Body dysmorphic disorder Health Article

Definition

Body dysmorphic disorder (BDD) is defined by the DSM-IV-TR(a handbook for mental health professionals) as a condition marked by excessive preoccupation with an imaginary or minor defect in a facial feature or localized part of the body. The diagnostic criteria specify that the condition must be sufficiently severe to cause a decline in the patient's social, occupational, or educational functioning. The most common cause of this decline is the time lost in obsessing about the "defect." The DSM-IV-TRassigns BDD to the larger category of somatoform disorders, which are disorders characterized by physical complaints that appear to be medical in origin but that cannot be explained in terms of a physical disease, the results of substance abuse, or by another mental disorder.

Although cases of BDD have been reported in the psychiatric literature from a number of different countries for over a century, the disorder was first defined as a formal diagnostic category by the DSM-III-Rin 1987. The word dysmorphiccomes from two Greek words, dysthat means "bad," or "ugly;" and, morphos,that means "shape," or "form." BDD was previously known as dysmorphophobia.

Description

BDD is characterized by an unusually exaggerated degree of worry or concern about a specific part of the face or body, rather than the general size or shape of the body. It is distinguished from anorexia nervosaand bulimia nervosa, to the extent that patients with these disorders are preoccupied with their overall weight and body shape. For example, an adolescent who thinks that her breasts are too large and wants to have plastic surgery to reduce their size but is otherwise unconcerned about her weight and is eating normally would be diagnosed with BDD, not anorexia or bulimia. As many as 50% of patients diagnosed with BDD undergo plastic surgery to correct their perceived physical defects.

Since the publication of DSM-IVin 1994, some psychiatrists have suggested that a subtype of BDD exists, which they term muscle dysmorphia. Muscle dysmorphia is marked by excessive concern with one's muscularity and/or fitness. Persons with muscle dysmorphia spend unusual amounts of time working out in gyms or exercising rather than dieting obsessively or looking into plastic surgery. Although gender stereotypes would suggest that women are more likely to develop BDD while men are more vulnerable to developing muscle dysmorphia, surveys indicate that both disorders have approximately equal gender ratios. DSM-IV-TRhas additional references regarding body build and excessive weight lifting to DSM-IV's description of BDD to accommodate muscle dysmorphia.

BDD and muscle dysmorphia can both be described as disorders resulting from the patient's distorted body image. Body image refers to the mental picture individuala have of their outward appearance, including size, shape, and form. It has two major components: how the people perceive their physical appearance, and how they feel about their body. Significant distortions in self-perception can lead to intense dissatisfaction with one's body and dysfunctional behaviors aimed at improving one's appearance. Some patients with BDD are aware that their concerns are excessive; others do not have this degree of insight. About 50% of patients diagnosed with BDD also meet the criteria for a delusional disorder, which is characterized by beliefs that are not based in reality.

The usual age of onset of BDD is late childhood or early adolescence; the average age of patients diagnosed with the disorder is 17. Ironically, even though BDD begins in childhood or adolescence, most research and treatment studies to date have been done on adults aged 35 and older.

BDD has a high rate of comorbidity, which means that people diagnosed with the disorder are highly likely to have been diagnosed with another psychiatric disorder— most commonly major depression, social phobia, or obsessive-compulsive disorder(OCD).