Body Dysmorphic Disorder Clinical Presentation

  • Author: Sing-Yi Feng, MD; Chief Editor: Caroly Pataki, MD   more...
 
Updated: May 6, 2010
 

History

  • Natural history
    • Body dysmorphic disorder (BDD) is a chronic disorder that can wax and wane in intensity.
    • The symptoms often start during adolescence. Over the course of a lifetime, new symptoms may be added onto the original presentation or symptoms may shift from one body part to another.
    • BDD may not be diagnosed for many years after its onset, often because of the patient's reluctance to reveal the symptoms. In some cases, patients who are ashamed of their symptoms may not identify individual symptoms, referring only to a sense of general ugliness.
  • Behavior
    • BDD may lead to time-consuming unproductive rumination. Patients adopt repetitive, obsessive, and ritualistic behavior and may spend most of their time in front of a mirror, repeatedly checking their perceived imperfections.
    • BDD is associated with significant social impairment ranging from diminished social activities to extreme social isolation. In severe cases, individuals may leave home only at night and avoid job interviews, dating, and peers.
    • Patients also have a constant need for reassurance about their perceived flaws and can often be extremely demanding to primary care physicians and cosmetic surgeons in their pursuit of perfection.
  • Common areas of perceived imperfections
    • Skin
    • Face
    • Nose
    • Mouth
    • Hair
    • Eyelids
    • Wrinkles
    • Excessive greasiness
    • Acne
    • Excessive facial hair
    • Nasal size and shape
    • Teeth
    • Bite of jaw
    • Breasts
    • Genitals
    • Buttocks
    • Lips
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Physical

Patients with BDD often have no distinguishing physical or dermatologic findings.

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Causes

Causes are unknown at this time.

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Contributor Information and Disclosures
Author

Sing-Yi Feng, MD  Assistant Professor, Department of Pediatrics, Division of Emergency Medicine, Section of Medical Toxicology, University of Texas Southwestern Medical Center; Staff Toxicologist, North Texas Poison Center, Parkland Memorial Hospital

Sing-Yi Feng, MD is a member of the following medical societies: American Academy of Pediatrics and American College of Medical Toxicology

Disclosure: Nothing to disclose.

Coauthor(s)

Jagvir Singh, MD  Director, Division of Pediatric Emergency Medicine, Lutheran General Hospital of Park Ridge

Jagvir Singh, MD is a member of the following medical societies: American Academy of Pediatrics

Disclosure: Nothing to disclose.

Specialty Editor Board

Carol Diane Berkowitz, MD  Executive Vice Chair, Department of Pediatrics, Professor, Harbor-University of California at Los Angeles Medical Center

Carol Diane Berkowitz, MD is a member of the following medical societies: Alpha Omega Alpha, Ambulatory Pediatric Association, American Academy of Pediatrics, American College of Emergency Physicians, American Medical Association, American Pediatric Society, and North American Society for Pediatric and Adolescent Gynecology

Disclosure: Nothing to disclose.

Mary L Windle, PharmD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine

Disclosure: Nothing to disclose.

Carrie Sylvester, MD, MPH  Director of Education in Child and Adolescent Psychiatry, Professor, Departments of Psychiatry and Pediatrics, Northwestern University Medical School

Carrie Sylvester, MD, MPH is a member of the following medical societies: American Academy of Child and Adolescent Psychiatry, American Academy of Pediatrics, American Medical Women's Association, American Psychiatric Association, and American Society for Adolescent Psychiatry

Disclosure: Nothing to disclose.

Chief Editor

Caroly Pataki, MD  Professor of Clinical Psychiatry and Behavioral Sciences, Department of Psychiatry, Division Chair, Child and Adolescent Psychiatry, Director of Training, Child and Adolescent Psychiatry Residency Program, University of Southern California Keck School of Medicine

Caroly Pataki, MD is a member of the following medical societies: American Academy of Child and Adolescent Psychiatry, New York Academy of Sciences, and Physicians for Social Responsibility

Disclosure: Nothing to disclose.

References

  1. APA. Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington, DC: American Psychiatric Association; 1994.

  2. Allen A, Hollander E. Body dysmorphic disorder. Psychiatr Clin North Am. Sep 2000;23(3):617-28. [Medline].

  3. Phillips KA, Atala KD, Albertini RS. Case study: body dysmorphic disorder in adolescents. J Am Acad Child Adolesc Psychiatry. Sep 1995;34(9):1216-20. [Medline].

  4. Cotterill JA. Body dysmorphic disorder. Dermatol Clin. Jul 1996;14(3):457-63. [Medline].

  5. Sarwer DB, Wadden TA, Pertschuk MJ, Whitaker LA. Body image dissatisfaction and body dysmorphic disorder in 100 cosmetic surgery patients. Plast Reconstr Surg. May 1998;101(6):1644-9. [Medline].

  6. Neziroglu F, Hsia C, Yaryura-Tobias JA. Behavioral, cognitive, and family therapy for obsessive-compulsive and related disorders. Psychiatr Clin North Am. Sep 2000;23(3):657-70. [Medline].

  7. Simon GE, Savarino J, Operskalski B, Wang PS. Suicide risk during antidepressant treatment. Am J Psychiatry. Jan 2006;163(1):41-7. [Medline]. [Full Text].

  8. Fritz GK, Fritsch S, Hagino O. Somatoform disorders in children and adolescents: a review of the past 10 years. J Am Acad Child Adolesc Psychiatry. Oct 1997;36(10):1329-38. [Medline].

  9. Siberry GK, Iannone R, eds. The Harriet Lane Handbook. 15th ed. St. Louis, Mo: Mosby-Year Book; 2000:615-891.

  10. Tasman A, Jerald K, Lieberman J, eds. Body dysmorphic disorder. In: Psychiatry. Philadelphia, Pa: WB Saunders Co; 1997:1148-51.

 
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