Editor's Note: Body Dysmorphic Disorder and Suicide Risk

Norman Sussman, MD, DFAPA

Editor, Primary Psychiatry and Psychiatry Weekly, Professor of Psychiatry, New York University School of Medicine

Although formally recognized as a disorder by the American Psychiatric Association in 1987, body dysmorphic disorder (BDD) continues to be both under-diagnosed and under-treated. Up to 2.4% of the population suffers from BDD. Persons with BDD have a distorted body image and think obsessively about an imagined or slight flaw in their appearance. BDD is socially and vocationally debilitating, with patients often spending hours a day staring in the mirror, preoccupied with their imagined flaw. Apart from extreme self-consciousness, and consequent social avoidance, there is a high risk of complications associated with cosmetic surgery. According to new findings, it appears that people with BDD are also at high risk for suicide.

In the July issue of the American Journal of Psychiatry, Drs. Katherine Philips and William Menard report the results of a long-term study of a group of patients with BDD. They found that patients with BDD are 45 times more likely to commit suicide than people in the general population. In the study, 58% of the 185 study subjects chronically thought about suicide. 2.6% of the subjects tried to kill themselves. Two people completed suicide attempts. These concerns about appearance go beyond vanity, leading, in some instances, to endless surgical procedures, and, as shown by Philips and Menard’s study, sometimes even to death.

The delusional quality of BDD makes traditional psychotherapy ineffective as an intervention. Research has identified CBT and SSRIs as effective treatments for BDD. With a high risk of complications and suicide, and with effective therapies available, there is no excuse for this disorder to be so under-recognized.

Disclosure: Dr. Sussman reports no affiliations with or financial interests in any organization that may pose a conflict of interest.