NEW ORLEANS -- Preoccupation with appearance may sound stereotypically feminine, but its extreme, pathologic expression--body dysmorphic disorder--is as common in men as in women. But because of patient shame and clinician unfamiliarity, it is frequently missed.
Characteristically individuals with body dysmorphic disorder (BDD) look normal, or have only a minor flaw that would not be noticeable if not pointed out. "When a patient walks into the office, I can't tell what his preoccupation is," Dr. Katharine A. Phillips said at the annual meeting of the American Psychiatric Association.
Patients with BDD obsess about their appearance for typically as much as 3-8 hours daily Most have poor, if any insight, and dose to half are delusional. Particularly common are ideas of reference--that people take special notice of them or single them out in a negative way. Virtually all men with BDD perform repetitive behaviors, such as mirror checking, compulsive comparing with others, or reassurance seeking.
Some studies have found less BDD in men than women, but the one study that has been considered the best methodologically found slightly more cases of BDD in men. In two-thirds of clinical samples, it has been more prevalent in men.
Profound shame and secretiveness make men unlikely to talk about their BDD symptoms, and few clinicians are alert to it. Many with the disorder come to psychiatrists with complaints of depression, anxiety, and social phobia; in two prevalence studies of clinical populations, all cases of BDD had been missed by treaters, said Dr. Phillips of Brown University, Providence, R.I.
For an accurate diagnosis, it is important to ask direct, detailed questions regarding the patient's feelings about his appearance, the overall importance of his appearance, …