Body Dysmorphic Disorder

Body dysmorphic disorder (BDD) involves the preoccupation with an imagined or slight defect in appearance. Preoccupation with the skin, hair, and nose are the most common, but any body area can be the focus of concern.

BDD was first described over a century ago and continues to be a challenge to treat. Patients with BDD often can be observed to pick their skin, check their appearance in mirror frequently, or try to camouflage their appearance with a hat or make-up.

Commonly seen in community, psychiatric, cosmetic surgery, and dermatological settings, people suffering from BDD often seek cosmetic surgery repeatedly, only to remain dissatisfied with their appearance. Nearly half of the patients are delusional, particularly having delusions of reference.

Although patients with BDD tend to have a normal appearance, their preoccupation with an imagined defective body part results in obsessional thinkingOpens in new window and compulsive behaviorOpens in new window such as mirror checking and camouflaging. Levels of insight vary among these patients; people may be well aware that their thoughts are distorted, or they may be completely sure about existence of the defect.

False assumptions about the importance of appearance, fear of rejection by others, perfectionism, and conviction of being disfigured lead to overwhelming emotions of disgust, shame and depression.

Patients are frequently concerned with their skin, hair, nose, stomach, teeth, and breasts/chest. Men tend to be concerned with body build and the appearance of their genitals. Women focus on the appearance of their skin, stomach, weight, breasts, buttocks, thighs, legs, hips, and toes.

Often the patient keeps the disorder secret for many years. The disorder is chronic and response to treatment is limited. BDD is associated with severe anxietyOpens in new window and frequent suicide attemptsOpens in new window.

Clinically it appears to be more closely related to social phobiaOpens in new window and obsessive-compulsive disorder (OCD)Opens in new window than to Somatization DisorderOpens in new window. BDD seems to be related to OCD because first-degree relatives often share those conditions. Patients are usually able to describe their emotions well, even though they are socially phobic, obsessive, and rejection-sensitive.

The prevalence of body dysmorphic disorder is slightly higher in females (2.5%) than males (2.2%). The rate of this problem is higher among patients seeking cosmetic surgery, dermatology treatment, adult orthodontiaOpens in new window, and oral/maxillofacial surgeryOpens in new window.

Individuals with this disorder often come from homes with abuse and neglect. The most common comorbid disorder is major depressive disorder, which usually comes on after body dysmorphic disorder. Social anxiety disorderOpens in new window, OCDOpens in new window, and substance use disorders are also seen along with this disorder.

Serotonergic antidepressants and cognitive-behavioral therapy like that used for social phobias and OCD is frequently effective in the treatment of BDD.