Body Dysmorphic Disorder
Body Dysmorphic Disorder (BDD) is a fairly common condition characterized by preoccupation with a perceived defect in one or more aspect of one’s physical appearance. This perception is either completely unrelated to reality or is a gross exaggeration of a minor defect. An equal gender distribution is seen in BDD. Typically, patients have poor insight and their beliefs may be held with delusional intensity, persisting despite evidence to the contrary and reassurance from others. Behaviors or activities to “improve” the defect are common, often occur for several hours each day, and may include excessive grooming, exercise, mirror checking, comparisons with other people, make-up application, and “do it yourself” procedures.
The extent of impairment varies from patient to patient, but social dysfunction is pervasive. Patients often isolate to their home, avoid family and friends, dating, and lose their job or stop working altogether due to the obsession with the perceived defect and belief that they are disgusting or sickening to others. Psychiatric hospitalization is also very common. Suicidal ideation occurs in well over half of BDD patients and nearly a third of patients with BDD seen in clinic have attempted suicide at least once in the past. High levels of stress and significantly impaired overall quality of life are the norm in BDD.