Body dysmorphic disorder and depression: phenomenological and psychotherapeutic aspects: a report of five cases.

Body dysmorphic disorder (BDD) is a hard-to-treat disorder that often coincides with depression and suicidal tendency. We investigate the correlations between depression and BDD in an idiographic study of 5 patients receiving treatment in the psychiatric ward of a general hospital in 2008. Among these patients we found common triggering factors - mainly separation - that were associated with humiliation, childhood stresses, worries in regard to attractiveness and masculinity, and personality structures showing dependent-avoidant, self-insecure and sensitive traits, as described by Kretschmer. It transpired that their BDD had developed out of a self-aggravating cycle of shame, controlling actions, alienation and self-disempowerment. After a certain period their self-disempowerment then gradually transforms into a depressive cycle of despair, increased withdrawal, inward-directed anger and self-depreciation. These correlations indicate that the depressive symptomatology among these patients can be better classified as adjustment disorder in regard to their BDD than as independent major depression. Finally, we present dance/movement therapy as a promising additional psychotherapeutic approach that can complement the recognized therapy forms (serotonin re-uptake inhibitors and cognitive behavioral therapy).