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Q7. Body Dysmorphic Disorder

Body Dysmorphic Disorder (BDD), also known as body dysmorphia or dysmorphic syndrome, but originally termed dysmorphophobia, is a mental disorder characterized by an obsessive preoccupation that some aspect of one's own appearance is severely flawed and warrants exceptional measures to hide or fix it. The DSM-5 categorizes BDD in the obsessive–compulsive spectrum, and distinguishes it from anorexia nervosa.

Diagnostic Criteria

Criterion A: Individuals with body dysmorphic disorder (formerly dysmorphophobia) are preoccupied with one or more perceived defects or flaws in their physical appearance, which they believe look ugly, unattractive, abnormal, or deformed. The perceived flaws are not observable or appear only slight to other individuals. 
Preoccupations can focus on one or many body areas. Any body area can be the focus of concern. Some individuals are concerned about perceived asymmetry of body areas. 
The preoccupations are intrusive, unwanted, time-consuming (occurring, on average, 3-8 hours per day), and usually difficult to resist or control.


Criterion B: Excessive repetitive behaviors or mental acts (e.g., comparing) are performed in response to the preoccupation. The individual feels driven to perform these behaviors, which are not pleasurable and may increase anxiety and dysphoria. They are typically time-consuming and difficult to resist or control. 
Common behaviors are comparing one's appearance with that of other individuals; repeatedly checking perceived defects in mirrors or other reflecting surfaces or examining them directly; excessively grooming; camouflaging; seeking reassurance about how the perceived flaws look; touching disliked areas to check them; excessively exercising or weight lifting; and seeking cosmetic procedures. 

Criterion C: The preoccupation must cause clinically significant distress or impairment in social, occupational, or other important areas of functioning; usually both are present. Body dysmorphic disorder must be differentiated from an eating disorder.
Insight regarding body dysmorphic disorder beliefs can range from good to absent/delusional. On average, insight is poor; one third or more of individuals currently have delusional body dysmorphic disorder beliefs. 

 Criterion D: The appearance preoccupation is not better explained by concerns with body fat or weight in an individual whose symptoms meet diagnostic criteria for an eating disorder.
 

Development and Course

The mean age at disorder onset is 16-17 years, the median age at onset is 15 years, and the most common age at onset is 12-13 years. 
The disorder appears to usually be chronic, although improvement is likely when evidence-based treatment is received. Individuals with disorder onset before age 18 years are more likely to attempt suicide, have more comorbidity, and have gradual (rather than acute) disorder onset than those with adult-onset body dysmorphic disorder.
 
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Individuals with body dysmorphic disorder (formerly dysmorphophobia) are preoccupied with one or more perceived defects or flaws in their physical appearance, which they believe look ugly, unattractive, abnormal, or deformed. Excessive repetitive behaviors or mental acts (e.g., comparing) are performed in response to the preoccupation. It causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
 
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