Body Dysmorphic Disorder: Recognition and Treatment

Frederick I. Penzel, PhD

Disclosures

April 10, 2002

In This Article

Abstract & Introduction

Body dysmorphic disorder (BDD) is characterized by a morbid preoccupation with an imagined or real physical flaw. This preoccupation leads to compulsive checking and questioning, inappropriate surgeries, and, occasionally, self-inflicted injury. These symptoms, in turn, lead to significant emotional disturbance, functional impairment, and social isolation. Current hypotheses suggest that BDD may be part of a spectrum of obsessive-compulsive disorders. Research indicates that symptoms of BDD may be significantly blunted by serotonin reuptake inhibitors or behavior therapy.

The Italian physician Morselli first recognized and named body dysmorphic disorder (BDD) in 1886,[1] calling it dysmorphophobia, or "fear of ugliness." It is still known by this name in some of the current literature. The Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV), classifies BDD as a somatoform disorder,[2] along with such entities as hypochondriasis, and defines it as a "Preoccupation with an imagined defect in appearance. If a slight physical anomaly is present, the person's concern is markedly excessive" (Table I). This preoccupation should not be confused with the "normal" dissatisfaction we see in our image-conscious society. BDD goes far beyond mere dislike into the realm of serious perceptual distortion and borders on delusion in some cases.[3]

Many individuals dislike at least one of their physical features. People often complain about the shape of their noses, the size of their thighs, or the fact that their hair is thinning. One survey of a college population indicated that 70% were dissatisfied with some aspect of their bodies.[4] In these cases, however, such dislikes do not seriously limit anyone's life, nor do they cause the extreme levels of distress and impairment seen in BDD.

Recently, researchers have seen certain links between BDD and obsessive-compulsive disorder (OCD). Hollander and Benzaquem[5] have suggested that OCD itself may not represent a single entity, but rather a group of related disorders that may include Tourette syndrome, trichotillomania (compulsive hair pulling), anorexia nervosa, bulimia, and BDD. This suggestion is controversial, however, and at present, these various disorders lie scattered throughout the DSM-IV under a variety of headings.

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