title: Delusional versus nondelusional body dysmorphic disorder: recommendations for DSM-5.
abstract: The core feature of body dysmorphic disorder (BDD) is distressing or impairing preoccupation with nonexistent or slight defects in one's physical appearance. BDD beliefs are characterized by varying degrees of insight, ranging from good (ie, recognition that one's BDD beliefs are not true) through "absent insight/delusional" beliefs (ie, complete conviction that one's BDD beliefs are true). The Diagnostic and Statistical Manual of Mental Disorders, 3rd ed., rev. (DSM-III-R) and The Diagnostic and Statistical Manual of Mental Disorders, 4th ed. (DSM-IV) classified BDD's nondelusional form in the somatoform section of the manual and its delusional form in the psychosis section, as a type of delusional disorder, somatic type (although DSM-IV allowed double-coding of delusional BDD as both a psychotic disorder and BDD). However, little or no evidence on this issue was available when these editions were published. In this article, we review the classification of BDD's delusional and nondelusional variants in earlier editions of DSM and the limitations of their approaches. We then review empirical evidence on this topic, which has become available since DSM-IV was developed. Available evidence indicates that across a range of validators, BDD's delusional and nondelusional variants have many more similarities than differences, including response to pharmacotherapy. Based on these data, we propose that BDD's delusional and nondelusional forms be classified as the same disorder and that BDD's diagnostic criteria include an insight specifier that spans a range of insight, including absent insight/delusional BDD beliefs. We hope that this recommendation will improve care for patients with this common and often-severe disorder. This increased understanding of BDD may also have implications for other disorders that have an "absent insight/delusional" form.
authors: 1 Body Dysmorphic Disorder Program, Rhode Island Hospital, Providence, Rhode Island, USA.
authors: Katharine A
authors: KA
authors: Phillips
authors: 1 Body Dysmorphic Disorder Program, Rhode Island Hospital, Providence, Rhode Island, USA.
authors: Ashley S
authors: AS
authors: Hart
authors: 3 Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, New York, USA.
authors: Helen Blair
authors: HB
authors: Simpson
authors: 5 Department of Psychiatry, University of Cape Town, Cape Town, South Africa.
authors: Dan J
authors: DJ
authors: Stein
mesh_terms: D057215:Body Dysmorphic Disorders / Q000145:classification / Q000523:psychology*; D001828:Body Image; D003702:Delusions / Q000145:classification / Q000523:psychology*; D039721:Diagnostic and Statistical Manual of Mental Disorders; D006801:Humans; D011569:Psychiatric Status Rating Scales
references: Hosp Community Psychiatry. 1968 Jun;19(6):169-74
references: 5661463
references: J Psychiatr Res. 2006 Mar;40(2):95-104
references: 16229856
references: J Psychiatr Res. 1994 Nov-Dec;28(6):531-45
references: 7699612
references: Am J Psychiatry. 2006 May;163(5):907-12
references: 16648334
references: Psychiatry Res. 1985 Feb;14(2):131-42
references: 3857653
references: Clin Schizophr Relat Psychoses. 2011 Oct;5(3):147-54
references: 21983499
references: J Pers Disord. 2012 Jun;26(3):345-56
references: 22686223
references: Compr Psychiatry. 2004 Jan-Feb;45(1):10-5
references: 14671731
references: Psychol Med. 2011 Sep;41(9):1951-61
references: 21211101
references: Am J Psychiatry. 1994 Aug;151(8):1132-6
references: 8037246
references: Arch Gen Psychiatry. 1965 Jan;12:63-70
references: 14221692
references: Schizophr Bull. 2007 Jul;33(4):877-85
references: 17548842
references: J Nerv Ment Dis. 1993 Nov;181(11):699-702
references: 8228952
references: Psychopharmacol Bull. 1994;30(2):179-86
references: 7831453
references: Psychopharmacol Bull. 1997;33(1):17-22
references: 9133747
references: J Nerv Ment Dis. 2000 Mar;188(3):170-5
references: 10749282
references: Arch Gen Psychiatry. 2002 Apr;59(4):381-8
references: 11926939
references: J Clin Psychiatry. 1993 Oct;54(10):389-95
references: 8262881
references: J Psychiatr Pract. 2007 Mar;13(2):65-71
references: 17414681
references: Am J Psychiatry. 2005 Feb;162(2):377-9
references: 15677604
references: Compr Psychiatry. 2010 Mar-Apr;51(2):177-82
references: 20152299
references: J Clin Psychiatry. 2001 Feb;62(2):87-91
references: 11247107
references: Am J Psychiatry. 1998 Jan;155(1):102-8
references: 9433346
references: Depress Anxiety. 2010 Jun;27(6):507-27
references: 20217853
references: Compr Psychiatry. 2005 Sep-Oct;46(5):315-21
references: 16122530
references: Child Abuse Negl. 2006 Oct;30(10):1105-15
references: 17005251
references: CNS Spectr. 2009 May;14(5):252-60
references: 19407724
references: Behav Res Ther. 1998 Apr;36(4):455-70
references: 9670605
references: Int Clin Psychopharmacol. 2006 May;21(3):177-9
references: 16528140
references: J Psychosom Res. 1998 May;44(5):565-71
references: 9623877
references: Am J Psychiatry. 1991 Sep;148(9):1138-49
references: 1882990
references: J Clin Psychiatry. 2001 Sep;62(9):721-7
references: 11681769
references: Depress Anxiety. 2010 Jun;27(6):556-72
references: 20336805
references: Psychopharmacol Bull. 1996;32(1):175-80
references: 8927669
references: Arch Gen Psychiatry. 1999 Nov;56(11):1033-9
references: 10565503
references: J Clin Psychiatry. 2003 Jun;64(6):715-20
references: 12823088
references: J Nerv Ment Dis. 1978 May;166(5):317-26
references: 650195
references: J Psychiatr Res. 2012 Oct;46(10):1293-9
references: 22819678
references: Psychol Med. 2013 May;43(5):1109-17
references: 23171833
references: CNS Spectr. 2008 Apr;13(4):316-22
references: 18408651
references: Depress Anxiety. 2010 Jun;27(6):573-91
references: 20533368