Body dysmorphic disorder is preoccupation with an imagined or a slight defect in appearance that causes significant distress or impairment of social, occupational, academic, or other aspects of functioning. Diagnosis is based on history. Treatment consists of drug therapy, psychotherapy, or both.

Body dysmorphic disorder usually begins during adolescence and may be somewhat more common among women.

Symptoms and Signs

Symptoms may develop gradually or abruptly. Although intensity may vary, the disorder is usually chronic unless patients are appropriately treated. Concerns commonly involve the face or head but may involve any body part or several parts and may change from one part to another. For example, patients may be concerned about thinning hair, acne, wrinkles, scars, vascular markings, color of complexion, or excessive facial or body hair. Or they may focus on the shape or size of the nose, eyes, ears, mouth, breasts, buttocks, legs, or other body part. Men may have a form of the disorder called muscle dysmorphia, which involves preoccupation with the idea that their body is not sufficiently lean and muscular.

Patients usually spend many hours a day worrying about their perceived defects. Most check themselves often in mirrors, others avoid mirrors, and still others alternate between the 2 behaviors. Other common compulsive behaviors include excessive grooming, skin picking, reassurance seeking, and clothes changing. Most try to camouflage their imagined defects—eg, by growing a beard to hide perceived scars or by wearing a hat to cover slightly thinning hair. Many undergo cosmetic, medical (most often, dermatologic), dental, or surgical treatment to correct their perceived defect, but such treatment is usually unsuccessful and may intensify their preoccupation. Men with muscle dysmorphia may use androgen supplements.

Because people with body dysmorphic disorder feel self-conscious about their appearance, they may avoid going out in public. For most, social, occupational, academic, and other aspects of functioning are impaired because of their concerns about appearance. Some leave their homes only at night; others, not at all. Social isolation, repeated hospitalization, and suicidal behavior may result.

Diagnosis

• History

Because many patients 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, impairment in functioning, or both.

Diagnosis is based on history. If the only concern is body shape and weight, an eating disorder may be the more accurate diagnosis (see Eating Disorders: Anorexia Nervosa); if the only concern is the appearance of sex characteristics, gender identity disorder may be considered (see Sexuality and Sexual Disorders: Gender Identity Disorder and Transsexualism).

Treatment

Serotonin reuptake inhibitors are often effective and are currently the drug of choice; relatively high doses are often required. Cognitive-behavioral therapy that specifically targets symptoms of body dysmorphic disorder is currently the psychotherapy of choice.

Last full review/revision June 2008 by Katharine A. Phillips, MD