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。 Summary: There are few reported cases of body dysmorphic disorder (BDD) for suicide. This article reports a 19-year-old male patient with BDD who, over the past two years, considered her face ugly, has gradually become more and more delusional. However, he was initially misdiagnosed as a depressive disorder, in part because of his attempted suicide when depressive symptoms and social withdrawal were present. Later confirmed that these symptoms are secondary to BDD. After eight weeks of hospitalization, the combination of fluoxetine and cognitive behavioral therapy improved the patient’s symptoms completely and his social function returned to normal. This case reminds us of the many causes of suicidal behavior and ideation; to avoid misdiagnosis and inappropriate treatment, clinicians can infer that suicide behavior and ideation are the direct result of depression only after excluding other possible causes. This article also discusses the many changes in understanding the diagnostic criteria for BDD and BDD since Enrico Morselli first reported BDD in 1886.