Body dysmorphic disorder

Body dysmorphic disorder
Synonyms	body dysmorphia, dysmorphic syndrome, dysmorphophobia
Classification and external resources
Specialty	Psychiatry
ICD-10	F45.2
ICD-9-CM	300.7
DiseasesDB	33723
eMedicine	med/3124
Patient UK	Body dysmorphic disorder
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Body dysmorphic disorder (BDD) is a mental disorder characterized by an obsessive preoccupation that some aspect of one's own appearance is severely flawed and warrants exceptional measures to hide or fix it. In BDD's delusional variant, the flaw is imagined. If the flaw is actual, its importance is severely exaggerated. Either way, one's thoughts about it are pervasive and intrusive, occupying up to several hours a day. The DSM-5 categorizes BDD in the obsessive–compulsive spectrum, and distinguishes it from anorexia nervosa.

A fairly common mental disorder, estimated to affect up to 2.4% of the population, BDD usually starts during adolescence, and affects men and women roughly equally. (The BDD subtype muscle dysmorphia, perceiving the body as too small, affects mostly males.) Besides thinking about it, one repetitively checks and compares the perceived flaw, and can adopt unusual routines to avoid social contact that exposes it. Fearing the stigma of vanity, one usually hides the preoccupation. Commonly unsuspected even by psychiatrists, BDD has been greatly underdiagnosed. Severely impairing quality of life via educational and occupational dysfunction and social isolation, BDD involves especially high rates of suicidal ideation and suicide attempts.

Whereas vanity concerns preoccupation with aggrandizing the appearance, BDD is compulsion to merely normalize the appearance. Although delusional in about one of three cases, the appearance concern is usually an overvalued idea. The perceived bodily defect can be at virtually any area, yet is usually the nose, stomach, thighs, skin, or hair. Cognitive testing and neuroimaging suggest both a bias toward detailed visual analysis and a tendency toward emotional hyperarousal.

Via BDD, some persons experience delusions that others are covertly pointing out their flaws. BDD can prompt a quest for dermatological treatment or cosmetic surgery, which interventions typically do not resolve the distress. On the other hand, attempts at self-treatment can paradoxically create lesions where none previously existed. BDD shares features with obsessive-compulsive disorder, but involves more depression and social avoidance. BDD often associates with social anxiety disorder.

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