Body Dysmorphic Disorder - Anatomy of Psych

What is body dysmorphic disorder?

Body dysmorphic disorder (BDD) is a disorder characterized by obsession over one's own appearance or body part being severely deformed or defective and warranting exceptional measures to hide or fix the dysmorphic part. The most common complaints involve features, such as the shape of one's nose, or facial symmetry. The significance of the body part of concern is severely and unrealistically exaggerated. The individual may have a history of numerous visits to plastic surgeons and dermatologists to correct the imagined defect.

The lifetime prevalence of BDD is around 2%, with both genders affected at the same rate.

What does BDD look like?

Signs & Symptoms

Comparing one's appearance with other individuals
Seeking reassurance about how the perceived flaws look
Excessively tanning to darken skin
Touching and checking disliked areas to check them
Repeatedly checking for perceived defects in mirrors or examining them directly
Excessive grooming (e.g. styling, combing, shaving, plucking, or pulling hair)
Camouflaging (e.g. repeatedly applying makeup or covering disliked areas with such things as a hat, clothing, makeup, or hair)
Excessively exercising or weight lifting (in muscle dysmorphia)
Seeking and repeatedly requesting cosmetic procedures

DSM-5 Criteria

Criterion A. Preoccupation with one or more perceived defects or flaws in physical appearance that are not observable or appear slight to others.

Criterion B. At some point during the course of the disorder, the individual has performed repetitive behaviors (e.g. mirror checking, excessive grooming, skin picking, reassurance seeking) or mental acts (e.g., comparing his or her appearance with that of others) in response to the appearance concerns.

Criterion C. The preoccupation causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Criterion D. The appearance preoccupation is not better explained by concerns with body fat or weight in an individual whose symptoms meet diagnostic criteria for an eating disorder.

Subtypes & Specifiers

Risk Factors

Childhood abuse and neglect
First-degree relatives with obsessive-compulsive disorder

Prognosis

Average age of onset is 16, and 2/3 of affected individuals have onset before age 18
Associated with higher levels of anxiety, social anxiety, social avoidance, low mood, neuroticism, and perfectionism

Differential Diagnosis

Normal appearance concerns and clearly noticeable physical defects
Eating disorders
Obsessive-compulsive disorder (OCD)
Excoriation disorder
Trichotillomania
Illness anxiety disorder
Social anxiety and avoidance behaviors
Major depressive disorder
Psychotic disorders
Gender dysphoria
Olfactory reference syndrome
Body identity integrity disorder
Koro
Dysmorphic concern

How is BDD investigated?

Yale-Brown Obsessive Compulsive Scale modified for Body Dysmorphic Disorder (BDD-YBOCS)

Clinical rater
12-item semi-structured clinician-rated instrument to measure the severity of BDD symptoms

How is BDD treated?

Fluoxetine, clomipramine

References

[1] American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Arlington, VA.

[2] Boyd, M. A. (2019). Psychiatric & mental health nursing for Canadian practice. Wolters Kluwer.

[3] Townsend, M. C. (2015). Psychiatric mental health nursing. F.A. Davis.