Body Dysmorphic Disorder
Body dysmorphic disorder (BDD) is a preoccupation with perceived flaws in appearance that others see as minor or nonexistent, defined per DSM-5.
Symptoms
Preoccupation with one or more perceived flaws in physical appearance that are not observable or appear slight to others, along with repetitive behaviors (mirror checking, excessive grooming, skin picking, seeking reassurance) in response to the appearance concern.
Causes and risk
A combination of genetic, neurobiological, and environmental factors; per current disease-primer research, BDD involves disturbances in visual processing and face/body perception in the brain.
How it is evaluated
Diagnosis follows DSM-5 criteria; the disorder carries a roughly fourfold higher risk of suicidal ideation, making a direct safety assessment an essential part of any evaluation.
Treatment
SSRIs at higher-than-typical doses, continued for 12-16 weeks (with at least 4 weeks at the maximum tolerated dose before judging response), and CBT specifically adapted for BDD are both first-line, per international expert consensus (ICOCS/ECNP). Cosmetic procedures are specifically not recommended, since they rarely resolve the underlying preoccupation.
When to seek care
Given the elevated suicide risk associated with BDD, any thoughts of self-harm require immediate crisis support -- call 911 or the 988 Suicide and Crisis Lifeline.