Journal Title:  Annals of Clinical Psychiatry | Vol:  20 | Issue:  1 | Year:  2008   
Print ISSN:  1040-1237 | Online ISSN:  1547-3325   

Severe Obsessive-Compulsive Disorder with and without Body Dysmorphic Disorder: Clinical Correlates and Implications

S. Evelyn Stewart MD
Denise Egan Stack MA
Sabine Wilhelm PhD

pages: 33 - 38


Objective. Body Dysmorphic Disorder is a putative obsessive-compulsive spectrum disorder. This exploratory study systematically examined prevalence and clinical correlates of Body Dysmorphic Disorder (BDD) comorbidity in an inpatient Obsessive-Compulsive Disorder (OCD) population.

Method. Consecutive patients from an OCD Intensive Residential Treatment program were included (N = 275). Clinician-rated and patient-rated measures were administered at baseline and repeated at discharge. The prevalence of BDD was determined and clinical characteristics were statistically compared between groups with (N = 42) and without (N = 233) comorbid BDD.

Results. The prevalence of BDD among residential patients with OCD was 15.3% (N = 42). Those with comorbid BDD were younger ( p = 0.007) and more predominantly female ( p = 0.02), with lower marriage rates ( p = 0.006), more severe depression ( p = 0.003) and increased self-reported illicit substance use histories ( p = 0.003) versus those without BDD. This cohort also had earlier onset OCD ( p = 0.02) and more severe hoarding ( p = 0.01), symmetry ( p = 0.01), reassurance-seeking ( p = 0.01) and checking symptoms ( p = 0.01) than patients without comorbid BDD. OCD treatment response was unaffected by the presence of BDD.

Conclusion. BDD is a common comorbidity in severe OCD. Younger women and those with early-onset OCD appear more likely to have BDD. OCD patients with BDD also have increased hoarding, symmetry, reassurance-seeking and checking severity, which requires consideration in treatment planning.