Prevalence and Characteristics of Body Dysmorphic Disorder Among Patients in a Partial Hospital Program

Body Dysmorphic Disorder and Major Depressive Episode Have Comorbidity-Independent Associations With Suicidality in an Acute Psychiatric Setting

(Appeared originally in Journal of Affective Disorders 2019; 259:266-270).

The comorbidity structure of fear, distress and compulsive disorders in an acute psychiatric sample

Body dysmorphic disorder (BDD) and obsessive-compulsive disorder (OCD), collectively referred to as compulsive disorders, have typically not been included in structural research on the internalizing spectrum due to low prevalence in community samples. The current study examined the higher-order structure of anxiety, depressive and compulsive disorders among patients in a psychiatric partial hospital program (N = 2,178). We applied confirmatory factor analysis to diagnostic data obtained at admission and compared several competing models of the comorbidity structure. A one-factor model accounted well for the co-occurrence of all the disorders. A two-factor model comprised of fear and distress factors, wherein compulsive disorders loaded on fear, also fit the data well. However, a very large factor correlation (r = 0.86) suggested limited discriminant validity of fear and distress in the sample. Alternate models that featured a distinct compulsivity factor were not viable owing to large correlations between fear and compulsive disorders. Overall, our findings indicate that a broad internalizing dimensions underlies not only anxiety and depression, but also compulsive disorders, in an acute psychiatric population. Future studies using symptom-level data are needed to replicate these results and determine the structure of internalizing disorders from the bottom up, starting with narrowly defined symptom components.

Body dysmorphic disorder is associated with risk for suicidality and inpatient hospitalization: A replication study

In a previous study, body dysmorphic disorder (BDD) was shown to have comorbidity-independent associations with suicidality among patients in a partial hospital program. Here, we replicated and extended this study in an independent cohort (N = 1612) from the same program using a different measure of suicidality. Semi-structured interviews were used to assess psychiatric diagnoses and suicide risk. We also documented inpatient hospitalization during treatment. BDD was associated with suicide risk and inpatient hospitalization even after adjusting for age, gender and other psychiatric disorders. The results suggest that BDD is associated with risk for suicidality and clinical deterioration in acute psychiatric settings.

Body dysmorphic disorder and major depressive episode have comorbidity-independent associations with suicidality in an acute psychiatric setting

BACKGROUND

This study sought to examine whether mood, anxiety, and obsessive-compulsive spectrum disorders have unique (comorbidity-independent) associations with suicidal thoughts and behaviors in an acute psychiatric population.

METHODS

Patients (N = 498) were evaluated during admission to a partial hospital. Semi-structured interviews were used to assess current psychiatric diagnoses and past-month suicidal ideation and suicidal behaviors (e.g., suicide attempts).

RESULTS

After adjusting for age, gender and other psychiatric disorders, body dysmorphic disorder (BDD) had a significant association with suicidal ideation (odds ratio [OR] = 6.62; 95% CI, 1.92-22.79) and suicidal behaviors (OR = 2.45; 95% CI, 1.05-5.71). Similarly, major depressive episode was associated with suicidal ideation (OR = 3.00; 95% CI, 1.95-4.63) and suicidal behaviors (OR = 2.11; 95% CI, 1.12-3.98). When unipolar and bipolar depression were analyzed separately, unipolar depression was associated with suicidal ideation (OR = 1.82; 95% CI, 1.20-2.74), but not suicidal behaviors, whereas, bipolar depression was associated with suicidal ideation (OR = 2.71; 95% CI, 1.36-5.40) and marginally with suicidal behaviors (OR = 2.02; 95% CI, 0.99-4.13). Anxiety disorders, obsessive-compulsive disorder, and posttraumatic stress disorder were unrelated to suicidality in this sample after controlling for comorbid disorders.

LIMITATIONS

Cross-sectional design and a relatively small sample for analyses of low base-rate conditions.

CONCLUSIONS

Major depressive episode and BDD are unique markers of suicidality in an acute psychiatric setting. BDD is a common but often underdiagnosed condition, and clinicians should be aware of high rates of suicidality among these patients.