Body Dysmorphic Disorder

Diagnostic Criteria                                                                            300.7 (F45.22)

Criteria A

Preoccupation with one or more perceived physical flaws or imperfections that are not visible to others or seem minor to them

Criteria B

In reaction to the anxieties over appearance, the individual engaged in repetitive actions (such as mirror checking, obsessive grooming, skin picking, and reassurance seeking) or mental activities (such as comparing one's looks to others).

Criteria C

Clinically substantial suffering or impairment in social, occupational, or other areas is brought on by the preoccupation. or other crucial functional areas

Criteria D

In a person whose symptoms fit diagnostic criteria for an eating disorder, worries about body fat or weight do not provide a better explanation for the obsession with beauty.

Preoccupation with one or more physical faults or imperfections that are not visible to others or seem minor to you.

Specify if:

When a person has muscle dysmorphia, they are fixated with the thought that their body type is inadequately muscular or too tiny. Even when the person is focused with other body parts, which is frequently the case, this specifier is employed.

Indicate if

• Describe your level of understanding of your body dysmorphic disorder beliefs, such as "I look horrible" or "I seem distorted,"
• With good or average awareness, the person is aware that the ideas related to body dysmorphic disorder are either untrue or may not be true.
• Poor insight: The person believes that the thoughts associated with body dysmorphic disorder are probably real.
• The person is totally convinced that the body dysmorphic disorder ideas are true due to lack of understanding or delusional views.
• 
  

Associated Features Supporting Diagnosis

Many persons who suffer from body dysmorphic disorder have notions or delusions that others are particularly interested in them or mock (imitate) them because of how they look.

High levels of anxiety are linked to body dysmorphic disorder.

Social phobia

Social withdrawal

Feeling down

narcissism, and

Low extroversion and perfectionism

a low sense of self

Many people are reluctant to discuss their worries with others because they are ashamed of how they look and spend too much time worrying about their looks.

On rare occasions, someone might operate on themselves.

Such treatments seem to have a poor response rate for body dysmorphic disorder, and

ü  

Prevalence

2.4% of adults in the US (2.5% of women and 2.2% of men) are obese.

The prevalence in Germany is currently between 1.7% and 1.8%, with a gender distribution comparable to that in the US.

The prevalence is currently 9%-15% among dermatological patients, 7%-8% among Americans undergoing cosmetic surgery, 3%-16% worldwide (according to most research), 8% among adults undergoing orthodontic treatment, and 10% among those undergoing oral or maxillofacial surgery.

Development and Course

ü  

The average age of onset of a condition is 16 to 17 years.

Age upon onset is 15 years on average.

12 to 13 years old is the average age of onset.

In two-thirds of cases, the illness manifests before the age of 18.

In general, signs of subclinical body dysmorphic disorder start around age 12 or 13.

Although some individuals have an abrupt beginning of body dysmorphic disorder, subclinical issues typically develop gradually to the full disease.

Risk and Prognostic Factors

Environmental

ü  Body dysmorphic disorder has been associated with high rates of childhood neglect and abuse

 

Genetic and physiological

ü  The prevalence of body dysmorphic disorder is elevated in first-degree relatives of individuals with obsessive-compulsive disorder (OCD).

Differential Diagnosis

 

 Normal concerns about looks and glaring physical flaws

 Body dysmorphic disorder is distinguished from normal appearance problems by repetitive behaviors that are obsessed with appearance, time consuming, usually difficult to resist and control, and cause clinically significant distress and disability.

Serious (that is, non-minor) physical defects are not diagnosed as body dysmorphic disorder.

Skin picking, a sign of body dysmorphic disorder, can, nevertheless, result in visible skin lesions and scarring. Body dysmorphic disorder should be identified in these circumstances.

v

Eating disorders

In For people with eating disorders, concerns about being fat are considered a symptom of an eating disorder rather than body dysmorphic disorder.

v Body dysmorphic disorder can cause weight problems. Eating disorders and body dysmorphic disorder can coexist, in which case both should be diagnosed.

 

Other obsessive-compulsive and related disorders

Body dysmorphic disorder's preoccupations and repetitive behaviors are distinct from OCD's obsessions and compulsions in that the former focus solely on appearance. These disorders also differ in other ways, such as body dysmorphic disorder's lack of insight.Body dysmorphic disorder, not excoriation (skin-picking) disorder, is diagnosed when skin picking is intended to improve the appearance of perceived skin defects.

Instead of trichotillomania (Hairpulling disorder), body dysmorphic disorder is diagnosed when hair removal (plucking, pulling, or other types of removal) is intended to improve perceived defects in the appearance of facial or body hair.

Other distinctions exist amongst disorders, such as body dysmorphic disorder's weaer insight. Excoriation (skin-picking) disorder, not excoriation (skin-picking) disorder, is diagnosed when skin picking is done to mask perceived skin flaws.

 

Illness anxiety disorder

v  Individuals with body dysmorphic disorder are not preoccupied with having or acquiring a serious illness and do not have particularly elevated levels of somatization.

 

Major depressive disorder

v  The prominent preoccupation with appearance and excessive repetitive behaviors in body dysmorphic disorder differentiate it from major depressive disorder

 

v  However, major depressive disorder and depressive symptoms are common in individuals with body dysmorphic disorder, often appearing to be secondary to the distress and impairment that body dysmorphic disorder causes

 

v  Body dysmorphic disorder should be diagnosed in depressed individuals if diagnostic criteria for body dysmorphic disorder are met

 

Anxiety disorders

v  Social anxiety and avoidance are common in body dysmorphic disorder.

 

v  Preoccupation may be delusional, and repetitive behaviors, and the social anxiety and avoidance are due to concerns about perceived appearance defects

 

v  They belief or fear that other people will consider these individuals ugly, ridicule them, or reject them because of their physical features

 

v  Anxiety and worry in body dysmorphic disorder focus on perceived appearance flaws in contrast to generalized anxiety disorder.

Psychotic disorders

v  Individuals with body dysmorphic disorder have delusional appearance beliefs (i.e., complete conviction that their view of their perceived defects is accurate), & is diagnosed as body dysmorphic disorder, with absent insight/delusional beliefs, not as delusional disorder.

      In contrast to schizophrenia and schizoaffective disorder, body dysmorphic disorder involves prominent appearance preoccupations and related repetitive behaviors. However, disorganized behavior and other psychotic symptoms are absent (with the exception of appearance beliefs, which may be delusional). Delusions of reference are common in body dysmorphic disorder.

Other disorders and symptoms

v  Body dysmorphic disorder should not be diagnosed if preoccupation is limited to discomfort with or a desire to be rid of one's primary and/or secondary sex characteristics in an individual with Gender Dysphoria

 

v  If the preoccupation focuses on the belief that one emits a foul or offensive body odor as in Olfactory Reference Syndrome (which is not a DSM-5 disorder).

 

 Body identity integrity disorder

A desire to have a limb amputated to correct an experience of a mismatch between a person's sense of body identity and their actual anatomy is known as apotemnophilia, which is not a DSM-5 disorder.However, unlike body dysmorphic disorder, the concern does not center on the limb's appearance.

Koro, which is not a DSM-5 disorder, is the desire to have a limb amputated to correct an experience of a mismatch between a person's sense of body identity and their actual anatomy.However, in contrast to body dysmorphic disorder, the focus of the concern is not on how the limb looks.

Dysmorphic concern (which is not a DSM-5 disorder) is a much broader constructs than, and is not equivalent to, body dysmorphic disorder. It involves symptoms reflecting an over concern with slight or imagined flaws in appearance.