Department of Psychiatry, Schlosspark-Klinik, Berlin, Germany.
Psychopathology. 2011;44(3):137-46. doi: 10.1159/000321551. Epub 2011 Mar 7.
Body dysmorphic disorder (BDD) is a hard-to-treat disorder that often coincides with depression and suicidal tendency. We investigate the correlations between depression and BDD in an idiographic study of 5 patients receiving treatment in the psychiatric ward of a general hospital in 2008. Among these patients we found common triggering factors - mainly separation - that were associated with humiliation, childhood stresses, worries in regard to attractiveness and masculinity, and personality structures showing dependent-avoidant, self-insecure and sensitive traits, as described by Kretschmer. It transpired that their BDD had developed out of a self-aggravating cycle of shame, controlling actions, alienation and self-disempowerment. After a certain period their self-disempowerment then gradually transforms into a depressive cycle of despair, increased withdrawal, inward-directed anger and self-depreciation. These correlations indicate that the depressive symptomatology among these patients can be better classified as adjustment disorder in regard to their BDD than as independent major depression. Finally, we present dance/movement therapy as a promising additional psychotherapeutic approach that can complement the recognized therapy forms (serotonin re-uptake inhibitors and cognitive behavioral therapy).
躯体变形障碍（BDD）是一种难以治疗的疾病，常与抑郁和自杀倾向同时发生。我们对 2008 年在一家综合医院的精神病病房接受治疗的 5 名患者进行了个体化研究，以调查抑郁与 BDD 之间的相关性。在这些患者中，我们发现了常见的触发因素——主要是分离，这些因素与羞辱、儿童时期的压力、对吸引力和男子气概的担忧以及依赖回避、自我不安全和敏感的人格结构有关，这是 Kretschmer 所描述的。事实证明，他们的 BDD 是由羞耻感、控制行为、异化和自我赋权的自我加剧循环发展而来的。一段时间后，他们的自我赋权逐渐转变为绝望、退缩加剧、内向愤怒和自我贬低的抑郁循环。这些相关性表明，与独立的重度抑郁症相比，这些患者的抑郁症状更适合将其归类为 BDD 相关的适应障碍。最后，我们提出舞蹈/运动疗法作为一种很有前途的补充心理治疗方法，可以补充已认可的治疗形式（血清素再摄取抑制剂和认知行为疗法）。
