BODY DYSMORPHIC DISORDER: SOME KEY ISSUES FOR DSM-V
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[edit] Original article
[edit] Author(s)
Phillips, Katharine A. M.D., Wilhelm, Sabine Ph.D., Koran, Lorrin M. M.D., Didie, Elizabeth R. Ph.D., Fallon, Brian A. M.D., Feusner, Jamie M.D., Stein, Dan J. M.D.
[edit] Source
Depression and Anxiety. Volume 27 Issue 6, Pages 573 - 591 Published Online: 2 Jun 2010
[edit] Abstract/Overview
Body dysmorphic disorder (BDD), a distressing or impairing preoccupation with an imagined or slight defect in appearance, has been described for more than a century and increasingly studied over the past several decades. This article provides a focused review of issues pertaining to BDD that are relevant to DSM-V. The review presents a number of options and preliminary recommendations to be considered for DSM-V: (1) Criterion A may benefit from some rewording, without changing its focus or meaning; (2) There are both advantages and disadvantages to adding a new criterion to reflect compulsive BDD behaviors; this possible addition requires further consideration; (3) A clinical significance criterion seems necessary for BDD to differentiate it from normal appearance concerns; (4) BDD and eating disorders have some overlapping features and need to be differentiated; some minor changes to DSM-IV's criterion C are suggested; (5) BDD should not be broadened to include body integrity identity disorder (apotemnophilia) or olfactory reference syndrome; (6) There is no compelling evidence for including diagnostic features or subtypes that are specific to gender-related, age-related, or cultural manifestations of BDD; (7) Adding muscle dysmorphia as a specifier may have clinical utility; and (8) The ICD-10 criteria for hypochondriacal disorder are not suitable for BDD, and there is no empirical evidence that BDD and hypochondriasis are the same disorder. The issue of how BDD's delusional variant should be classified in DSM-V is briefly discussed and will be addressed more extensively in a separate article. Depression and Anxiety, 2010. © 2010 Wiley-Liss, Inc.
[edit] Comments/Analysis
This is an interesting article that confirms what many people with BIID have been saying: BIID is not a sub-condition of BDD. In fact we wrote BIID and BDD - two different conditions a while back.
However, it is unclear whether the suggestion of including Body Integrity Identity Disorder in the DSM-V would only happen if included as a sub-condition of BDD. The paper looks at several questions, only one of which directly interests us. This is question #5:
Should BDD's criteria be broadened to include olfactory reference syndrome (ORS) or body integrity identity disorder (apotemnophilia)?
Of course, we don't really rate a full question by ourselves!
As with most every other academic writing about BIID, they've focused solely on the need for amputation. This is definitely one of those viscious circles I wish we could break!
The authors write:
Body integrity identity disorder (apotemnophilia)."Body integrity identity disorder," or "apotemnophilia," is a poorly understood and likely rare clinical phenomenon that is occasionally confused with BDD.
No argument from us, it is poorly understood, and poorly researched. More research is necessary.
Individuals with body integrity identity disorder have a longstanding desire to have a specific limb amputated.[
This was citing Sabine Mueller, an academic that is fairly solidly "against" the idea BIID could be resolved through surgical means. There are many other authors which could have been selected to cite from. Is the selection of one of the most "anti-BIID" an indication of this paper's authors' feelings?
... unlike in BDD, most individuals with body integrity identity disorder report that the driving desire behind a wish for amputation is to correct an experience of mismatch between their sense of bodily identity and their actual anatomy.
An important distinction to make.
Individuals with such desires to have a limb amputated, unlike those with BDD, are not concerned about the limb's appearance. They do not perceive their limb as inherently defective, and they are not ashamed or selfconscious of it. Rather, the distress appears to center on the feeling that the limb is not congruent with their sense of self.
Very well said!
Although virtually no research has been done on body integrity identity disorder, it appears to have different core clinical features than BDD. Thus, there is no good evidence for broadening BDD's clinical features to include body integrity identity disorder {in the DSM-V}.
We would agree that BIID shouldn't be included in the DSM-V as a related condition to BDD.
However, we hope this conclusion doesn't further imply that BIID shouldn't be included in the DSM-V, as it is the only hope for people who have BIID to ever hope to be taken seriously by mental health professionals, and to perhaps one day see surgery as a viable option for us.
