress sensitivity and emotional problems and thus leading to better selfregulatory abilities, useful to improve tic suppression. : In sum, some clinical guidance can be given, but there remain many uncertainties because of a scarce database for psychopharmacotherapy in OCD with TS.

scholarly journals A Brazilian version of the "Children's Interview for Psychiatric Syndromes" (ChIPS)

2009 ◽  
Vol 58 (2) ◽  
pp. 115-118 ◽  
Author(s):  
Isabella G. S. de Souza ◽  
Maria Antonia Serra-Pinheiro ◽  
Renata Mousinho ◽  
Paulo Mattos
Keyword(s):  
Anxiety Disorder ◽  
Psychotic Disorders ◽  
Separation Anxiety ◽  
Child And Adolescent Psychiatry ◽  
Brazilian Portuguese ◽  
Separation Anxiety Disorder ◽  
Obsessive Compulsive ◽  
Children And Adolescent ◽  
Compulsive Disorder ◽  
Oppositional Defiant

OBJETIVE: The advance of research in child and adolescent psychiatry in Brazil heavily depends on the existence of instruments for the investigation of psychiatric syndromes adapted to Brazilian Portuguese. METHODS: This article describes a careful process of translation of the Children's Interview for Psychiatric Syndromes for the purpose of use in research in Brazil. The Children's Interview for Psychiatric Syndromes has a version for parents (P-ChIPs) and a version for children (ChIPS). In this article, the sections of P-ChIPS referring to attention-deficit hyperactivity disorder, oppositional-defiant disorder, conduct disorder, mania/hypomania, anorexia nervosa, bulimia nervosa and psychotic disorders were translated to Brazilian Portuguese. The sections of the ChIPS referring to substance use disorders, social anxiety disorder, specific phobias, obsessive-compulsive disorder, generalized anxiety disoder, separation anxiety disorder, post-traumatic disorders and depression/dysthimia were also adapted. Each section was translated by two independent translators and later discussed in a committee composed of experts in the field of Psychiatry and a professional of the field of linguistics. RESULT: A final version containing an interview for the main psychiatric syndromes was defined. CONCLUSION: The translated P-ChIPS is a helpful instrument in children and adolescent clinical evaluation.

Anxiety Disorders

2017 ◽  
Author(s):  
Ambreen Ghori ◽  
Aarti Gupta
Keyword(s):  
Anxiety Disorder ◽  
Anxiety Disorders ◽  
Body Dysmorphic Disorder ◽  
Stress Disorder ◽  
Acute Stress ◽  
Medical Condition ◽  
Generalized Anxiety ◽  
Obsessive Compulsive ◽  
Compulsive Disorder ◽  
General Medical Condition

This chapter reviews topics on anxiety disorders including panic disorder, specific phobia, social anxiety disorder, obsessive-compulsive disorder, posttraumatic stress disorder, acute stress disorder, generalized anxiety disorder, anxiety disorder due to a general medical condition, Substance/medication-induced anxiety disorder and body dysmorphic disorder

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