Section 7. Mental Health Disorders

Chapter 99. Somatoform Disorders

Topics: Introduction | Somatization Disorder | Conversion Disorder | Hypochondriasis | Body Dysmorphic Disorder

Body Dysmorphic Disorder

In body dysmorphic disorder, a preoccupation with a perceived defect in appearance results in significant distress or impaired functioning.

People with body dysmorphic disorder believe they have a defect in appearance that in reality is nonexistent or slight. The disorder usually begins in adolescence and is believed to occur in men and women equally.

Symptoms

Symptoms may develop gradually or abruptly, vary in intensity, and tend to persist without treatment. Concerns commonly involve the face or head but may involve any body part or several parts and may change from one body part to another. A person may be concerned about hair thinning, acne, wrinkles, scars, color of complexion, or excessive facial hair. Or a person may focus on the shape or size of a body part, such as the nose, eyes, ears, mouth, breasts, or buttocks. Some young men with athletic builds think that they are puny and obsessively try to gain weight and muscle.

Most people with body dysmorphic disorder have difficulty controlling their preoccupation and spend hours each day thinking about their perceived defect. Many people check themselves often in mirrors, others avoid mirrors, and still others alternate between the two behaviors. Most try to camouflage their imagined defect--for example, by growing a beard to hide "scars" or by wearing a hat to cover "thinning" hair. Many undergo medical, dental, or surgical treatment, sometimes repeatedly, to correct their perceived defect, which may intensify their preoccupation.

Because people with body dysmorphic disorder feel self-conscious, they may avoid appearing in public, including going to work and participating in social activities. Some leave their homes only at night; others not at all. This behavior can result in social isolation. Distress and dysfunction associated with the disorder can lead to repeated hospitalization and suicidal behavior.

Diagnosis and Treatment

Because people with body dysmorphic disorder are reluctant to reveal their symptoms, the disorder may go undiagnosed for years. It is distinguished from normal concerns about appearance because it is time-consuming and causes significant distress or impairs functioning.

Information regarding effective treatment is limited. Treatment with serotonin reuptake inhibitors, a class of antidepressants, is often effective. Cognitive-behavior therapy may also diminish symptoms.