7.2.5 Body dysmorphic disorders

6B21.Z

Dysmorphophobia, Dermatologic hypochondriasis.

No gender differences. Global prevalence:  0.7–2.4%.

Symptoms most commonly begin during adolescence (12-13 years of age).

Complex chronic obsessive-compulsive mental disorder characterized by excessive preoccupation with a perceived defect in physical appearance that is not observable or significant to others and results in repetitive, obsessive behaviors and thoughts.

Etiology: Unknown.

Emotional unconscious displacement causing feelings of shame and embarrassment, persistent feeling of being unloved, insecurity, and rejection.

Broad spectrum of severity, ranging from obsessional worry to frank delusion.

Firm belief that some aspect of his or her appearance is ugly, abnormal, or deformed. Causes severe distress, impairs normal functioning and decreases quality of life. 

Complete body contour which includes belly, breast, buttocks, genitalia. Special skin concerns facial contouring, scarring, wrinkles, followed by hair concerns (hair loss, thinning, balding, excessive facial hair or body hair) and nose (e.g., too large or misshapen) and nail concerns.

Categorized under Obsessive Compulsive and Related Disorders in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).

Absence of relevant abnormalities.

Minor or absent histopathological changes.

The condition is chronic, and lifelong.  Untreated, the prognosis is poor.

Patients constantly seek medical and surgical treatments in order to improve their physical appearance.  Distortion of the own physical appearance leads to psychiatric co-morbidities: anxiety, stress, depression, and personality disorder.

Over-treatment. Skin picking is seen in one-third of patients and can exacerbate mild acne, causing scarring.

Major depression, severe anxiety disorders or personality disorders. Suicidal thoughts.

Careful clinical history. Physical examination. Evaluate the impact on the quality of the patient’s life. DMS-5 diagnostic criteria.

Real dermatological diseases. Invisible dermatoses.  

Psychiatric consultation needed.

A significant proportion of patients entertain thoughts of suicide.