Body Dysmorphic Disorder (300.7

up in their own mind.

Compulsions are the mental acts or repetitive behaviors that the individual feels they must do

to quell the thoughts related to an obsession. The behaviors or mental acts tend to reduce the

patient’s stress and will decrease the tendency to carry out the obsession. They may or may

not be directly related to the obsession, as in compulsive washing in order to stave off

contamination. The symptoms seen in OCD cannot be explained by another mental illness,

substance use, or a medical condition.

The first medical line of treatment involves SSRI therapy, which reduces obsessions and

associated anxiety. Cognitive-behavioral therapy can be used, which consists of exposure and

response prevention methods. Psycho-education and relaxation training (PRT) is used to treat

children with the disorder. Behavior therapy and family-based therapy will decrease OCD in

children; however, individual CBT does not seem to be helpful in these kids. Family members

often feel confused and angry about these symptoms, especially in kids, so parent management

therapy along with CBT will reduce the symptomatology better than CBT alone. Deep brain

stimulation will improve some aspects of the disorder.

Without treatment, the patient can have a severely affected quality of life in many life areas.

The compulsions are often time-consuming and will impact the level of functioning. Severely

affected patients will spend hours a day doing their rituals and will be perceived as eccentric or

odd. The patient will be reluctant to get treatment as they feel their behavior is shameful or

embarrassing. Family members suffer, which is why family-focused cognitive behavioral

therapy (FCBT) will usually be more beneficial than individual CBT.

BODY DYSMORPHIC DISORDER (300.7)

This is also referred to as BDD. It is a DSM-V diagnoses that involves having anxiety or distress due to a perceived physical anomaly, such as a scar, a certain physical feature, or the shape/size

of a body part. While most individuals will have a degree of dissatisfaction with their

appearance at times, people with BDD will have ongoing and intrusive thoughts about their

flaw, which may be exceedingly minor and will be something others are not concerned with or

don’t notice. It is different from distorted body image seen in eating disorders, which is more

related to total body mass rather than a specific area.

Individuals with an eating disorder may be preoccupied with certain areas of their body that

they don’t like, but the focus is regarding the mass of the area as it relates to the total body

mass. BDD patients will be concerned about body mass but only related to certain things like a

lack of muscle definition in an area or in the entire body. There is self-consciousness, distress, and avoidance of social situations and/or intimacy because of their perceptions, which lead to

depression, social isolation, and suicidality.

The patient will often undergo unnecessary cosmetic surgery, skin procedures, or dental

procedures to correct the perceived flaw. Unfortunately, they are rarely satisfied with the

results because of ongoing perceptual problems. Some believe that this disorder is actually

part of OCD; however, the DSM-V classifies this as a discrete disorder under the umbrella of

OCD-related disorders.

There are four diagnostic criteria for body dysmorphic disorder with four different specifiers.

The major criteria include the following:

1. Being preoccupied with a physical feature they perceive as flawed, which is not

concerning to others.

2. Having repetitive behavior focusing on the perceived anomaly, like examining

oneself in the mirror or trying to hide the flaw. They constantly seek reassurance

about their appearance but aren’t satisfied with the responses they get.

3. The preoccupation causes clinically significant distress or impairment in social,

occupational, or other important areas of functioning.

4. The appearance preoccupations are not restricted to concerns with body fat or

weight and the patient does not meet the criteria for an eating disorder.

Specifiers include the following:

A. Dysmorphia—obsession regarding musculature, in which there is a fixation about

one or more muscle groups.

B. Good or fair insight—the patient will be able to be distracted from their

preoccupation and have a good prognosis.

C. Poor insight with the patient needing constant reassurance with brief moments of

insight.

D. Absent insight or delusional—the patient is convinced of their defect and will not

respond to surgical intervention or reassurance.

The average age of onset of BDD is 16 years; although it is often seen in kids who develop the

disorder at around puberty (aged 12-13 years). The prevalence of body dysmorphic disorder in

the US is about 2.5 percent in males and 2.2 percent in females. Risk factors for BDD are child

abuse, a history of sexual trauma, bullying, and hormonal imbalances. The main comorbidities

are depression, OCD, and substance abuse. They may use substances to self-medicate and may

be so depressed as to be suicidal.

While BDD is chronic, it responds favorably to treatment. CBT is effective as it challenges the

patient’s irrational beliefs and perceptions regarding their bodily features. They are somewhat

resistant to starting treatment as they don’t see their beliefs as irrational. SSRIs are a good

first-line therapy for the treatment of this disorder.

There are several things to rule out as part of diagnosing BDD. These include OCD, somatic

anxiety, eating disorders, major depressive disorder, psychotic disorders, and anxiety disorders.

There are several rarer disorders that can mimic BDD, such as gender dysmorphia, body identity

integrity disorder, dysmorphic concern, and olfactory reference syndrome.