By Gary M. White, MD
Body dysmorphic disorder (BDD) is a chronic mental illness wherein the afflicted person has concerns with body image, manifested as excessive preoccupation with a perceived defect in physical appearance.
There is a preoccupation with an imagined defect in appearance. If a slight physical anomaly is present, the person's concern is markedly excessive. Typical are 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. The preoccupation causes clinically appreciable distress or impairment in social, occupational, or other functioning. For diagnostic considerations, the preoccupation is not better accounted for by another mental disorder.
One recognized variant is seen in patients who feel that their body is too small or insufficiently muscular.
The average onset is in the teen years, but the average age of presentation is in the 30's. The degree of insight into their disease is highly variable. A quarter or more of patients are delusional. The frequency of suicide attempts is high, e.g., 22% to 24%. Completed suicide rate is 37 times higher than the general population.
See also JAAD 2015;73;304 for a discussion of the ethics of treating BDD by a dermatologist.
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