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Body dysmorphic disorder

Body dysmorphic disorder
Classification and external resources
ICD-10 F45.2
ICD-9 300.7
DiseasesDB 33723
eMedicine med/3124
NCI Body dysmorphic disorder
Patient UK Body dysmorphic disorder

Body dysmorphic disorder (also known as BDD, body dysmorphia, dysmorphic syndrome, or dysmorphophobia), is a disorder that involves belief that one's own appearance is unusually defective and is worthy of being hidden or fixed.[1] This belief manifests in thoughts that many times are pervasive and intrusive.

About half of those diagnosed with BDD spend over three hours a day attempting to conceal or correct flaws that are perceived but often not reality.[1][2] If the perceived flaw has any foundation in reality, it is typically minor, though severely exaggerated.[2] The distress that accompanies BDD can affect quality of life by impairing social, occupational, and academic functioning, and yielding social isolation, though it is important to note that this is not found in all cases.[2] Causal factors seem to be grounded in many different aspects including: genetic, developmental, personality, and social engagement.[2] BDD is relatively common, as it is found in about 1% to 2% of the population, and is generally thought to be equally prevalent in women and men.[2] That being said there are discrepancies about the prevalence in relation to sex. These discrepancies predominantly come from an inconsistent view of BDD by researchers who, before the creation of a standardized questionnaire, had trouble with its diagnosis.[1] BDD can occur in adults or in children, yet usually begins during adolescence where large amounts of change is happening within the body.[2][3] That being said the causes of BDD are not fully understood. There are many indicators that BDD may have strong link to social aspects, such as bullying and abuse at a young age.[3]

The social aspect of the manifestation of BDD is also seen when looking at the expectation of attractiveness that is prevalent in society.[1] It is also important to note that there are suggestions that genetics may be crucial to determining who is more susceptible to BDD.[3] Studies have shown that 8% of people with BDD have a close relative who have also had the disorder and about 7% of people with BDD have a close relative who had OCD.[3] That being said, BDD is in fact an obsessive-compulsive related disorder (OCRD).[2][4] Similarly, BDD and anxiety disorders, such as OCD, social phobia, and panic disorder have a 7% comorbidity rate.[5] This correlation is particularly exemplified when looking at the methods used to assist people to recover from BDD in comparison with methods used to assist people to recover from OCD, which very much parallel each other.[1] BDD also shares many treatment rituals with OCD as well as many symptoms.[1] Eating disorders as well share many similarities in symptoms, including a heightened sense of perfectionism and a particularly negative body image [6]

Besides the main version of BDD, the DSM-I also describes a delusional version of the disorder which can involve delusions of reference, whereby one believes, for instance, that passersby are pointing at the flaw.[1][2]


One of the main characteristics of BDD is the belief in unreal imperfections and the preoccupation or even obsession with them.[1] People experiencing BDD many times wish to change or improve the aspects of their physical appearance that they find troublesome and may seek cosmetic surgery, or dermatological treatment, or other cosmetic modification for their concealment, although the outcome usually does not resolve the symptoms of BDD itself.[2] Skin picking sometimes manifests as a symptom of BDD and can both paradoxically create a larger 'imperfection' as well as harm the individual.[2] BDD sufferers are often prone to compulsive or repetitive behavior to try to conceal what they are insecure about, a solution that often gives only momentary relief.[1] These repetitive actions usually stem from a sense of shame about the perceived imperfection and an insecurity about it being seen.[1] A few examples of repetitive behaviors that have been seen in patients with BDD are camouflaging (clothing, makeup, hair, hats, etc.), comparing themselves to others in terms of appearance, seeking surgery, constantly checking in a mirror, and skin picking.[1] BDD has also generally been referenced as paralleling Obsessive Compulsive Disorder (OCD) and many of its characteristics. Specifically BDD manifests in greater levels of depression and a greater fear of social interaction than OCD typically [1]


BDD is under-diagnosed though it has been described for more than one hundred years all over the world.[7] It only first received diagnostic criteria in the fourth edition of the DSM, and clinicians' knowledge of it, especially among general practitioners, is still not widespread.[8] This is evident when looking at the fact that many cases of BDD have not been adequately recorded.[1] Different sources have provided extremely different numbers for the disease's prevalence both between males and females but also in terms of other variation between individuals. This can be attributed to some practitioner's inability to correctly detect BDD and consequently the inadequate reporting of the disease.[1] This inconsistency in prevalence is indicative of the importance of education around what BDD is and how it can be diagnosed. BDD is sometimes thought to be merely major depressive disorder or social phobia.[9] In order to correctly diagnose BDD a series of questions are asked to the patient to determine if they are consumed with distress about a seemingly small or unnoticeable flaw. This is then evaluated in correlation with the repercussions of this distress on the individual's ability to function.[7] The series of questions is also known as the Body Dysmorphic Disorder Questionnaire and has been shown to have a 92.5% specificity rate as well as a 100% sensitivity rate.[10] To be properly diagnosed with BDD the patient must fully fulfill the DSM-VI criteria.[11] Besides physicians inability to detect BDD, diagnosis is also hindered by patients who often fear being thought vain and sometimes attempt to hide both the perceived deformity and their preoccupation with it.[2][12]


Cognitive behavior therapy (CBT) is thought to be an effective treatment for BDD.[13][14] A meta-analysis found CBT more effective than medication after 16 weeks of treatment.[15] CBT may improve connections between the orbitofrontal cortex and the amygdala.[16]


The disorder was first documented in 1886 by Enrico Morselli, who dubbed the condition dysmorphophobia.[17] BDD was recognized by the American Psychiatric Association as a disorder in 1987 with the revision to the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM).[17] The name has since been changed from dysmorphophobia to body dysmorphic disorder, as the original implies a phobia of people, not a reluctance to interact socially because of poor body image.[citation needed]

The fourth edition of the DSM defines BDD as a somatoform disorder marked by a preoccupation with an imagined or trivial defect in appearance, but a preoccupation causing clinically significant distress or impairment in social, occupational, or other functioning. The individual's symptoms must not be better accounted for by another disorder, such as anorexia nervosa, an obsession with becoming thinner.[18] In the manual's new edition, DSM-5, published in 2013, BDD is grouped in a new category, obsessive–compulsive spectrum. The DSM-5 also includes operational criteria, such as repetitive behaviors or mental acts, and notes the subtype muscle dysmorphia, which involves belief that one's body is too small or not muscular enough.


Neuroimaging[19] suggest weaker connection between the amygdala (involved in basic emotions) and the orbitofrontal cortex (involved in regulation of emotional arousal).[16] In a cognitive-behavioral model, BDD arises through interaction of personality factors, such as introversion and self-consciousness, with early childhood experiences and social learning.[20] As a group, BDD cases report high incidence of emotional abuse during childhood.[21] BDD might also reflect social effects of the biomedical paradigm,[22] which depicts bodies as either normal or abnormal, thus either acceptable or unacceptable as aesthetic objects, amid the biomedical quest for "better" and more youthful bodies[23]

See also


  1. ^ a b c d e f g h i j k l m n Cororve, Michelle; Gleaves, David (August 2001). "Body dysmorphic disorder: a review of conceptualizations, assessment, and treatment strategies". Clinical Psychology Review 21 (6): 949–970. doi:10.1016/s0272-7358(00)00075-1. 
  2. ^ a b c d e f g h i j k Bjornsson AS, Didie ER & Phillips KA (2010). "Body dysmorphic disorder". Dialogues Clin Neurosci 12 (2): 221–32. PMC 3181960. PMID 20623926. 
  3. ^ a b c d Feusner, J.D.; Neziroglu, F; Wilhelm, S.; Mancusi, L.; Bohon, C. (2010). "What causes BDD: Research findings and a proposed model". Psychiatric Annals 40 (7): 349–355. doi:10.3928/00485713-20100701-08. 
  4. ^ Fornaro M, Gabrielli F, Albano C et al. (2009). "Obsessive-compulsive disorder and related disorders: A comprehensive survey". Annals of Genernal Psychiatry 8: 13. PMC 2686696. PMID 19450269. doi:10.1186/1744-859X-8-13. 
  5. ^ Grant, Jon; Suck, Won Kim; Crow, Scott (2001). "Prevalence and Clinical Features of Body Dysmorphic Disorder in Adolescent and Adult Psychiatric Inpatients". J Clin Psychiatry: 517–522. 
  6. ^ Hartmann, A. "A comparison of self-esteem and perfectionism in anorexia nervosa and body dysmorphic disorder". The journal of nervous and mental disease. 
  7. ^ a b Phillips, Katherine; Castle, David (November 3, 2001). British Medical Journal 323: 1015–1016.  Missing or empty |title= (help)
  8. ^ Katharine A Phillips. The Broken Mirror. Oxford University Press, 1996. p. 39. 
  9. ^ Katharine A Phillips. The Broken Mirror. Oxford University Press, 1996. p. 47. 
  10. ^ Grant, Jon; Won Kim, Suck; Crow, Scott (2001). "Prevalence and Clinical Features of Body Dysmorphic Disorder in Adolescent and Adult Psychiatric Inpatients.". J Clin Psychiatry: 527-522. 
  11. ^ Grant, Jon; Won Kim, Suck; Crow, Scott (2001). "Prevalence and Clinical Features of Body Dysmorphic Disorder in Adolescent and Adult Psychiatric Inpatients.". J Clin Psychiatry: 527-522. 
  12. ^ Prazeres AM, Nascimento AL, Fontenelle LF (2013). "Cognitive-behavioral therapy for body dysmorphic disorder: A review of its efficacy". Neuropsychiatric Disease Treatment 9: 307–16. PMC 3589080. PMID 23467711. doi:10.2147/NDT.S41074. 
  13. ^ Veale, "Cognitive-behavioural therapy for body dysmorphic disorder", 2001.
  14. ^ Ipser JC, Sander C & Stein DJ, "Pharmacotherapy and psychotherapy for body dysmorphic disorder", Cochrane Database of Systematic Reviews, 2009;1.
  15. ^ Williams J, Hadjistavropoulos T & Sharpe D, "A meta-analysis of psychological and pharmacological treatments for body dysmorphic disorder", Behaviour Research and Therapy, 2006;44(1):99–111.
  16. ^ a b Buchanan B, Rossell S, Maller J, Toh W, Brennan S & Castle D, "Brain connectivity in body dysmorphic disorder compared with controls: A diffusion tensor imaging study", Psychological Medicine, 2013, pp 1–9.
  17. ^ a b Hunt TJ, Thienhaus O & Ellwood A (July 2008). "The mirror lies: Body dysmorphic disorder". American Family Physician 78 (2): 217–22. PMID 18697504. 
  18. ^ Diagnostic and Statistical Manual of Mental Disorders (Fourth text revision ed.). American Psychiatric Association, Washington DC. 2000. pp. 507–10. 
  19. ^ Buchanan BG, Rossell SL & Castle DJ, "Body dysmorphic disorder: A review of nosology, cognition and neurobiology", Neuropsychiatry, 2011;1:71-80.
  20. ^ Veale D, "Body dysmorphic disorder", British Medical Journal, 2004;80(940):67-71.
  21. ^ Didie E, Tortolani C, Pope C, Menard W, Fay C & Phillips K, "Childhood abuse and neglect in body dysmorphic disorder", Child Abuse and Neglect, 2006;30:1105–1115.
  22. ^ Silver J & Reavey P, "'He's a good-looking chap aint he?': Narrative and visualizations of self in body dysmorphic disorder", Social Science & Medicine, 2010;70:1641–1647.
  23. ^ Lock M & Nguyen VH, An Anthropology of Biomedicine (Oxford: Wiley-Blackwell, 2010).

Further reading

External links