Body dysmorphic disorder

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 …