People with body dysmorphic disorder, a preoccupation with a real or imagined physical defects, have far higher than average rates of suicidal thoughts and suicide attempts, a new study indicates.

The disorder, known as BDD, is diagnosed when a person becomes obsessed with a flaw - anything from a large nose to excess fat to underdeveloped muscles - that either doesn’t exist or is far less significant than the person perceives.

People may become so distressed by the “defect” that they avoid social situations or take great pains to camouflage the flaw. They often suffer other psychiatric conditions as well, such as major depression, Eating disorders or substance abuse problems.

In the new study, researchers found that of 200 people who had ever been diagnosed with BDD, 78 percent said they had contemplated suicide at some point. More than one-quarter had actually tried to take their lives.

That rate of suicidal thoughts is higher than some studies have found for major depression and schizophrenia, according to the study authors. And the rate of suicide attempts is far higher than the norm; 3 percent of participants said they had attempted suicide in just the previous month, a rate 30 times higher than in the general U.S. population.

Dr. Katharine A. Phillips of Butler Hospital in Providence, Rhode Island, led the study. The findings are published in the Journal of Clinical Psychiatry.

The study included 200 men and women who had ever suffered from BDD, many of whom were currently receiving treatment for it, with either medication, talk therapy, or a combination.

The risk of suicidal behavior was particularly high among men and women who had ever suffered from post-traumatic stress disorder in addition to BDD, which described 9 percent of study participants.

The risk of suicidal thoughts and behavior was high regardless of whether study participants were currently receiving treatment. The reason is unclear, according to Phillips and her colleagues, but one explanation could be that suicidal patients are more likely to seek or be referred to treatment.

The available evidence, the researchers add, suggests that behavioral therapy and psychiatric drugs that act on the mood-related brain chemical serotonin can diminish BDD patients’ suicidal behavior.

Still, they conclude, their findings “highlight the critical need to develop more effective treatments for BDD and to ascertain the extent to which such treatments may decrease suicidality.”

More immediately, the researchers add, doctors should carefully monitor BDD patients for signs of suicidal behavior.

SOURCE: Journal of Clinical Psychiatry, June 2005.