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Body dysmorphic disorder

BMJ 2015; 350 doi: https://doi.org/10.1136/bmj.h2278 (Published 18 June 2015) Cite this as: BMJ 2015;350:h2278
  1. David Veale, consultant psychiatrist and visiting reader in cognitive behavioural psychotherapies1,
  2. Anthony Bewley, consultant dermatologist2
  1. 1South London and Maudsley NHS Foundation Trust, and the Institute of Psychiatry, Psychology and Neuroscience, King’s College London, UK
  2. 2St Bartholomew’s Hospital, London, UK
  1. Correspondence to: D Veale david.veale{at}kcl.ac.uk
  • Accepted 20 March 2015

The bottom line

  • People with body dysmorphic disorder may not reveal the degree of their concern unless asked directly because of shame about their appearance, leading them also to seek inappropriate help

  • If body dysmorphic disorder is suspected, ask about degree of preoccupation, distress, and interference with daily life, to distinguish the condition from more common, non-pathological body dissatisfaction and refer for mental health assessment

  • Treatment options include cognitive behavioural therapy that is specific for body dysmorphic disorder or a selective serotonin reuptake inhibitor at the highest tolerated dose if symptoms are moderate to severe

People with body dysmorphic disorder (also known as BDD) have a preoccupation with a perceived defect or defects or ugliness in their appearance. The “flaws” are often either a normal physical variation, or appear objectively only slight, yet cause enormous shame or interference in a person’s life.1 The disorder is relatively common, with a prevalence of about 2% in the general population, which makes it more common than schizophrenia or anorexia nervosa.2 3 It occurs equally in both sexes. People with body dysmorphic disorder may present to general practitioners; dermatologists; cosmetic, ear, nose, and throat, and maxillary facial surgeons; orthodontists; gynaecologists; or urologists with a desire to improve their defect. Although the condition is a serious psychiatric disorder, it presents to mental health services less commonly, and usually only when there are additional problems such as depression, being housebound, or a risk of suicide.

The condition is easily trivialised and stigmatised, but doctors should not confuse it with body dissatisfaction, which is common but does not cause major distress or interference with life. Patients with “real disfigurements” may be viewed as more worthy of attention,4 but are often less disabled than a person with body dysmorphic disorder. Patients with the condition consume substantial NHS resources …

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