Body dysmorphic disorder and olfactory reference disorder: proposals for ICD-11

Abstract

The article reviews the historical background and symptoms of body dysmorphic disorder (BDD) and olfactory reference disorder, and describes the proposals of the WHO ICD-11 Working Group on the Classification of Obsessive-Compulsive and Related Disorders related to these categories. This paper examines the possible classification of BDD symptoms in ICD-10. Four different possible diagnoses are found (hypochondriacal disorder, schizotypal disorder, delusional disorder, or other persistent delusional disorder). This has led to significant confusion and lack of clear identification in ICD-10. Olfactory reference disorder can also be classified as a delusional disorder in ICD-10, but there is no diagnosis for non-delusional cases. The Working Group reviewed the classification and diagnostic criteria of BDD in DSM-5, as well as cultural variations of BDD and olfactory reference disorder that include Taijin Kyofusho. The Working Group has proposed the inclusion of both BDD and olfactory reference disorder in ICD-11, and has provided diagnostic guidelines and guidance on differential diagnosis. The Working Group's proposals for ICD-11 related to BDD and olfactory reference disorder are consistent with available global evidence and current understanding of common mechanisms in obsessive-compulsive and related disorders, and resolve considerable confusion inherent in ICD-10. The proposals explicitly recognize cultural factors. They are intended to improve clinical utility related to appropriate identification, treatment, and resource allocation related to these disorders.

Innovations and changes in the ICD‐11 classification of mental, behavioural and neurodevelopmental disorders

“…Individuals with body dysmorphic disorder are persistently preoccupied with one or more defects or flaws in their bodily appearance that are either unnoticeable or only slightly noticeable to others. The preoccupation is accompanied by repetitive and excessive behaviours, including repeated examination of the appearance or severity of the perceived defect or flaw, excessive attempts to camouflage or alter the perceived defect, or marked avoidance of social situations or triggers that increase distress about the perceived defect or flaw.…”

“…This condition is characterized by a persistent preoccupation with the belief that one is emitting a perceived foul or offensive body odour or breath, that is either unnoticeable or only slightly noticeable to others.…”

Prevalence of body dysmorphic disorder on a psychiatric inpatient ward and the value of a screening question

“…The study adds to previous observations that BDD is poorly identified in psychiatric inpatients. BDD (Veale and Matsunaga, 2014). BDD is more common than previously recognized with a prevalence of about 2% in the general population (Koran et al, 2008;Rief et al, 2006).…”

Clinically related or predictive factors and impacts on long-term treatment outcomes of involvement behaviors in patients with obsessive–compulsive disorder

“…OCD patients with IBs accommodate their caregivers, especially their family members, to their OCD symptoms by 1) asking them for reassurance, 2) forcing them to participate in their rituals, or 3) forcing them to assist in avoidance according to the patients' rules or demands [1]. Among IBs, reassurance seeking has been included as a type of repetitive behavior in a diagnostic set of body dysmorphic disorders in DSM-5 [2], and patients with other obsessive compulsive spectrum disorders (OCSD) such as a hoarding disorder, olfactory reference syndrome [3], or illness anxiety disorder (hypochondriasis) often exhibit repetitive patterns similar to IBs. Thus, IBs may be common phenomena of OCRDs or OCSDs.…”