1,54 In two studies, 27% to 31% of individuals with BDD had been completely housebound for at least

1 week due to BDD symptoms, and more than 40% had been psychiatrically hospitalized.52,55 Risk behaviors: suicidality, substance abuse, and violence Rates of suicidal ideation, suicide attempts, and completed suicide appear find more markedly elevated.79 Approximately 80% of individuals with BDD report past or current suicidal ideation, and about one quarter have attempted suicide, which is often attributed to BDD symptoms.42,50,52,79-81 In the only prospective study of the course of BDD, completed suicide was reported in 0.3% of cases per year.82 This Inhibitors,research,lifescience,medical finding should be considered preliminary, because the sample size was relatively Inhibitors,research,lifescience,medical small and the follow-up period was relatively brief; nonetheless, this suicide rate is markedly elevated. While caution should be used in comparing this rate

to that of other disorders, the standardized mortality ratio in this study is higher than that reported for nearly any other mental disorder.83 Approximately one third of people with BDD report violent behavior that they attribute primarily to BDD symptoms (eg, attacking someone or damaging property).1,84 Clinical impressions suggest that anger or violence may be fueled by anger about looking “deformed,” inability to fix the “defect,” delusions of Inhibitors,research,lifescience,medical reference (eg, believing that other people are mocking the “defect”), and feeling rejected by others because of the “defect.” In addition, anger or even violent behavior may be caused by dissatisfaction with cosmetic procedures. According to one survey, 12% of plastic surgeons said that they had been threatened physically by a dissatisfied Inhibitors,research,lifescience,medical BDD patient.85 Inhibitors,research,lifescience,medical There are occasional reports of individuals with probable BDD who attacked and even

killed their plastic surgeon after being distraught by the outcome of a cosmetic procedure.2 Many individuals with BDD abuse alcohol or drugs. In one study,86 48.9% of BDD participants were diagnosed with a lifetime substance-use disorder, with 42.6% reporting an alcohol-use disorder and 30.1% reporting a cannabis-use disorder. Onset of BDD preceded onset of a substance-use disorder by at least 1 year in 60% of Florfenicol the participants, followed onset of the substance-use disorder in 19% of the participants, and began in the same year in 21%. When asked about the relationship between substance use and BDD symptoms, 68% said that BDD symptoms contributed to the substance use becoming problematic.86 Comorbidity BDD is often comorbid with other mental disorders. In the two largest phenomenology studies of individuals ascertained for BDD (n=293 and n=200), which assessed all participants with the Structured Clinical Interview for DSM,14 major depressive disorder was the most common comorbid disorder, with a lifetime prevalence of about 75% in both samples.