Body Image and Body
KATHARINE A. PHILLIPS
Body dysmorphic disorder (BDD), also known as dysmorphophobia, is an intriguing disorder that has been described around the world for more than a century. BDD appears to be relatively common in the general population and in psychiatric, dermatologic, and cosmetic surgery settings. However, it remains underrecognized and has received relatively little investigation.
BDD consists of a preoccupation with an imagined defect in appearance; if a slight physical anomaly is present, the person’s concern is markedly excessive. The preoccupation causes clinically significant distress or impairment, and it cannot be better accounted for by another mental disorder (such as anorexia nervosa). In the fourth edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), BDD is classified as a somatoform disorder, whereas its delusional variant is classified as a psychotic disorder—a type of delusional disorder, somatic type.
Individuals with BDD are preoccupied with the idea that some aspect of their appearance is unattractive, deformed, or “not right” in some way, when, in reality, the perceived flaw is minimal or nonexistent. Preoccupations commonly involve the face or head, most often the skin, hair, or nose (e.g., acne, scarring, thinning hair, or a large or crooked nose). However, any body part can be the focus of concern.
BDD preoccupations are distressing, time-consuming, and usually difficult to resist or control. Clinical observations and research findings suggest that these preoccupations are typically associated with low self-esteem, shame, embarrassment, and fear of rejec-