Body Dysmorphic Disorder (BDD)

Body Dysmorphic Disorder (BDD) is a mental disorder characterized by the obsessive idea that an aspect of one's own body part or appearance is severely flawed and warrants exceptional measures to hide or fix the dysmorphic part. Individuals are preoccupied with perceived flaws in their physical appearance that are not observable (or appear only slight to others). In addition, there are repetitive behaviors (e.g. - mirror checking, excessive grooming, skin picking, or reassurance seeking) or mental acts (e.g. - comparing one's appearance to others) in response to the appearance concerns.

Epidemiology

The lifetime prevalence is 1-2%. There is comorbidity with depression, social phobia, and substance use.

Criterion A

Preoccupation with 1 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 seek ing) 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.

Specifiers

Specifier

  • With muscle dysmorphia: The individual is preoccupied with the idea that his or her body build is too small or insufficiently muscular. This specifier is used even if the individual is preoccupied with other body areas, which is often the case.

Insight Specifier

Indicate degree of insight regarding body dysmorphic disorder beliefs (e.g. - “I look ugly” or “I look deformed”).

  • With good or fair insight: The individual recognizes that the body dysmorphic disorder beliefs are definitely or probably not true or that they may or may not be true.
  • With poor insight: The individual thinks that the body dysmorphic disorder beliefs are probably true.
  • With absent insight/delusional beliefs: The individual is completely convinced that the body dysmorphic disorder beliefs are true.

Symptoms of body dysmorphic disorder are generally more responsive to SSRIs and clomipramine, with a potential role for augmentation with antipsychotics. The most recent research evidence suggests that SSRIs and CBT are the best treatment approaches.[1] A trial of medication may require up to 12-16 weeks. The 2017 evidence review notes that “while dose finding studies have not been conducted in BDD, available data and clinical experience indicate that BDD often requires SSRI doses that are higher than those required to treat depression and similar to those report to treat OCD.” Of note, clinical experts in the field have suggested that dose is required to treat BDD often exceed the regulatory limit“. There is a very small case–report literature on the use of electroconvulsive therapy in body dysmorphic disorder, typically in the context of comorbid depression.

Cognitive Behavioural Therapy (CBT) consisting of exposure to social situations, identification of safety behaviours, and resisting compulsions (i.e. - mirror-checking, reassurance seeking) are effective.

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