A 4-year prospective observational follow-up study of course and predictors of course in body dysmorphic disorder.

BACKGROUND: This report prospectively examines the 4-year course, and predictors of course, of body dysmorphic disorder (BDD), a common and often severe disorder. No prior studies have prospectively examined the course of BDD in individuals ascertained for BDD. Method The Longitudinal Interval Follow-Up Evaluation (LIFE) assessed weekly BDD symptoms and treatment received over 4 years for 166 broadly ascertained adults and adolescents with current BDD at intake. Kaplan-Meier life tables were constructed for time to remission and relapse. Full remission was defined as minimal or no BDD symptoms, and partial remission as less than full DSM-IV criteria, for at least 8 consecutive weeks. Full relapse and partial relapse were defined as meeting full BDD criteria for at least 2 consecutive weeks after attaining full or partial remission respectively. Cox proportional hazards regression examined predictors of remission and relapse. RESULTS: Over 4 years, the cumulative probability was 0.20 for full remission and 0.55 for full or partial remission from BDD. A lower likelihood of full or partial remission was predicted by more severe BDD symptoms at intake, longer lifetime duration of BDD, and being an adult. Among partially or fully remitted subjects, the cumulative probability was 0.42 for subsequent full relapse and 0.63 for subsequent full or partial relapse. More severe BDD at intake and earlier age at BDD onset predicted full or partial relapse. Eighty-eight percent of subjects received mental health treatment during the follow-up period. CONCLUSIONS: In this observational study, BDD tended to be chronic. Several intake variables predicted greater chronicity of BDD.

Delusional versus nondelusional body dysmorphic disorder: clinical features and course of illness.

DSM-IV's classification of body dysmorphic disorder (BDD) is controversial. Whereas BDD is classified as a somatoform disorder, its delusional variant is classified as a psychotic disorder. However, the relationship between these BDD variants has received little investigation. In this study, we compared BDD's delusional and nondelusional variants in 191 subjects using reliable and valid measures that assessed a variety of domains. Subjects with delusional BDD were similar to those with nondelusional BDD in terms of most variables, including most demographic features, BDD characteristics, most measures of functional impairment and quality of life, comorbidity, and family history. Delusional and nondelusional subjects also had a similar probability of remitting from BDD over 1 year of prospective follow-up. However, delusional subjects had significantly lower educational attainment, were more likely to have attempted suicide, had poorer social functioning on several measures, were more likely to have drug abuse or dependence, were less likely to currently be receiving mental health treatment, and had more severe BDD symptoms. However, when controlling for BDD symptom severity, the two groups differed only in terms of educational attainment. These findings indicate that BDD's delusional and nondelusional forms have many more similarities than differences, although on several measures delusional subjects evidenced greater morbidity, which appeared accounted for by their more severe BDD symptoms. Thus, these findings offer some support for the hypothesis that these two BDD variants may constitute the same disorder. Additional studies are needed to examine this issue, which may have relevance for other disorders with both delusional and nondelusional variants in DSM.

The influence of expertise and task factors on age differences in pilot communication.

The influence of expertise and task factors on age differences in a simulated pilot-Air Traffic Control (ATC) communication task was examined. Young, middle-aged, and older pilots and nonpilots listened to ATC messages that described a route through an airspace, during which they referred to a chart of this airspace. Participants read back each message and then answered a probe question about the route. It was found that pilots read back messages more accurately than nonpilots, and younger participants were more accurate than older participants. Age differences were not reduced for pilots. Pilots and younger participants also answered probes more accurately, suggesting that they were better able to interpret the ATC messages in terms of the chart in order to create a situation model of the flight. The findings suggest that expertise benefits occur for adults of all ages. High levels of flying experience among older pilots (as compared with younger pilots) helped to buffer age-related declines in cognitive resources, thus providing evidence for the mediating effects of experience on age differences.

Icons improve older and younger adults' comprehension of medication information.

We examined whether timeline icons improved older and younger adults' comprehension of medication information. In Experiment 1, comprehension of instructions with the icon (icon/text format) and without the icon (text-only format) was assessed by questions about information that was (a) implicit in the text but depicted explicitly by the icon (total dose in a 24 hour period), (b) stated and depicted in the icon/text condition (medication dose and times), and (c) stated but not depicted by the icon (e.g., side effects). In a separate task, participants also recalled medication instructions (with or without the icon) after a study period. We found that questions about dose and time information were answered more quickly and accurately when the icon was present in the instructions. Notably, icon benefits were greater for information that was implicit rather than stated in the text. This finding suggests that icons can improve older and younger adults' comprehension by reducing the need to draw some inferences. The icon also reduced effective study time (study time per item recalled). In Experiment 2, icon benefits did not occur for a less integrated version of the timeline icon that, like the text, required participants to integrate dose and time information in order to identify the total daily dose. The integrated version of the icon again improved comprehension, as in Experiment 1, as well as drawing inferences from memory. These findings show that integrated timeline icons improved comprehension primarily by aiding the integration of dose and time information. These findings are discussed in terms of a situation model approach to comprehension.

The influence of list format and category headers on age differences in understanding medication instructions.

We examined whether instructions are better understood and remembered when they contain organizational cues. Our previous research found that older and younger adults organize medication information in similar ways, suggesting that they have a schema for taking medication. In the present study, list formats (vs. paragraphs) emphasized the order of information and category headers emphasized the grouping of information specified by this schema. Experiment 1 examined whether list and header cues improve comprehension (answer time and accuracy) and recall for adults varying in age and working memory capacity (measured by a sentence span task). List instructions were better understood and recalled than paragraphs, and reduced age differences in answer time and span differences in accuracy. Headers reduced paragraph comprehension for participants with lower levels of working memory capacity, presumably because they were not salient cues in the paragraphs. Experiment 2 investigated if headers were more effective when more saliently placed in paragraphs and lists, and if list and header cues helped readers draw inferences from the instructions. List formats again reduced age differences in comprehension, especially reducing the time needed to draw inferences about the medication. While headers did not impair comprehension, these cues did impair recall. The present study suggests that list-organized instructions provide an environmental support that improves both older and younger adult comprehension and recall of medication information.