Body Image and Body
KATHARINE A. PHILLIPS
Body dysmorphic disorder (BDD), also known as dysmorphophobia, is a fascinating disorder of body image 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, dermatological, and cosmetic surgery settings. Still, it is underrecognized in many clinical settings and has received relatively little scientific study.
According to criteria in the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV), BDD entails a preoccupation with an imagined defect in appearance; if a slight physical anomaly is present, the person's concern is markedly excessive. This preoccupation must cause clinically significant distress or impairment in social, occupational, or other important areas of functioning, and it cannot be better accounted for by another mental disorder, such as anorexia nervosa. In DSM-IV, BDD is classified as a somatoform disorder. Its delusional variant is classified as a psychotic disorder—a type of delusional disorder, somatic type. A patient with delusional BDD would receive diagnoses of both BDD and delusional disorder.
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. Preoccupa-