ARE YOUR DISORDERS RELATIVES OF BDD?IS BDD A SYMPTOM OR AN ILLNESS?
ARE YOUR DISORDERS RELATIVES OF BDD?IS BDD A SYMPTOM OR AN ILLNESS?1 HypothesisBDD Is a nonspecific symptom that can occur in a wide variety of psychiatric disorders (such as schizophrenia, depression, or personality disorders)Medical AnalogyBDD is like a fever2 HypothesisBDD is a symptom or form of another specific psychiatric disorder (not of a wide variety of psychiatric disorders, as proposed by hypothesis I)Medical Analogy BDD is like the butterfly rash in lupus3 HypothesisBDD is a distinct diagnostic entity-separate disorder-that is, aMedical AnalogyBDD is like diabetesWhich hypothesis is correct is important for several reasons. If hypothesis 1 is correct, then treatment would presumably be directed at whatever the underlying disorder was thought to be in a particular person. If in one person it were schizophrenia, the schizophrenia would be treated. If in another person it were OCD, the OCD would be treated. The BDD symptoms would be expected to resolve as the underlying illness did.If BDD is a symptom of a particular other disorder (hypothesis 2), then treatment would in all cases be directed at that one underlying disorder. But if BDD is a separate illness (hypothesis 3), then treatment would be directed at the BDD itself. Treatment directed at another coexisting illness—if one were present—wouldn’t necessarily successfully treat the BDD.What I’ve written about BDD to this point has implied that it’s a separate disorder, and indeed DSM-IV classifies it that way. But some authors have proposed that hypotheses 1 or 2 are more accurate. G. G. Hay, a British psychiatrist, proposed hypothesis 1 when he wrote in 1983 that “dysmorphophobia is a symptom, not a diagnosis or an illness”; he believed that it could occur as a symptom of a “variety of psychiatric syndromes.” Hay thought that the underlying illness could vary from a personality problem (such as a “sensitive” personality type) to schizophrenia to mood disorder.It seems unlikely that this hypothesis is valid. While it’s true that various types of body image symptoms can occur in other disorders, the syndrome BDD—as described in the published scientific literature and in this book—is a well-defined syndrome. It has characteristic symptoms that have been consistently described around the world for more than 100 years. Research that’s been done, especially in the past 10 years, has increasingly clarified its clinical features, which aren’t identical to those of any other disorder, let alone a variety of disorders. Also compelling is what patients say: 62 percent of those I’ve seen have reported that BDD is their most severe and primary problem or their only problem, suggesting that BDD isn’t simply a nonspecific symptom of other psychiatric problems or disorders. In addition, BDD can occur in the absence of other psychiatric disorders. If BDD were simply a nonspecific symptom of other disorders, it would be expected that symptoms of some other disorder, such as schizophrenia or depression, would always be present. This isn’t always the case.*358\204\8*
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