title: Severe obsessive-compulsive disorder with and without body dysmorphic disorder: clinical correlates and implications.
abstract: 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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: McLean Hospital Obsessive-Compulsive Disorder Institute, Belmont, MA, USA.
authors.forename: S Evelyn
authors.initials: SE
authors.lastname: Stewart
authors.forename: Denise Egan
authors.initials: DE
authors.lastname: Stack
authors.forename: Sabine
authors.initials: S
authors.lastname: Wilhelm
mesh_terms: D000328:Adult; D001828:Body Image; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D017533:Marital Status; D008404:Massachusetts; D008875:Middle Aged; D009771:Obsessive-Compulsive Disorder / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D010343:Patient Admission; D012737:Sex Factors; D019966:Substance-Related Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology