Department of Psychology, University of Iceland, Aragata 14, 101 Reykjavik, Iceland.
Compr Psychiatry. 2013 Oct;54(7):893-903. doi: 10.1016/j.comppsych.2013.03.019. Epub 2013 Apr 30.
Age at onset is an important clinical feature of all disorders. However, no prior studies have focused on this important construct in body dysmorphic disorder (BDD). In addition, across a number of psychiatric disorders, early age at disorder onset is associated with greater illness severity and greater comorbidity with other disorders. However, clinical correlates of age at onset have not been previously studied in BDD.
Age at onset and other variables of interest were assessed in two samples of adults with DSM-IV BDD; sample 1 consisted of 184 adult participants in a study of the course of BDD, and sample 2 consisted of 244 adults seeking consultation or treatment for BDD. Reliable and valid measures were used. Subjects with early-onset BDD (age 17 or younger) were compared to those with late-onset BDD.
BDD had a mean age at onset of 16.7 (SD=7.3) in sample 1 and 16.7 (SD=7.2) in sample 2. 66.3% of subjects in sample 1 and 67.2% in sample 2 had BDD onset before age 18. A higher proportion of females had early-onset BDD in sample 1 but not in sample 2. On one of three measures in sample 1, those with early-onset BDD currently had more severe BDD symptoms. Individuals with early-onset BDD were more likely to have attempted suicide in both samples and to have attempted suicide due to BDD in sample 2. Early age at BDD onset was associated with a history of physical violence due to BDD and psychiatric hospitalization in sample 2. Those with early-onset BDD were more likely to report a gradual onset of BDD than those with late-onset in both samples. Participants with early-onset BDD had a greater number of lifetime comorbid disorders on both Axis I and Axis II in sample 1 but not in sample 2. More specifically, those with early-onset BDD were more likely to have a lifetime eating disorder (anorexia nervosa or bulimia nervosa) in both samples, a lifetime substance use disorder (both alcohol and non-alcohol) and borderline personality disorder in sample 1, and a lifetime anxiety disorder and social phobia in sample 2.
BDD usually began during childhood or adolescence. Early onset was associated with gradual onset, a lifetime history of attempted suicide, and greater comorbidity in both samples. Other clinical features reflecting greater morbidity were also more common in the early-onset group, although these findings were not consistent across the two samples.
发病年龄是所有障碍的一个重要临床特征。然而，以前的研究都没有关注到躯体变形障碍（BDD）中的这一重要结构。此外，在许多精神障碍中，发病年龄早与疾病严重程度更高和与其他障碍的共病率更高有关。然而，BDD 的发病年龄的临床相关性以前并未研究过。
在两个 DSM-IV BDD 成年患者样本中评估了发病年龄和其他感兴趣的变量；样本 1 由 184 名参加 BDD 病程研究的成年参与者组成，样本 2 由 244 名寻求 BDD 咨询或治疗的成年人组成。使用了可靠和有效的测量方法。将发病年龄在 17 岁或以下的 BDD 患者与发病年龄较晚的 BDD 患者进行比较。
在样本 1 中，BDD 的平均发病年龄为 16.7（SD=7.3），在样本 2 中为 16.7（SD=7.2）。样本 1 中有 66.3%的患者和样本 2 中有 67.2%的患者在 18 岁之前发病。在样本 1 中，女性中早发性 BDD 的比例较高，但在样本 2 中则不然。在样本 1 的三个测量指标中的一个上，早发性 BDD 患者目前的 BDD 症状更为严重。在两个样本中，早发性 BDD 患者更有可能自杀未遂，在样本 2 中更有可能因 BDD 而自杀未遂。早发性 BDD 与 BDD 引起的身体暴力和样本 2 中的精神病住院有关。与晚发性 BDD 相比，在两个样本中，早发性 BDD 患者更有可能报告 BDD 逐渐发病。在样本 1 中，早发性 BDD 患者一生中的共病障碍在轴 I 和轴 II 上均比晚发性 BDD 患者更多，但在样本 2 中则不然。更具体地说，在两个样本中，早发性 BDD 患者更有可能患有终生饮食障碍（神经性厌食症或神经性贪食症）、终生物质使用障碍（酒精和非酒精）和边缘型人格障碍，在样本 1 中还患有终生焦虑障碍和社交恐惧症。
BDD 通常始于儿童或青春期。发病年龄早与逐渐发病、终生自杀未遂史和两个样本中的共病率较高有关。其他反映更高发病率的临床特征在早发性组中也更为常见，尽管这些发现并非在两个样本中都一致。
