Fontenelle Leonardo F, Telles Leonardo L, Nazar Bruno P, de Menezes Gabriela Bezerra, do Nascimento Antonio Leandro, Mendlowicz Mauro V, Versiani Marcio
Federal University of Rio de Janeiro, Brazil.
Int J Psychiatry Med. 2006;36(2):243-59. doi: 10.2190/B6XM-HLHQ-7X6C-8GC0.
The main characteristic of body dysmorphic disorder (BDD) is a preoccupation with an imagined defect in appearance in a normal-appearing person or an excessive preoccupation with appearance in a person with a small physical defect. In this non-controlled study, our objective was to describe the socio-demographic, phenomenological, and long-term outcome features of a Brazilian sample of patients with BDD.
We performed a chart-review of the 166 patients who attended the Obsessions, Compulsions, and Impulsions Subprogram of the Institute of Psychiatry of the Federal University of Rio de Janeiro, Brazil, during the period between 1998 and 2005.
Twenty patients (12%) had clinically significant BDD. This sample was characterized by a predominance of female (n = 11; 55%), single or divorced (n = 18; 90%), and economically unproductive patients (n = 17; 85%). We found an average of 2.5 current imagined defects per patient. The most frequently reported body parts of excessive concern were the overall appearance, size or shape of the face (n = 7; 35%), the skin (n = 6; 30%), the hair (n = 6; 30%), the nose (n = 5; 25%), and the body build and weight (n = 5; 25%). Most individuals exhibited a chronic condition (n = 13; 65%) and kept the same concerns during the course of the disorder (n = 12; 60%). All patients displayed compulsive behaviors, including recurrent mirror checking (n = 14; 70%), camouflaging (n = 13; 65%), reassurance seeking by means of repetitive questioning of others (n = 9; 45%), and excessive use of cosmetics (n = 7; 35%). Two patients reported "do-it-yourself" surgeries. Seven patients had current suicidal ideation (35%). Six patients (30%) showed no insight over their dysmorphic beliefs. Fifteen patients (95%) exhibited psychiatric comorbidities, mostly obsessive-compulsive disorder (OCD) (n = 14, 70%) and major depressive disorder (n = 11; 55%). The majority of patients were treated naturalistically with serotonin reuptake inhibitors (n = 15; 75%), either solo or in association with antipsychotics (n = 10; 50%). Nevertheless, only 5 (25%) responded favorably to treatment during the long-term follow-up (CGI < or = 2).
BDD is a severe disorder that is frequently associated with other psychiatric conditions and responds poorly to treatment in the naturalistic setting. No significant trans-cultural variations were identified in the comparison between Brazilian, North American, and European samples.
躯体变形障碍（BDD）的主要特征是，外表正常的人过度关注自己想象中的外貌缺陷，或身体存在轻微缺陷的人过度关注自身外貌。在这项非对照研究中，我们的目的是描述巴西BDD患者样本的社会人口学、现象学及长期预后特征。
我们对1998年至2005年期间在巴西里约热内卢联邦大学精神病学研究所的强迫观念、强迫行为和冲动行为子项目就诊的166例患者的病历进行了回顾。
20例患者（12%）患有具有临床意义的BDD。该样本的特征为女性占多数（n = 11；55%），单身或离异者居多（n = 18；90%），且无经济收入的患者占多数（n = 17；85%）。我们发现，每位患者目前平均存在2.5个想象中的缺陷。过度关注的身体部位最常见的是整体外貌、面部大小或形状（n = 7；35%）、皮肤（n = 6；30%）、头发（n = 6；30%）、鼻子（n = 5；25%）以及身材和体重（n = 5；25%）。大多数个体病情呈慢性（n = 13；65%），且在病程中一直存在相同的担忧（n = 12；60%）。所有患者均表现出强迫行为，包括反复照镜子（n = 14；70%）、伪装（n = 13；65%）、通过反复询问他人寻求安心（n = 9；45%）以及过度使用化妆品（n = 7；35%）。两名患者报告进行了“自己动手”的手术。7例患者目前有自杀观念（35%）。6例患者（30%）对自己的变形观念缺乏洞察力。15例患者（95%）存在精神共病，主要是强迫症（OCD）（n = 14，70%）和重度抑郁症（n = 11；55%）。大多数患者接受了5-羟色胺再摄取抑制剂的自然疗法（n = 15；75%），单独使用或与抗精神病药物联合使用（n = 10；50%）。然而，在长期随访中，只有5例（25%）对治疗反应良好（临床总体印象量表评分≤2）。
BDD是一种严重的疾病，常与其他精神疾病相关，在自然环境中对治疗反应不佳。在巴西、北美和欧洲样本的比较中，未发现明显的跨文化差异。
