Dysmorphophobia

The patient with body dysmorphic disorder (BDD) (dysmorphophobia) is convinced that part of their body is too large, too small or deformed in some way. To the observer the appearence is normal or of a minor abnormality.

BDD has both psychotic and nonpsychotic variants, which are classified as separate disorders in DSM-IV (delusional disorder and a somatoform disorder)

• despite their separate classification, available evidence indicates that BDD's delusional and nondelusional forms have many similarities (although the delusional variant appears more severe), suggesting that they may actually be the same disorder, characterized by a spectrum of insight

Common parts of the body complained about include the nose, ears, mouth, breasts, buttocks and penis, but any part of the body may be involved.

Factors that may predispose persons to BDD include:

• low self-esteem
• critical parents and significant others
• early childhood trauma
• unconscious displacement of emotional conflict

Patients with BDD also had an earlier onset of major depression and higher lifetime rates of major depression (26%), social phobia (16%), obsessive compulsive disorder (6%), and psychotic disorder diagnoses as well as higher rates of substance use disorders in first-degree relatives (3,4)

Studies have reported rates of BDD of 7% and 15% in patients seeking cosmetic surgery and a rate of 12% in patients seeking dermatologic treatment (2)

Reference:

• Diagnostic and Statistical Manual of Mental Disorders (Fourth text revision ed.). American Psychiatric Association, Washington DC 2000:507-10.
• Phillips KA, Dufresne RG, Jr, Wilkel CS, Vittorio CC. Rate of body dysmorphic disorder in dermatology patients. J Am Acad Dermatol. 2000;42:436-41
• Phillips KA, Gunderson CG, Mallya G, McElroy SL, Carter W. A comparison study of body dysmorphic disorder and obsessive-compulsive disorder. J Clin Psychiatry. 1998;59:568-75.
• Gunstad J, Phillips KA. Axis I comorbidity in body dysmorphic disorder. Compr Psychiatry. 2003;44:270-6.