Body dysmorphic disorder

Until 2013, BDD had been categorised as a somatoform disorder along with health anxiety, somatisation and pain disorders. In DSM-5 (American Psychiatric Association, 2013) it has been moved into the category of obsessive–compulsive and related disorders. One other difference in DSM-5 is that insight is no longer a prerequisite for the diagnosis of OCD but is also categorised on a continuum from complete insight to total lack of insight.

Body dysmorphic disorder is defined as a preoccupation about an imagined or trivial defect. This preoccupation causes clinically significant distress or impairment in social, occupational or other important areas of functioning (American Psychiatric Association, 2013). A study of 200 individuals with BDD (Phillips et al, 2005) identified chief concerns people had, presented here in Table 10.1. It can be seen from the table that many people have more than one concern. In addition, there does seem to be some gender difference in the area of the body most likely to be complained about (details available from the author on request).

It is a surprisingly common condition with an estimated point prevalence of 0.7–2.4% in the general population, although the majority of individuals do not seek psychiatric or psychological intervention (see reviews by Phillips, 2009 and Bjornsson et al, 2010). It generally starts in adolescence and progresses from there. Epidemiological studies have found an almost equal gender incidence but with a slight predominance of women (Bjornsson et al, 2010). Most patients attend dermatology and cosmetic surgery clinics and request treatment for their imagined defect; there tend to be few patients with BDD seen in psychiatric clinics.