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Definition and diagnosis of Body Dysmorphic Disorder

Body dysmorphic disorder is categorized as a somatoform disorder in the fourth edition of the Diagnostic and Statistical Manual (DSM-IV: American Psychiatric Association (APA). There are three DSM-IV criteria that must be met before a diagnosis of BDD can be made:

1There is a preoccupation with an imagined defect in appearance. If a slight physical anomaly is present, the person’s concern is markedly excessive.

2The preoccupation causes clinically significant distress or impairment in social, occupational or other important areas of functioning.

3The preoccupation is not better accounted for by another mental disorder (for example, dissatisfaction with body shape and size in anorexia nervosa).

Differential diagnosis is important and a diagnosis of BDD should not be made if the preoccupation is specific to ‘fatness’ (for example, anorexia nervosa) or sexual identity (for example, gender identity disorder). It is also important to differentiate between BDD and social phobia. In BDD the fear is of negative evaluation due to appearance while in social phobia the fear is due to negative evaluation because of behaviour. It is also important to distinguish BDD from obsessive-compulsive disorder (OCD), due to the obsessive and compulsive qualities involved in both (for example, long periods of time ruminating, excessive checking behaviours. In some cases the preoccupation and intensity of belief can be such that it is of a delusionallike intensity. In such cases it is common for a diagnosis of delusional disorder (somatic type) to be made. Veale et al.’s survey of 50 people with BDD (excluding those with body image disturbances due to an eating disorder), found that BDD has a high co-morbidity with social phobia and depression and that a large proportion of the participants had attempted suicide.

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