Rapid Responses to:
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Rapid Responses: Rapid Responses published:
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self-citation
- David Baker (5 November 2001)
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Body dismorphic disorder and violence
- Philip Lucas (6 November 2001)
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body dysmorphia
- Lisa Carter (6 November 2001)
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Re: self-citation
- Peter Morrell (8 November 2001)
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re:re:self-citation
- David Carvel (10 November 2001)
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Response to comments on citations
- Katharine A. Phillips, David J. Castle (24 February 2002)
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Re: Response to comments on citations
- David M Veale (29 April 2002)
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Re: body dysmorphia
- David M Veale (29 April 2002)
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Re: Response to comments on citations [apology]
- Peter Morrell (2 May 2002)
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Re: Re: body dysmorphia
- Jim C Cooper (7 August 2002)
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David Baker, GP Dorset
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Of the 12 references quoted by Katherine Phillips she is an author or part-author of 8 and editor of another. This gives a "self-citation rate" of 75%. Is this a record? |
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Philip Lucas, consultant forensic psychiatrist North London forensic service, Hadley Lodge, Chase Farm Hospital, Enfield EN2 8JL
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Body dysmorphic disorder and violence Sir, Your editorial on body dysmorphic disorder (BDD) in men [1] stated that patients disappointed with ineffective surgical or dermatological treatment may become ‘violent towards the treating physician’. There are grounds for considering that violence may be a more serious problem in this disorder than hitherto recognised, especially in view of the associated use of anabolic steroids [1]. I have recently reported the case of a patient with BDD whose violence against others led to his compulsory detention in a secure unit under the Mental Health Act [2]. My review of the BDD literature suggested violence to be more common in BDD than previously recognised. Perugi et al [3] found that 29% of 34 male and 46% of 24 female BDD sufferers responded affirmatively to at least one of the following questions: ‘Are you ever so enraged and in despair that you lose control and become insulting, aggressive or violent towards your relatives and friends?’ and ‘At these times do you break any object or punch and kick walls and doors?’. Similarly, 38% of the young patients in Albertini and Phillips’ study [4] acknowledged a ‘history of violence due to BDD’. These two studies differ from others in that the subjects were asked directly about aggressive and violent behaviour. Their answers revealed an unexpectedly high incidence. Phillips and Castle [1] indicate that men and boys fail to volunteer their core BDD symptoms. Unless sought by direct questioning, this is also likely to apply to associated violence and aggression which may profoundly affect the BDD sufferer’s life and that of his family [2]. Philip Lucas, consultant forensic psychiatrist North London Forensic Service, Hadley Lodge, Chase Farm Hospital, The Ridgeway, Enfield, EN2 8JL philip.lucas@enfieldcc-tr.nthames.nhs.uk 1. Phillips KA, Castle DJ. Body dysmorphic disorder in men. BMJ 2001; 323: 1015-6.(3 November) 2. Lucas P. Body dysmorphic disorder and violence: case report and literature review. J Forensic Psychiatry (in press) 3. Perugi G, Akiskal H, Giannotti D, Frare F, Di Vaio S, Cassano G. Gender-related differences in body dysmorphic disorder (dysmorphophobia). J Nerv Ment Dis 1997; 185: 578-82 4. Albertini RS, Phillips KA. Thirty-three cases of body dysmorphic disorder in children and adolescents. Journal of the American Academy Child and Adolescent Psychiatry 1999; 38: 453-9. |
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Lisa Carter, GP registrar East Craigs medical practice, Edinburgh
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I wonder the value of devoting an editorial to such a condition as body dysmorphic disorder. Whilst it may appear to be a debilitating condition in the 40% of men who responded as being disatisfied with their appearance, the 1 in 236 one legged Cambodian land mine victims may disagree. |
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Peter Morrell, Researcher, History & Philosophy of Medicine UK
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Sir, Dr David Baker is absolutely right [1] to worry about such alarming high self-citation rates. Purely from a research angle, for example, it is not acceptable because it strongly implies that the author of such a paper is sloppy and has not bothered to complete in advance a thorough search of all relevant literature on that subject BEFORE they publish. Every citation list should reflect - and at least feebly hint - that such a search has taken place. Likewise, if there is no hint of such a search having taken place, then readers are fully entitled to assume that no such search did take place. Therefore, which ever way one looks at it, high self-citation is a bad thing and implies that the researcher is shoddy and not thorough. This inevitably devalues their work in the eyes of paper readers and other researchers in that field. Indeed, in any field. 'What goes around, comes around' and thus they begin to be seen - quite rightly - as generators and promoters of unreliable knowledge. In terms of publications, there are even worse implications of this type of paper. Any journal publishing high quality papers must send papers out for peer review. If such papers as this get through peer review as 'acceptable', then it suggests that such 'peer review' is not working and is not worth its salt. It actually implies that those folks who checked that paper did not see that 8 out of 12 references were to the main author. That is quite an outrageous omission on their part. And if no thorough peer review was undertaken, then BMJ is to blame as well. Finally, if the author doesn't care about being cited as the source in 75% of the citations, and peer reviewers don't care either, or are too blind to see it, then what about the journal editors? They are also culpable for publishing such shabby research papers. So, everyone is a loser in this and BMJ should hang its head in shame along with all the rest. Decent research and decent peer review, plus thorough editorial review are the key 'gate-keepers' preventing authors like this getting published and 'polluting' journals with incorrect or dubious, low-quality papers. It reflects badly on everything else published by the same journal, for accepting [or failing to detect] such a shabby set-up. [1] BMJ letter, Self-citation, Dr David Baker, 5-11-2001 http://www.bmj.com/cgi/eletters/323/7320/1015#EL2 |
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David Carvel, GP ML12 6BE
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Perhaps a 75% self citation rate is evidence of EDD (Ego dysmorphic disorder). |
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Katharine A. Phillips, Associate Professor Butler Hospital, Providence RI 02906 USA, David J. Castle
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We would like to reply to comments about the references in our editorial on Body Dysmorphic Disorder in Men. There are several reasons for our high rate of self-citation, which we agree is best avoided if possible. First, because the number of references that could be included in the editorial was limited, we thought it would be most useful to readers to include more comprehensive references that included primary references. There are few such references available. Second, while research on BDD is increasing, there are still relatively few researchers in the field and even fewer who have researched or reviewed certain aspects of this disorder. For both of these reasons, we believe that our reference list is reasonable. We hope that more researchers will begin to study this disorder so more perspectives may be brought to this work and BDD will become better understood. |
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David M Veale, Consultant Psychiatrist The Priory Hospital North London, The Bourne, London, N14 6RA
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I think the comments on the high self-citation rates by the authors are unfair. BDD is a neglected area of research and Katherine Phillips has contributed more than anyone else to research into understanding and treatment of BDD. I am aware of the literature and was cited for one reference. It is always difficult to select the most appropriate references for a brief editorial with a limited number of refernces. I did not review the article but I thought they were all appropriate for guiding the reader towards the best source of further references. |
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David M Veale, Consultant Psychiatrist The Priory Hospital North London, The Bourne, London, N14 6RA
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Comparing the distress of someone with Body Dysmorphic disorder (BDD) to someone having had their leg blown off by a mine is unfair and may casue an adjustment disorder. Being "dissatisfied" with one's appearance is extremely common (43% of men cited) but this is not the same as BDD, which was the content of the editorial. The prevalence of BDD is about 1% in the general population and many cases are extremely disabled with high suicide rates. They are often unemployed, socially isolated or housebound because of their disorder. They know that their appearance is not as bad as someone who is severly disfigured by burns or an amputee but they can't just stop obsessing. Patients with BDD are preocuupied for most hours of the day and perform countless rituals like mirror gazing. Our own experience is that they are highly ashamed of their preoccupation and if they do present to primary care, they are more likely to complain of depression or social anxiety for many years (and not reveal their main symptoms of BDD) because of the attitude expressed by Dr Carter! BDD is a recognized mental disorder and patients need a great deal of understanding to engage them in a treatment programme. |
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Peter Morrell, freelance researcher UK
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Sir, Though in general terms I believe I was right to say that the use of “high self-citation rates…are not acceptable…indicate a sloppy paper…and indicates a researcher who is shoddy and not thorough…and generators and promoters of unreliable knowledge,” [1] and that journals who easily accept such material “are to blame as well…[and should] hang their head in shame along with all the rest.” [1] Yet, in this particular case, I would say that Katharine Phillips is obviously a sole expert in this field and quite right to cite her own publications as the most important papers in what is a very small field, especially considering that she herself, “hopes that more researchers will begin to study this disorder so more perspectives may be brought to this work,” [2] and that “BDD is a neglected area of research and Katherine Phillips has contributed more than anyone else to research into understanding and treatment of BDD.” [3] I would therefore like to apologise for any offence so caused by my previous remarks specific to this paper. Nevertheless, it still remains true in general terms that those researchers who continue to insist on habitually citing mostly their own papers, in what is a much wider field of research [4, 5], should be exposed as purveyors of very shabby research methods and certainly “the generators and promoters of unreliable knowledge.” [1] Sources [1] http://bmj.com/cgi/eletters/323/7320/1015#17366 [2] BMJ e-letter, Katharine Phillips http://bmj.com/cgi/eletters/323/7320/1015#19912 [3] BMJ e-letter David Veale http://bmj.com/cgi/eletters/323/7320/1015#21720 [4] George Lewith BMJ article, 30 June 2001 http://bmj.com/cgi/eletters/322/7302/1574#16056 [5] E Ernst article: http://www.bmj.com/cgi/content/full/321/7269/1133 one of the very worst examples of high self-citation in this field; 16 to his own work out of 24 refs [66.7% self-citation] |
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Jim C Cooper
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Thank you for stating that BDD is not the same as trivial appearance concerns. There is an internet site called www.bddcentral.com where people who suffer from bdd have been able to meet and discuss their problems. There should be an information campaign including articles and television shows to make the condition known to the public at large. Most people who suffer from bdd do not know they have a problem with a name,they just think they are as ugly as beasts and hide all their lives if they don't commit suicide in the first place. It took me 14 years for someone to spot i had bdd. There is a program to treat BDD at the Buttler hospital in the US where Katharina Philipps , author of the book " the broken mirror" which deals with bdd, carries out testing and therapy on bdd sufferers.There is also the Neysa Jane Memorial Fund in the US for families of bdd sufferes who commited suicide. The fact is that health practicians and the population at large do not know that this condition exists and how distressing it may be. I was not surprised to see a doctor belittle the condition by saying that it was not worth writing about. BDD belongs to the Obsessive compulsive disorders and involves serious social problems of which suicide attempts is the number one concern. Once again thank you for publishing this article, Kind regards, Jim C Cooper. |
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