Body dysmorphic disorder
Ritualistic behaviors, such as self-examinations at a reflective surface, picking, tanning, excessive grooming, camouflaging, and reassurance seeking, are characteristic. The shame, guilt, fear of negative criticism, and embarrassment from the imagined defect can impart a negative impact on the patient's social and professional life.
Patients may visit a dermatology clinic to address their self-image defects. In particular, acne, hair changes, wrinkles, pores, benign skin lesions, dyschromia, body habitus, and genital size are common complaints. Patients may seek appearance-restoring or modifying procedures to hide or alter the perceived abnormality. Despite multiple procedures, the patient could remain dissatisfied with the outcomes if body dysmorphic disorder is not addressed properly. Concomitant psychiatric disorders, such as anxiety, depression, addiction, social phobia, and personality disorder, are common. The prognosis is poor, and patients have varying levels of insight into their suboptimal quality of life.
Body dysmorphic disorder affects about 2% of the general population. The prevalence in dermatology patients is 5-10 times greater than that of the general population. The symptoms often start during adolescence, without any sex predilection. Unmarried or divorced patients may be at higher risk. A history of childhood adversity (eg, bullying, abuse) may be reported.
Patients with this disorder may have an increased risk of various general medical conditions.
F45.22 – Body dysmorphic disorder
83482000 – Body dysmorphic disorder
Differential Diagnosis & Pitfalls
- Social anxiety disorder (see generalized anxiety disorder)
- Major depressive disorder
- Body-focused repetitive behavior disorder
- Eating disorders (eg, anorexia nervosa, bulimia)
- Psychotic disorders
- Zoom dysmorphia – A survey of dermatologists during the COVID-19 pandemic revealed that cosmetic consultations for facial cosmetic concerns had risen. The major reason for this, as cited by patients, was their appearance on video conference calls.