Synonyms

Dysmorphia

Definition

Previously known a dysmorphia, body dysmorphic disorder (BDD) is an obsessive-compulsive disorder (OCD)-related condition characterized by a preoccupation with one or more perceived defects or flaws in one’s physical appearance that are not observable or appear slight to others. The disorder is manifested through repetitive behaviors such as excessive grooming, skin picking, or mental acts such as comparing one’s appearance to others, in efforts to assuage appearance concerns. Muscle dysmorphia is a subtype of BDD, in which there is a preoccupation with one’s body build being too small or insufficiently muscular.

Categorization

The disorder is classified with the obsessive-compulsive and related disorders in the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5; American Psychiatric Association 2013).

Current Knowledge

Epidemiology

National prevalence rates of BDD range from 1.7% to 2.4%, with higher rates in outpatient (1–8-6.7%) and inpatient (13.1–16%) clinical samples, as well as in patients seeking cosmetic surgery and dermatologic treatments (7.7–24.5%). Risk factors for BDD include childhood neglect and abuse and a family history of OCD. The mean age of onset is 16–17 years and most individuals develop symptoms by age 18. Nevertheless, BDD does occur among the elderly as well, though much less is known about the nature of the disorder in this segment of the population.

Etiology and Clinical Issues

The etiology of BDD is complex, encompassing biological, psychological, and socioenvironmental factors. Biological factors that have been implicated include hyperactivity in the left orbitofrontal cortex and volume abnormalities in the orbitofrontal cortex and anterior cingulate cortex. Additionally, maladaptive beliefs and cognitive biases about physical appearance, reinforced through life experiences, likely play a role. Compared to obsessive-compulsive disorder, BDD tends to be associated with higher suicidal ideation, greater psychiatric comorbidity, and poorer insight. Associated/comorbid conditions include major depressive disorder, social anxiety disorder, and substance-related disorders.

Assessment and Treatment

With regard to assessment, the primary rule out is eating disorders, however, BDD must also be differentiated from other OCD-related disorders, illness anxiety, depressive and anxiety disorders, and psychotic disorders. It is recommended that patients receiving mental health treatment be screened for BDD, by asking whether individuals are worried or unhappy with their appearance and through use of standardized measures such as the Yale-Brown Obsessive-Compulsive Scale. Effective pharmacologic interventions include serotonin reuptake inhibitors such as escitalopram and fluoxetine. Psychotherapeutic interventions include BDD-specific cognitive-behavioral therapy (CBT). There is emerging evidence for the utility of internet-based CBT.

See Also