In body dysmorphic disorder, a preoccupation with a nonexistent or slight defect in appearance results in significant distress or impairs functioning.
People with body dysmorphic disorder believe they have a flaw or defect in their physical appearance that in reality is nonexistent or slight. The disorder usually begins during adolescence. It is believed to occur in men and women about equally or somewhat more frequently in women.
Symptoms may develop gradually or abruptly, vary in intensity, and tend to persist unless appropriately treated. Concerns commonly involve the face or head but may involve any body part or several parts and may change from one body part to another. For example, people may be concerned about hair thinning, acne, wrinkles, scars, color of complexion, or excessive facial or body hair. Or people may focus on the shape or size of a body part, such as the nose, eyes, ears, mouth, breasts, legs, or buttocks. Some men with normal or even athletic builds think that they are puny and obsessively try to gain weight and muscle; this is called muscle dysmorphia.
Most people with body dysmorphic disorder have difficulty controlling their preoccupation and spend hours each day worrying about their perceived defect. Many people check themselves often in mirrors, others avoid mirrors, and still others alternate between the two behaviors. Many people compulsively and excessively groom themselves, pick at their skin, seek reassurance, and change their clothes. Most try to camouflage their nonexistent or slight defect—for example, by growing a beard to hide perceived scars or by wearing a hat to cover slightly thinning hair. Many have cosmetic medical (most often, dermatologic), dental, or surgical treatment, sometimes repeatedly, to correct their perceived defect. Such treatment is usually unsuccessful and may intensify their preoccupation. Men with muscle dysmorphia may take anabolic steroids such as testosterone.
Because people with body dysmorphic disorder feel self-conscious about their appearance, they may avoid going out in public, including going to work, school, and social events. Some with severe symptoms leave their homes only at night, and others not at all. This behavior can result in social isolation. Distress and dysfunction caused by the disorder can lead to repeated hospitalization and suicidal behavior.
Diagnosis and Treatment
Because many people with body dysmorphic disorder are too embarrassed and ashamed to reveal their symptoms, the disorder may go undiagnosed for years. It is distinguished from normal concerns about appearance because the preoccupations are time-consuming and cause significant distress or impair functioning.
Treatment with serotonin reuptake inhibitors, a class of antidepressants, is often effective. Cognitive-behavioral therapy that specifically focuses on this disorder may also lessen symptoms.
Last full review/revision June 2008 by Katharine A. Phillips, MD