1,52,55,64-66 Many BDD patients (27% to 45%) pick at their skin in an attempt to improve perceived blemishes or imperfections; however, this behavior sometimes causes observable appearance defects and can even cause severe damage such as skin infections and rupture of blood vessels.67-69 Many other examples of compulsive behaviors exist, which are often idiosyncratic, such as drinking more than

3 gallons of water a day to make one’s face look fuller.1 Avoidance is a common behavior in BDD.70,71 Patients often avoid social situations since they fear being negatively judged by other people because they look “ugly.” They may not Inhibitors,research,lifescience,medical take a job where they think they will be scrutinized by others. Avoidance may serve a similar purpose Inhibitors,research,lifescience,medical as the compulsive behaviors in the short term – that is, to temporarily relieve BDD-related anxiety and distress. However, clinical experience indicates that compulsions and avoidance seldom improve anxiety or reduce the intensity of BDD-related thoughts; rather these behaviors may contribute to the chronicity and severity of BDD.1,72 Course of illness BDD Inhibitors,research,lifescience,medical usually begins during adolescence, with two studies reporting a mean age at onset of 16 and a mode of 13.55,73 Retrospective

data indicate that BDD appears to usually have a chronic course, unless it is treated.52,55 In what is to our knowledge the Inhibitors,research,lifescience,medical only prospective study of BDD’s

course, it was found that the probability of full remission from BDD over 1 year of follow-up was only .09, which is lower than has been reported for mood disorders, most anxiety disorders, and personality see more disorders in other longitudinal studies.74 More severe BDD symptoms at intake, longer duration of BDD, and the presence of Inhibitors,research,lifescience,medical one or more comorbid personality disorders at intake predicted a lower likelihood of remission from BDD.75 Psychosocial functioning and quality of life BDD is associated with substantial impairment Phosphatidylinositol diacylglycerol-lyase in psychosocial functioning and markedly poor quality of life. In a sample of 200 individuals with BDD (n=200), 36% did not work for at least one week in the past month because of psych opathology, and 11% had permanently dropped out of school because of BDD symptoms.54 Individuals with BDD have, on average, much poorer mental health, emotional well-being, social functioning, and overall quality of life than the general population, and scores on quality of life measures are poorer than for patients with diabetes or clinical depression.76,77 In the only prospective study of BDD, overall functioning continued to be poor over 1 to 3 years, and poorer functioning was predicted by more severe BDD and greater delusionality of BDD beliefs at intake.