Phillips K A
Butler Hospital, Brown University School of Medicine, Providence, RI, USA.
J Clin Psychiatry. 1996;57 Suppl 8:61-4; discussion 65.
Body dysmorphic disorder (BDD), a preoccupation with an imagined or slight defect in appearance, has been described for more than a century and reported around the world. However, this distressing and impairing disorder often goes undiagnosed, even though available data suggest that it is relatively common. Virtually any body part can be the focus of concern, with preoccupations most often involving the hair, nose, or skin. Most patients engage in excessive and repetitive behaviors such as mirror checking, skin picking, and reassurance seeking. Insight is generally poor, and many patients are frankly delusional. Most patients experience significant impairment in functioning, and suicide attempts are relatively common. Although the majority of patients with BDD seek often costly nonpsychiatric treatment-most often, surgical or dermatologic-such treatment usually appears to be unsuccessful. In contrast, preliminary data from open studies suggest that the serotonin reuptake inhibitors are often, and perhaps preferentially, effective for BDD. Augmentation, combination, and switching strategies may be useful in treatment-resistant cases. Preliminary data suggest that cognitive-behavioral strategies using exposure and response prevention may also be effective. Investigation of all aspects of this understudied disorder, including controlled treatment trials, is greatly needed.
躯体变形障碍（BDD），一种对外表想象中的或轻微的缺陷的过度关注，已被描述了一个多世纪且在世界各地均有报道。然而，这种令人痛苦且造成损害的疾病常常未被诊断出来，尽管现有数据表明它相对常见。实际上身体的任何部位都可能成为关注焦点，其中最常涉及的关注点是头发、鼻子或皮肤。大多数患者会出现过度且重复的行为，如照镜子、抠皮肤以及寻求他人肯定。自知力通常较差，许多患者存在明显的妄想。大多数患者的功能受到显著损害，自杀未遂情况相对常见。虽然大多数BDD患者常常寻求费用高昂的非精神科治疗——最常见的是外科或皮肤科治疗——但这类治疗通常似乎并不成功。相比之下，开放性研究的初步数据表明，5-羟色胺再摄取抑制剂对BDD常常有效，甚至可能是优先有效的。增效、联合及换药策略可能对难治性病例有用。初步数据表明，采用暴露与反应阻止法的认知行为策略也可能有效。对这种研究不足的疾病的各个方面进行调查，包括对照治疗试验，是非常必要的。
