Body Dysmorphic Disorder


Dysmorphic Disorder

Carol E. Watkins, M.D.

Baltimore, MD

Body Dysmorphic

Disorder, (BDD) is listed in the DSM-IV under somatization disorders, but

clinically, it seems to have similarities to Obsessive-Compulsive Disorder


BDD is a

preoccupation with an imagined physical defect in appearance or a vastly

exaggerated concern about a minimal defect. The preoccupation must cause

significant impairment in the individual’s life. The individual thinks about

his or her defect for at least an hour per day.  

The individual’s

obsessive concern most often is concerned with facial features, hair or odor.

The disorder often begins in adolescence, becomes chronic and leads to a great

deal of internal suffering. 

The person may fear

ridicule in social situations, and may consult many dermatologists or plastic

surgeons and undergo painful or risky procedures to try to change the perceived

defect. The medical procedures rarely produce relief. Indeed they often lead to

a worsening of symptoms. BDD may limit friendships. Obsessive ruminations about

appearance may make it difficult to concentrate on schoolwork. 

Other behaviors that

may be associated with BDD

  • Frequent

    glancing in reflective surfaces

  • Skin


  • Avoiding


  • Repeatedly

    measuring or palpating the defect

  • Repeated

    requests for reassurance about the defect.

  • Elaborate

    grooming rituals.

  • Camouflaging

    some aspect of one’s appearance with one’s hand, a hat, or makeup.

  • Repeated

    touching of the defect

  • Avoiding

    social situations where the defect might be seen by others.

  • Anxiety

    when with other people.

BDD tends to be

chronic and can lead to social isolation, school dropout major depression,

unnecessary surgery and even suicide.  

It is often

associated with social phobia and OCD, and delusional disorder. Chronic BDD can

lead to major depressive disorder. If it is associated with delusions, it is

reclassified as Delusional disorder, somatic subtype. Bromosis (excessive

concerns about body odor) or Parasitosis (concern that one is infested by

parasites) can classically be associated with delusions. 

Other conditions that

might be confused with BDD: Neglect caused by a parietal lobe brain lesion;

anorexia nervosa, gender identity disorder. 

Milder body image

disturbances that do not meet criteria for BDD. :

  • Benign

    dissatisfaction with one’s looks. This does not affect the person’s

    quality of life. 30-40% of Americans may have these feelings. 

  • Moderate

    disturbance with one’s body image. The person’s concerns about

    appearance cause some intermittent anxiety or depression.

Treatment: It is at

times difficult to get an individual with BDD into psychiatric treatment because

he or she may insist that the disorder has a physical origin. We prefer that the

referring physician call us in advance so that we can strategize on how best to

encourage the individual to accept help. Treatment often

involves the use of SSRI medications (such as sertraline or fluoxetine) and

cognitive-behavioral psychotherapy. In this type of psychotherapy the therapist

helps the affected individual resist the compulsions associated with the BDD

such as repeatedly looking in mirrors or excessive grooming (response

prevention)  If the individual

avoids certain situations because of fear of ridicule, he or she should be

encouraged to gradually and progressively face feared situations. If the

individual plans to seek invasive medical/surgical treatment, the therapist

should attempt to dissuade the patient or ask permission to talk with the

surgeon. The therapist helps the individual to understand how some of his or her

thoughts and perceptions are distorted and helps the patient replace these

perceptions with more realistic ones.  Family

behavioral treatment can be useful, especially if the affected individual is an

adolescent. Support groups if available, can help. 


For more information,

read The Broken Mirror or Learning to Live with Body Dysmorphic

Disorder by Katharine Phillips, M.D.

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Northern County Psychiatric


Our practice has experience in the treatment of Attention

Deficit disorder

(ADD or ADHD), Depression, Separation Anxiety Disorder, Obsessive-Compulsive

Disorder, and other

psychiatric conditions. We are located in Northern Baltimore County and serve the

Baltimore County, Carroll County and Harford County areas in Maryland. Since we are near

the Pennsylvania border, we also serve the York County area.   Our

services include psychotherapy, psychiatric evaluations, medication management, and

family therapy. We treat children, adults, and the elderly.

We also maintain a list of informative web sites on mental health

topics, such as Attention Deficit Disorder, Parenting and Support Groups.

Carol Watkins, MD

Glenn Brynes, Ph.D., M.D.

Northern County Psychiatric Associates
Niacin Pills to Pass a Drug Test

Lutherville and Monkton

Baltimore County, Maryland

Phone: 410-329-2028

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