Definition and Diagnosis
Body Dysmorphic Disorder involves a persistent preoccupation with one or more perceived defects in physical appearance that are not observable or appear only slight to others, accompanied by repetitive behaviors such as mirror-checking or excessive grooming.
Epidemiology
Estimated prevalence is around 2% in the general population, with similar rates in men and women, though the specific body areas of concern can differ by sex. Onset is usually in adolescence.
Risk Factors
Risk factors include a history of teasing or bullying about appearance, perfectionistic traits, and co-occurring anxiety or OCD. Sociocultural pressures around appearance can also play a contributing role.
Symptoms and Subtypes
Individuals may spend hours a day thinking about the perceived flaw, seeking reassurance, comparing their appearance to others, or avoiding social situations. Insight varies, with some individuals recognizing the concern is excessive and others holding delusional-level beliefs.
Diagnosis
DSM-5-TR criteria require preoccupation with a perceived appearance flaw plus repetitive behaviors or mental acts, causing significant distress or impairment, not better explained by an eating disorder. Clinicians assess insight level and screen for co-occurring OCD or depression.
Treatment
CBT adapted for body image concerns, including exposure and response prevention for appearance-related rituals, is a primary treatment, often combined with SSRIs. Cosmetic procedures are generally not recommended, as they rarely resolve the underlying preoccupation.
Prognosis
Without treatment, Body Dysmorphic Disorder tends to be chronic and can be associated with significant impairment. Targeted therapy and medication lead to meaningful improvement for many individuals.
Reference
American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders (5th ed., text rev.).