Body Dysmorphic Disorder, Major Depressive Episode, and Suicidality

Major depressive episodes (MDEs) are associated with
suicidal ideation and suicidal behaviors, and comparably, body dysmorphic
disorder (BDD) is significantly associated with suicidal ideation and suicidal
behaviors, according to a study published in the Journal of Affective Disorders. Furthermore, although bipolar
depression was associated with suicidal ideation and marginally associated with
suicidal behaviors, unipolar depression was only associated with suicidal
ideation.

This study examined the possible associations between anxiety,
mood, and obsessive-compulsive spectrum disorders and suicidal ideation and
behaviors in a sample of patients from the Behavioral Health Partial Program at
McLean Hospital (N=498; 55.2% women; 88% white, 3% black, 8% Asian, 4% other
races; average age 34.8 years [SD=14.4, range=18-74]). Data on current
diagnosis and past-month suicidal ideation and behaviors were assessed by
semi-structured interviews.

After adjustments were made for sex, age, and other psychiatric disorders, multivariant analysis demonstrated that body dysmorphic disorder was significantly associated with suicidal ideation (OR, 6.62; 95% CI, 1.92-22.79; P =.003) and suicidal behaviors (OR, 2.45; 95% CI, 1.05-5.71; P =.038). Similarly, episodes of major depression were associated with suicidal ideation and suicidal behaviors. While bipolar depression was associated with suicidal ideation (OR, 2.71; 95% CI, 1.36-5.40; P =.005) and was marginally associated with suicidal behaviors (OR, 2.02; 95% CI, 0.99-4.13; P =.054), unipolar depression was only associated with suicidal ideation (OR, 1.82; 95% CI, 1.20–2.74; P =.005). After controlling for comorbid disorders, no association was found between suicidality and obsessive-compulsive disorder, anxiety disorders, or post-traumatic stress disorder.

Although there were limitations to the study, such as the
cross-sectional design and the low base rates of certain disorders, which led
to a relatively small sample size, study investigators concluded that, “MDE and
BDD have unique relationships with suicidality in a partial hospital setting
that is independent of other internalizing disorders. BDD is a common and often
underrecognized disorder (Zimmerman and Mattia, 1998), and clinicians should be
aware of elevated risk of suicidality in this population. Further research is
needed to better understand the nature of the relationship between BDD and
suicidality, and whether the results generalize to other clinical settings.”

Reference

Snorrason I, Beard C, Christensen K, Bjornsson AS, Björgvinsson T. Body dysmorphic disorder and major depressive episode have comorbidity-independent associations with suicidality in an acute psychiatric setting [published online August 19, 2019]. J Affect Disord. doi: 10.1016/j.jad.2019.08.059

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