Body dysmorphic disorder

• ICD-11 diagnostic criteria:
• • Persistent preoccupation with one or more perceived defects or flaws in appearance, or ugliness in general, that is either unnoticeable or only slightly noticeable to others.
• • Excessive self-consciousness about the perceived defect(s) or flaw(s), often including ideas of self-reference [i.e., the conviction that people are taking notice, judging, or talking about the perceived defect(s) or flaw(s)].
• The preoccupation or self-consciousness is accompanied by any of the following:

  • Repetitive and excessive behaviours, such as repeated examination of the appearance or severity of the perceived defect(s) or flaw(s)
  • Excessive attempts to camouflage or alter the perceived defect
  • Marked avoidance of social or other situations or stimuli that increase distress about the perceived defect(s) or flaw(s)
  • The symptoms are not a manifestation of another medical condition and are not due to the effects of a substance or medication on the central nervous system
• • The symptoms result in significant distress or significant impairment in personal, family, social, educational, occupational, or other important areas of functioning. If functioning is maintained, it is only through significant additional effort.
• There is a high risk of suicide in adolescents and adults with Body Dysmorphic Disorder, particularly when depressive symptomatology co-occurs
• The onset of Body Dysmorphic Disorder commonly occurs during adolescence with two thirds of individuals reporting onset before age 18.
• Management:

  • Risk assessment
  • CBT
  • SSRIs - fluoxetine
  • Referral to secondary care if above treatment ineffective
• In the assessment of people at higher risk of BDD, the following 5 questions should be asked to help identify individuals with BDD.

  • Do you worry a lot about the way you look and wish you could think about it less?
  • What specific concerns do you have about your appearance?
  • On a typical day, how many hours a day is your appearance on your mind? (More than 1 hour a day is considered excessive.)
  • What effect does it have on your life?
  • Does it make it hard to do your work or be with friends?
• Symptoms:

  • worry a lot about a specific area of your body (particularly your face)
  • spend a lot of time comparing your looks with other people's
  • look at yourself in mirrors a lot or avoid mirrors altogether
  • go to a lot of effort to conceal flaws – for example, by spending a long time combing your hair, applying make-up or choosing clothes
  • pick at your skin to make it "smooth"