Insight impairment in body image disorders: delusionality and overvalued ideas in anorexia nervosa versus body dysmorphic disorder

Autor(en): Hartmann, Andrea S. 
Thomas, Jennifer Joanne
Wilson, Anne C.
Wilhelm, Sabine
Affiliationen: Institute of Psychology, Department of Human Sciences, University of Osnabrück, Knollstrasse 15, 49069 Osnabrück, Germany
Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
Department of Psychiatry, Harvard Medical School, Boston, MA, USA. Electronic address:
Stichwörter: Body Mass Index; Severity of Illness Index; Delusions/diagnosis/psychology; Body image; Humans; Male; Anorexia Nervosa/psychology; Psychiatric Status Rating Scales; Mental Disorders; Adult; Female; Interviews as Topic; Surveys and Questionnaires; Qualitative Research; Body Dysmorphic Disorders/psychology
Erscheinungsdatum: 2013
Journal: Psychiatry Research
Volumen: 210
Ausgabe: 3
Startseite: 1129
Seitenende: 1135
The two body image disorders anorexia nervosa (AN) and body dysmorphic disorder (BDD) share many similarities. Delusionality in BDD has recently gained increased attention, as the new DSM-5 criteria for BDD include an insight specifier. However, delusionalilty in AN has rarely been examined. We evaluated the delusionality of appearance-related beliefs in AN (n=19) vs. BDD (n=22) via structured interview. Participants also completed measures of disorder-specific psychopathology and body image. Compared to those with AN, individuals with BDD exhibited significantly greater delusionality on a dimensional scale (p=0.0014, d=1.07), and were more likely to meet dichotomous criteria for delusional beliefs (p=0.021, V=0.36). In AN, delusionality was associated specifically with shape concerns and drive for thinness; in BDD, delusionality was related to the severity of BDD symptoms (all p<0.05). Delusionality of appearance beliefs is present in individuals with AN, but is less pronounced than in BDD. Nevertheless, as high delusionality might predict poor treatment outcome in AN, treatment strategies that were originally developed to address delusionality in BDD might be modified for AN.
ISSN: 0165-1781
DOI: 10.1016/j.psychres.2013.08.010

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