title: Age at onset and clinical correlates in body dysmorphic disorder.
abstract: OBJECTIVE
  Age at onset is an important clinical feature of all disorders. However, no prior studies have focused on this important construct in body dysmorphic disorder (BDD). In addition, across a number of psychiatric disorders, early age at disorder onset is associated with greater illness severity and greater comorbidity with other disorders. However, clinical correlates of age at onset have not been previously studied in BDD.
  
  
  METHODS
  Age at onset and other variables of interest were assessed in two samples of adults with DSM-IV BDD; sample 1 consisted of 184 adult participants in a study of the course of BDD, and sample 2 consisted of 244 adults seeking consultation or treatment for BDD. Reliable and valid measures were used. Subjects with early-onset BDD (age 17 or younger) were compared to those with late-onset BDD.
  
  
  RESULTS
  BDD had a mean age at onset of 16.7 (SD=7.3) in sample 1 and 16.7 (SD=7.2) in sample 2. 66.3% of subjects in sample 1 and 67.2% in sample 2 had BDD onset before age 18. A higher proportion of females had early-onset BDD in sample 1 but not in sample 2. On one of three measures in sample 1, those with early-onset BDD currently had more severe BDD symptoms. Individuals with early-onset BDD were more likely to have attempted suicide in both samples and to have attempted suicide due to BDD in sample 2. Early age at BDD onset was associated with a history of physical violence due to BDD and psychiatric hospitalization in sample 2. Those with early-onset BDD were more likely to report a gradual onset of BDD than those with late-onset in both samples. Participants with early-onset BDD had a greater number of lifetime comorbid disorders on both Axis I and Axis II in sample 1 but not in sample 2. More specifically, those with early-onset BDD were more likely to have a lifetime eating disorder (anorexia nervosa or bulimia nervosa) in both samples, a lifetime substance use disorder (both alcohol and non-alcohol) and borderline personality disorder in sample 1, and a lifetime anxiety disorder and social phobia in sample 2.
  
  
  CONCLUSIONS
  BDD usually began during childhood or adolescence. Early onset was associated with gradual onset, a lifetime history of attempted suicide, and greater comorbidity in both samples. Other clinical features reflecting greater morbidity were also more common in the early-onset group, although these findings were not consistent across the two samples.
authors: Department of Psychology, University of Iceland, Aragata 14, 101 Reykjavik, Iceland. Electronic address: asb@hi.is.
authors: Andri S
authors: AS
authors: Bjornsson
authors: Elizabeth R
authors: ER
authors: Didie
authors: Jon E
authors: JE
authors: Grant
authors: William
authors: W
authors: Menard
authors: Emily
authors: E
authors: Stalker
authors: Katharine A
authors: KA
authors: Phillips
mesh_terms: D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D001008:Anxiety Disorders / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology; D057215:Body Dysmorphic Disorders / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology; D015897:Comorbidity; D005260:Female; D006801:Humans; D010554:Personality Disorders / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology; D012720:Severity of Illness Index; D019966:Substance-Related Disorders / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology; D013406:Suicide, Attempted
references: J Psychiatr Res. 1994 Nov-Dec;28(6):531-45
references: 7699612
references: Body Image. 2005 Dec;2(4):401-5
references: 17075614
references: Compr Psychiatry. 2003 Jul-Aug;44(4):270-6
references: 12923704
references: Psychiatry Res. 2004 Sep 30;128(2):175-82
references: 15488960
references: J Clin Psychiatry. 2005 Mar;66(3):309-16; quiz 404-5
references: 15766296
references: Arch Gen Psychiatry. 1992 Aug;49(8):630-6
references: 1637253
references: Psychiatry Res. 2004 Dec 15;129(2):127-40
references: 15590040
references: Eur Psychiatry. 2008 Aug;23(5):331-5
references: 18455370
references: Compr Psychiatry. 2004 Mar-Apr;45(2):114-20
references: 14999662
references: Child Adolesc Psychiatr Clin N Am. 2011 Apr;20(2):287-304
references: 21440856
references: Arch Gen Psychiatry. 1997 Mar;54(3):271-8
references: 9075468
references: Psychol Med. 1999 Jul;29(4):869-78
references: 10473314
references: Acta Psychiatr Scand. 2009 Jun;119(6):494-500
references: 19207132
references: Arch Gen Psychiatry. 1987 Jun;44(6):540-8
references: 3579500
references: Int J Psychiatry Med. 2006;36(2):243-59
references: 17154152
references: Am J Psychiatry. 2006 May;163(5):907-12
references: 16648334
references: J Child Psychol Psychiatry. 2005 Aug;46(8):881-7
references: 16033636
references: Br J Psychiatry. 2009 Oct;195(4):286-93
references: 19794194
references: Int J Neuropsychopharmacol. 2001 Jun;4(2):169-78
references: 11466167
references: J Clin Psychiatry. 2004 Jul;65(7):908-14
references: 15291678
references: Psychopharmacol Bull. 1997;33(1):17-22
references: 9133747
references: Compr Psychiatry. 2005 Jul-Aug;46(4):254-60
references: 16175755
references: Psychiatry Res. 1985 Feb;14(2):131-42
references: 3857653
references: Compr Psychiatry. 2008 Nov-Dec;49(6):561-9
references: 18970904
references: Behav Res Ther. 2009 Feb;47(2):99-104
references: 19084820
references: J Clin Psychiatry. 1998 Apr;59(4):165-71
references: 9590666
references: Bipolar Disord. 2009 Mar;11(2):205-8
references: 19267703
references: Arch Gen Psychiatry. 2002 Apr;59(4):381-8
references: 11926939
references: Am J Psychiatry. 1997 Sep;154(9):1299-301
references: 9286193
references: J Affect Disord. 2004 Apr;79(1-3):241-6
references: 15023501
references: J Nerv Ment Dis. 1999 Apr;187(4):237-42
references: 10221557
references: Am J Psychiatry. 1996 Oct;153(10):1308-12
references: 8831439
references: J Anxiety Disord. 2011 Jan;25(1):131-7
references: 20832989
references: Psychiatry Res. 2007 Jul 30;152(1):21-7
references: 17363071
references: Am J Psychiatry. 2001 Nov;158(11):1899-903
references: 11691698
references: CNS Spectr. 2006 Jun;11(6):419-22
references: 16816779
references: Braz J Psychiatry. 2005 Mar;27(1):32-6
references: 15867981
references: Bipolar Disord. 2007 Nov;9(7):698-705
references: 17988359
references: J Clin Psychiatry. 2005 Jun;66(6):717-25
references: 15960564
references: Am J Psychiatry. 1993 Feb;150(2):302-8
references: 8422082
references: Compr Psychiatry. 2000 Sep-Oct;41(5):373-9
references: 11011834
references: Am J Psychiatry. 1998 Jan;155(1):102-8
references: 9433346
references: J Clin Psychiatry. 2006 May;67(5):703-11
references: 16841619
references: Arch Gen Psychiatry. 1992 Aug;49(8):624-9
references: 1637252
references: Acta Neuropsychiatr. 2009 Aug;21(4):191-6
references: 25384633
references: J Abnorm Psychol. 2012 May;121(2):339-351
references: 22004113
references: Behav Res Ther. 1997 Jan;35(1):67-70
references: 9009045
references: Am J Psychiatry. 2007 Oct;164(10):1539-46
references: 17898345
references: Compr Psychiatry. 2006 Mar-Apr;47(2):77-87
references: 16490564
references: Psychopharmacol Bull. 1993;29(2):321-6
references: 8290681
references: Depress Anxiety. 2005;21(3):112-7
references: 15965994
references: J Psychiatr Res. 2003 Mar-Apr;37(2):127-33
references: 12842166
references: CNS Spectr. 2009 May;14(5):252-60
references: 19407724
references: Int Clin Psychopharmacol. 2006 May;21(3):177-9
references: 16528140
references: Eur Psychiatry. 2008 Apr;23(3):187-94
references: 18329252
references: Compr Psychiatry. 2002 Jan-Feb;43(1):28-36
references: 11788916
references: J Nerv Ment Dis. 1997 Sep;185(9):570-7
references: 9307619
references: Behav Res Ther. 1996 Sep;34(9):755-66
references: 8936758
references: J Clin Psychiatry. 2003 Jun;64(6):715-20
references: 12823088
references: Psychosomatics. 2005 Jul-Aug;46(4):317-25
references: 16000674
references: J Affect Disord. 1999 Jul;54(1-2):109-17
references: 10403154
references: J Nerv Ment Dis. 1978 May;166(5):317-26
references: 650195
references: BMC Psychiatry. 2006 May 09;6:20
references: 16684346
references: Psychol Med. 2005 Feb;35(2):237-43
references: 15841681
references: CNS Spectr. 2009 Sep;14(9):503-13
references: 19890232
references: Depress Anxiety. 2010 Jun;27(6):528-55
references: 20533367