Body dysmorphic disorder (BDD) affects both adults and children, with symptoms usually appearing in adolescence or early adulthood. The older term for BDD is dysmorphophobia, which is sometimes still used. It is also referred to as “imagined ugliness syndrome”, however, this term is considered trivializing to people with BDD.
The Diagnostic and Statistical Manual of Disorders is the tool used to diagnose mental disorder in the US. The DSM-IV-TR (fourth edition, text revision) is the most current version and contains criteria for BDD. However, BDD is also usually included on the obsessive-compulsive spectrum, a hypothesized family of disorders that share features with OCD.
Symptoms of Body Dysmorphic Disorder
People with BDD are preoccupied with either a completely imagined defect, or a slight anomaly in appearance. Where there is a slight defect present, the person with BDD will have excessive concerns about it.
Any body part can be of concern to someone with BDD, and in many cases the person with BDD will perceive several defects. Common perceived defects are usually facial, such as concerns about the texture of one’s skin or the shape of one’s nose.
Many people with BDD perform rituals surrounding the perceived defect. Examples include:
- Frequently looking in mirrors or reflective surfaces (or, conversely, avoiding mirrors altogether)
- Excessive grooming, including hair styling, skin picking or applying makeup
- Hiding the perceived defect, for example, using hats or makeup as camouflage
- Asking others for reassurance regarding the perceived defect
- Comparing themselves with other people
- Seeking dermatological or surgical intervention for the perceived defect
People with BDD often struggle with relationships and are likely to experience difficulties in socializing, working and/or other life areas. In some cases, people with BDD feel unable to leave their homes.
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Diagnosis and Body Dysmorphic Disorder
In order to make a diagnosis of BDD using the DSM-IV-TR, the following conditions must be satisfied:
- The person has concerns about an appearance flaw, albeit slight or imagined
- The person is preoccupied with the perceived flaw for at least an hour per day
- The preoccupations result in significant distress or impairment of functioning
BDD is currently classified as a somatoform disorder. Where there is poorer insight, i.e. the person is convinced their perception is accurate, the case of BDD is classified as a delusional disorder. BDD is frequently comorbid with other disorders such as major depression. People with both BDD and major depression are at increased risk of suicide.
BDD often goes undiagnosed. People with symptoms of BDD are often inhibited about coming forward due to feelings of shame and/or embarrassment. In particular, they may be worried about being labelled vain and/or narcissistic. It is more likely to be diagnosed when the physician asks specific questions relating to BDD.
Prevalence of Body Dysmorphic Disorder
Studies suggest that 1-2% of the US population has BDD, however, this figure cannot consider the cases that go undiagnosed. There is also little data available in other countries to estimate BDD’s prevalence on an international level. The available data suggests no gender differential in cases of BDD.
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