U. Albert, L. Pellegrini, G. Maina, A.-R. Atti, D. De Ronchi, Z. Rhimer
Suicide attempts • Suicidal ideation • BDD • HD • Trichotillomania • Skin Picking Disorder
To estimate prevalence rates of suicide attempts and suicidal ideation in individuals with a principal
diagnosis of obsessive-compulsive related disorders (OCRDs); 2. to identify predictors of
suicide risk among subjects with OCRDs (where available).
The systematic review was conducted by searching PubMed from the date of the first available
article to December 31, 2018. The search terms [suicide] OR [suicidality] OR [suicide attempts]
OR [suicidal ideation] OR [suicidal thoughts] were combined with the following: [BDD] OR [body
dysmorphic disorder]; [HD] OR [hoarding disorder]; [trichotillomania] OR [hair pulling disorder];
[excoriation disorder] OR [skin picking disorder].
In BDD, data concerning lifetime suicide attempts are consistent across studies: mean rate is
21.5% (range 9-30.3%). Mean rate of current suicidal ideation is 37.4% (range 26.5-49.7%) and
mean rate of lifetime suicidal ideation is 74.5% (range 53.5-85%). BDD-specific factors such as
early onset, severity, poor insight and muscle dysmorphia and comorbid disorders increase the
risk of suicide attempts or suicidal ideation. Only 2 studies recruited individuals with DSM-5 HD:
suicidality appears to be low, with rates of current suicidal ideation comprised between 5% and
10%, although 19% of individuals attempted suicide during their lifetime. Concerning the grooming
disorders, lifetime rates of suicide attempts are low as compared to rates in other OCRDs;
approximately 40% of individuals, however, reported lifetime suicidal ideation.
OCRDs taken together may be at risk for suicide attempts and suicidal ideation independently
from comorbid disorders (and specifically independently from comorbid OCD); BDD remains the
disorder more strongly associated with an increased risk for suicide, followed by HD and then the