We read with interest Bass et al's (Reference Bass, Peveler and House2001) review on somatoform disorders. Although the authors usefully pointed out that these disorders are common and cause severe disability, we were dismayed to find that, ironically, they neglected to mention one of the more common somatoform disorders: body dysmorphic disorder (BDD; also known as dysmorphophobia). A distressing or impairing preoccupation with an imagined or slight defect in appearance, BDD has reported rates in the community of 0.7-2.3% (Reference Phillips and PhillipsPhillips, 2001). People with this disorder commonly present to psychiatrists, dermatologists, cosmetic surgeons and other physicians (Reference Phillips, Castle, Castle and PhillipsPhillips & Castle, 2001).
Body dysmorphic disorder causes severe distress and marked impairment in functioning (Reference Veale, Boocock and GournayVeale et al, 1996; Reference Phillips and PhillipsPhillips, 2001). A high proportion of patients require hospitalisation, become housebound and/or attempt suicide. Completed suicide has been reported in both psychiatric and dermatology settings. Mental-health-related quality of life is poorer than that reported for patients with depression, obsessive—compulsive disorder and a variety of physical illnesses, including recent myocardial infarction and type II diabetes.
Like the other somatoform disorders, BDD is often neglected by psychiatrists. The diagnosis is usually missed in mental health settings (Reference Phillips, Castle, Castle and PhillipsPhillips & Castle, 2001). This is unfortunate, because a majority of these patients request and receive non-psychiatric treatments, such as dermatological treatment and surgery, which are usually ineffective. Many patients consult numerous physicians, request extensive work-ups, and pressure dermatologists and surgeons to provide unsuitable and ineffective remedies. Some patients, in desperation, even perform their own surgery. As one dermatologist stated, “The author knows of no more difficult patients to treat than those with body dysmorphic disorder” (Reference CotterillCotterill, 1996).
The good news is that emerging data indicate that a majority of these patients can be successfully treated with selective serotonin reuptake inhibitors or cognitive—behavioural therapy (Reference Phillips and PhillipsPhillips, 2001). It is important that psychiatrists and other physicians screen patients for this disorder so that effective treatment can be provided. Body dysmorphic disorder is a severe psychiatric illness that we cannot afford to neglect.
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