因自杀行为而就诊的躯体变形障碍1例报告

概述：对治疗伴自杀行为的躯体变形障碍(body dysmorphic disorder, BDD)的病例报道较少。本文报道了一位患有BDD的19岁男性患者，两年来认为自己面部变丑，这一信念逐渐加重，几乎达妄想程度。然而，他最初被误诊为抑郁障碍，部分原因是他企图自杀，当时存在抑郁症状和社会退缩。后来经证实，这些症状是继发于BDD的。经过8周住院治疗，采用氟西汀和认知行为治疗相结合，患者的症状彻底改善，社会功能也恢复正常。这一病例提醒我们，自杀行为和意念有多方面原因；为了避免误诊和不恰当的治疗，临床医生只有在排除其它可能的原因后才能推断自杀行为和意念是抑郁症的直接结果。本文也讨论了自1886年Enrico Morselli首度报道BDD后，在理解BDD和BDD的诊断标准上的诸多变化。

Case report of body dysmorphic disorder in a suicidal paitent

Summary: Few reports exist about the treatment of body dysmorphic disorder (BDD) in patients who are suicidal. This case report describes a 19-year-old male with BDD who had delusional-intensity beliefs about facial disifgurement that had gradually intensiifed over a 2-year period. However, he was iniitally misdiagnosed with depression partly because he was admitted immediately atfer a suicide attempt that was associated with depressive symptoms and social withdrawal, symptoms that subsequently proved to be secondary to his BDD. The symptoms resolved completely and his social functioning returned to normal after 8 weeks of inpatient treatment with fluoxetine and cognitive behavioral therapy. This report is a reminder that suicidal behavior and ideation can have many causes; to avoid misdiagnosis and inappropriate treatment, clinicians should consider other possibiliites before assuming that suicidal behavior or ideaiton is the direct result of depression. We discuss the many changes in the understanding and diagnositc classiifcaiton of BDD since it was ifrst reported by Enrico Morselli in 1886.