COMMENTARY
Thirty‐Three Cases of Body Dysmorphic Disorder in Children and Adolescents

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ABSTRACT

Objective

Body dysmorphic disorder (BDD), a preoccupation with a nonexistent or slight defect in appearance, usually begins during adolescence. Because there have been no studies of the clinical features of BDD in children and adolescents, the authors assessed these features in the largest series to date.

Method

Thirty-three children and adolescents with DSM-IV BDD were assessed for demographic characteristics, phenomenology, associated psychopathology, and treatment history and response.

Results

Bodily preoccupations most often focused on the skin (61%) and hair (55%). All subjects had associated compulsive behaviors, most often camouflaging (e.g., with clothing) in 94%, comparing with others (87%), and mirror checking (85%). Ninety-four percent reported impairment in social functioning and 85% in academic or job functioning due to BDD. Thirty-nine percent had had psychiatric hospitalizations, and 21% had made a suicide attempt. Ten (53%) of 19 subjects treated with a serotonin reuptake inhibitor had much or very much improvement in BDD symptoms; in contrast, 0 of 8 trials with other psychotropic medications, 0 of 1 trial of cognitive-behavioral therapy, and 1 of 20 psychotherapy trials resulted in improvement. Twelve (36%) subjects received surgical, dermatological, or dental treatment, with a poor outcome in all cases.

Conclusions

BDD can cause significant morbidity in children and adolescents. These preliminary data suggest that serotonin reuptake inhibitors may be an effective treatment in this age group. J. Am. Acad. Child Adolesc, Psychiatry, 1999, 38(4):453–459.

Key Words

body dysmorphic disorder
dysmorphophobia
body image

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Presented at the American Psychiatric Association Annual Meeting, Toronto, June 1998.

This work was supported in part by an unrestricted educational grant from Solvay Pharmaceuticals. We thank Lynne M. DeMarco, M.S.P.H., for her assistance with data analysis.