Body Dysmorphic Disorder

Body Dysmorphic Disorder - Flawed Reflections

• Preoccupation with ≥1 perceived defects/flaws in physical appearance, not observable or appearing slight to others.
• Repetitive behaviors (e.g., mirror checking, excessive grooming, skin picking, reassurance seeking) or mental acts (e.g., comparing appearance to others).
• Causes clinically significant distress/impairment.
• Specify: muscle dysmorphia, insight level (good/fair, poor, absent/delusional).

⭐ BDD has high rates of suicidal ideation (~80%) and attempts (~25-30%).

Body Dysmorphic Disorder - Unmasking BDD Roots

• Epidemiology:
  • Prevalence: ~2.4% (general population); higher in cosmetic surgery settings (~15%) and dermatology clinics.
  • Age of Onset: Typically adolescence (mean 16-17 years); often insidious.
  • Gender: Slightly more common in females; males may present with muscle dysmorphia.
• Etiology: Multifactorial model
  • Genetic: Increased risk in first-degree relatives.
  • Neurobiological: Serotonin pathway dysregulation; abnormalities in visual processing (bias towards details over holistic view).
  • Psychological: Childhood trauma (e.g., teasing, abuse), perfectionism, low self-esteem.
  • Sociocultural: Societal emphasis on appearance, media influence.

⭐ BDD has high comorbidity with major depressive disorder (MDD), social anxiety disorder, and obsessive-compulsive disorder (OCD). Suicidal ideation is notably high in BDD patients.

Body Dysmorphic Disorder - Symptom Spotlight

• Preoccupations: Focus on perceived flaws in appearance (e.g., skin, hair, nose, teeth, weight, muscles).
  • Flaws are slight or not observable to others.
  • Common areas: face (acne, scars, asymmetry), hair (thinning, excessive), nose shape/size.
• Repetitive Behaviors (Compulsions): In response to appearance concerns.
  • Mirror checking (excessive).
  • Excessive grooming.
  • Skin picking.
  • Reassurance seeking.
  • Comparing appearance with others.
  • Camouflaging (e.g., with makeup, clothing, hats).

⭐ Insight specifier: BDD can occur with good/fair insight, poor insight, or absent insight/delusional beliefs (most severe).

Body Dysmorphic Disorder - Diagnosis Decoded

• Insight: Good/fair, poor, absent/delusional.
• Muscle dysmorphia: Variant, focus on muscularity.
• DDx: OCD, Eating Disorders, Social Anxiety.

⭐ High suicide risk (~25-28% attempts); often seeks cosmetic procedures, usually with poor satisfaction.

Body Dysmorphic Disorder - Treatment & Outlook

• Pharmacotherapy:

  ⭐ SSRIs (e.g., Fluoxetine) are first-line, needing higher doses (Fluoxetine 60-80 mg/day) & longer trials (10-12 wks) than for depression.

  • Clomipramine (TCA): Potent serotonergic; effective second-line.
  • Augmentation: Antipsychotics (e.g., Aripiprazole) for delusional insight or refractory BDD.
• Psychotherapy:
  • Cognitive Behavioral Therapy (CBT) with Exposure and Response Prevention (ERP): Gold standard. Targets cognitive distortions, compulsive behaviors/rituals.
  • Psychoeducation for patient & family is vital.
• Outlook & Prognosis:
  • Chronic, fluctuating course if untreated.
  • High comorbidity: Depression, anxiety, social phobia, OCD.
  • ↑↑ Suicidal ideation (~80%) & attempts (~25-30%).
  • Combined treatment offers significant improvement; complete remission less common. Relapse risk if treatment stopped.

High-Yield Points - ⚡ Biggest Takeaways

• Preoccupation with one or more perceived flaws in physical appearance, not observable or appearing slight to others.
• Engages in repetitive behaviors (e.g., mirror checking, skin picking, reassurance seeking) or mental acts (e.g., comparing appearance) due to appearance concerns.
• Causes clinically significant distress or functional impairment.
• Insight varies: good/fair, poor, to absent/delusional (BDD with delusional beliefs).
• High comorbidity with depression, anxiety disorders, OCD; significant suicide risk.
• Treatment: SSRIs (often high doses, e.g., fluoxetine) and CBT (Exposure and Response Prevention).