Hospitalizations for Body Dysmorphic Disorder Across the U.S: Insights From the Nationwide Inpatient Sample Database

Abstract

Background/Aim: Body dysmorphic disorder (BDD) has been associated with significant psychiatric comorbidity and suicidal ideation in the outpatient setting. We examined the hospitalization rates, resource utilization, comorbidities, and outcomes of BDD using inpatient data. In addition, we compared the outcomes of BDD hospitalizations with those of patients with other mental disorders. Methods: Adult hospitalizations for a primary diagnosis of BDD were identified from the 2017-2020 nationwide inpatient sample database using the ICD-10 code (F45.22). We used χ2 analysis to compare categorical variables. For continuous variables, we used t-tests and the Wilcoxon rank-sum test to analyze data with normal and nonnormal distributions. Using rank commands and ICD-10-CM/PCS codes, we identified the most recurring comorbidities and procedures associated with hospitalizations for BDD. The study endpoints included hospitalization rates, secondary indications for hospitalization, most recurring comorbidities and procedures, and outcomes (hospitalization costs, length of stay, and discharge disposition). Results: 3,384 BDD hospitalizations were analyzed (67 cases per 100,000 hospitalizations for mental disorders). 67.6% were female, whereas non-BDD admissions had a male preponderance (67.5%). 71.4% of BDD hospitalizations were for individuals aged between 18 and 40 years. Hospitalizations for BDD were younger than those for other mental disorders (median age: 33 [IQR, 24-50] vs 37 [IQR, 24-54], P<0.001). Approximately 94.6% of BDD hospitalizations had at least one other psychiatric comorbidity. The most common comorbidities were social anxiety disorder (40%), major depressive disorder (22.8%), bipolar II disorder (2.2%), and substance use disorder (18.9%). 17 individuals (O.5%) had attempted suicide, while 10.3% received various cosmetic procedures. BDD was associated with a longer mean hospital stay compared with other mental disorders combined (9 vs 7.8 days; P=0.002). 89.8% of BDD hospitalizations were discharged home routinely, and no mortality was recorded over the period. BDD hospitalizations were associated with higher mean hospital costs than hospitalizations for other mental disorders combined ($34,314 vs. $27,770; P<0.001). Conclusion: BDD hospitalizations are most common among young women, and involve significant psychiatric comorbidities, longer hospital stays, and higher costs than other mental health conditions.