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Ann Clin Psychiatry. 2008 Jan-Mar;20(1):33-8. doi: 10.1080/10401230701844463.

Severe obsessive-compulsive disorder with and without body dysmorphic disorder: clinical correlates and implications.

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  • 1McLean Hospital Obsessive-Compulsive Disorder Institute, Belmont, MA, USA.



Body Dysmorphic Disorder is a putative obsessive-compulsive spectrum disorder. This exploratory study systematically examined prevalence and clinical correlates of Body Dysmorphic Disorder (BDD) comorbidity in an inpatient Obsessive-Compulsive Disorder (OCD) population.


Consecutive patients from an OCD Intensive Residential Treatment program were included (N = 275). Clinician-rated and patient-rated measures were administered at baseline and repeated at discharge. The prevalence of BDD was determined and clinical characteristics were statistically compared between groups with (N = 42) and without (N = 233) comorbid BDD.


The prevalence of BDD among residential patients with OCD was 15.3% (N = 42). Those with comorbid BDD were younger (p = 0.007) and more predominantly female (p = 0.02), with lower marriage rates (p = 0.006), more severe depression (p = 0.003) and increased self-reported illicit substance use histories (p = 0.003) versus those without BDD. This cohort also had earlier onset OCD (p = 0.02) and more severe hoarding (p = 0.01), symmetry (p = 0.01), reassurance-seeking (p = 0.01) and checking symptoms (p = 0.01) than patients without comorbid BDD. OCD treatment response was unaffected by the presence of BDD.


BDD is a common comorbidity in severe OCD. Younger women and those with early-onset OCD appear more likely to have BDD. OCD patients with BDD also have increased hoarding, symmetry, reassurance-seeking and checking severity, which requires consideration in treatment planning.

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