Body Dysmorphic Disorder in Patients With Acne O ¨ zcan Uzun, Cengiz Bas ¸og ˘ lu, Ahmet Akar, Adnan Cansever, Aytekin O ¨ zs ¸ ahin, Mesut C ¸ etin, and Servet Ebrinc ¸ There is growing evidence that the prevalence of body dysmorphic disorder (BDD) is significantly higher in specially selected populations as compared to the general population. The goal of the current study was to evaluate prevalence of BDD in Turkish patients with mild acne presenting to a dermatologist for treatment. This study was the first empirical investi- gation of BDD in acne patients in Turkey. One hundred fifty-nine outpatients diagnosed with acne who con- sulted to the dermatology clinic were included in the study. The diagnosis of BDD was based on DSM-IV criteria and the Structured Clinical Interview for DSM-IV (SCID-I). A study-specific questionnaire was administered to document and investigate the demo- graphic and clinical characteristics of the cases. Four- teen (8.8%) patients were diagnosed with BDD. Three (21.4%) patients with acne and BDD also had concom- itant psychiatric diagnoses. All of the patients were psychiatric management-naive, never received any psychological or physical treatments. BDD was a com- mon psychiatric condition in acne cases. We suggest that dermatologists should routinely explore symp- toms and screen such patients for BDD. © 2003 Elsevier Inc. All rights reserved. B ODY DYSMORPHIC DISORDER (BDD) is a relatively common yet underdiagnosed psychiatric disorder. 1,2 BDD is characterized by the presence of preoccupation about an imagined or exaggerated physical anomaly. In patients with BDD any aspect of the appearance can be the focus of concern. As a consequence, preoccupation with appearance causes significant impairment of social and occupational functioning. 3 BDD was previously known as “dysmorphopho- bia” and was originally described by Morselli in 1886. In 1987, BDD was described as distinct psychiatric diagnosis in DSM-III-R. 4 However, re- search on BDD is still at an early stage, with no existing large controlled studies of BDD. Preva- lence in the general population has been estimated to be 1% to 3%. 2,5,6 The true prevalence may be much greater because these patients usually tend to hide their complaints and many cases never come to the attention of psychiatrists. 2,7,8 Affected indi- viduals generally prefer to consult an internal med- icine, cosmetic surgery, or dermatology clinic for treatment. 1,9-11 Thus the prevalence of BDD is much higher in selected populations than in the general population. In a large survey of dermatol- ogy patients, Phillips et al. 10 found that the diag- nostic rate of BDD in patients seeking treatment was 11.9%. According to these investigators, der- matologists may be the type of physicians most often consulted by patients with BDD. Acne is a distressing condition that affects the majority of adolescents, 12 and it is one of the reasons for dematologic treatment of BDD pa- tients. 10 Subjects with BDD frequently request in- appropriate and excessive cosmetic procedures, in- cluding laser therapy, dermabrasion, or corrective surgery, or request systemic retinoid therapy for minimal acne. 13 However, the frequency of BDD among acne patients seeking dermatologic treat- ment is still unknown. This study was the first empirical investigation of BDD in acne patients in Turkey. On the other hand, it was suggested that cultural norms and values may influence the content of BDD symp- toms and might affect the prevalence of BDD. 14,15 However, there are relatively few cross-cultural studies of BDD. The aim of the present study was to investigate the prevalence of BDD and related demographic characteristics in patients with acne in a Turkish sample consulted to the dermatology outpatient clinic. METHOD Participants Participants were consecutive outpatient diagnosed with acne who applied to the general dermatology outpatient unit (Depart- ment of Dermatology, Gu ¨lhane School of Medicine, Ankara, Turkey) between February 2000 and March 2001. The original sample included 718 subjects. However, 541 subjects with moderate or severe acne were excluded from the study. Sixteen of the subjects who were asked to participate did not wish to take part, and two subjects who had a real defect of appearance and whose defect was found to be concordant with their com- From the Department of Psychiatry and Dermatology, Gu ¨l- hane Military Medical Academy School of Medicine, Ankara; and GATA Haydarpas ¸a Eg ˘itim Hastanesi Psychiatry Clinic, Istanbul, Turkey. Address reprint requests to Dr. Cengiz Bas ¸og ˘lu, GATA Hay- darpas ¸a Eg ˘itim Hastanesi, Psikiyatri Klinigi 81327, Kadiko ¨y/ Istanbul, Turkey. © 2003 Elsevier Inc. All rights reserved. 0010-440X/03/4405-0016$30.00/0 doi:10.1016/S0010-440X(03)00102-0 Comprehensive Psychiatry, Vol. 44, No. 5 (September/October), 2003: pp 415-419 415