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Body dysmorphic disorder: Assessment, diagnosis, and differential diagnosis

Katharine A Phillips, MD
Section Editor
Joel Dimsdale, MD
Deputy Editor
David Solomon, MD


Body dysmorphic disorder (BDD) is characterized by preoccupation with nonexistent or slight defects in physical appearance, such that patients believe that they look abnormal, unattractive, ugly, or deformed, when in reality they look normal. The preoccupation with perceived flaws leads to repetitive behaviors (eg, checking their appearance in mirrors), which are difficult to control and are not pleasurable. BDD is common but usually under-recognized, causes distress and/or impaired functioning, and is often associated with suicidal ideation and behavior.

Patients with BDD may present to mental health professionals as well as other clinicians, such as dermatologists, plastic surgeons, primary care physicians, pediatricians, and dentists. Most patients seek nonpsychiatric treatment (most commonly dermatologic or surgical) for their perceived physical defects; this treatment appears to be ineffective for most patients and can be risky for clinicians to provide. By contrast, pharmacotherapy (eg, selective serotonin reuptake inhibitors or clomipramine) and/or cognitive-behavioral therapy tailored specifically to BDD are often efficacious.

This topic reviews the assessment, diagnosis, and differential diagnosis of BDD. The epidemiology, pathogenesis, clinical manifestations, treatment and prognosis of BDD are discussed separately. (See "Body dysmorphic disorder: Epidemiology, pathogenesis, and clinical features" and "Body dysmorphic disorder: Treatment and prognosis".)


The initial clinical evaluation of patients with a possible diagnosis of body dysmorphic disorder (BDD) includes a general psychiatric history, general medical history, and mental status examination, with emphasis upon suicidal ideation and behavior, delusional BDD symptoms, and depressive symptoms [1-3]. As with all psychiatric patients, a physical examination is indicated and typically is performed by the patient’s primary care clinician or an internal medicine consultant; however, many patients refuse examinations because they do not want their bodies seen by others. Laboratory tests are obtained on the basis of the history and examination.

Screening instruments — Screening instruments can facilitate diagnosis, but are not intended to diagnose BDD by themselves. For patients who screen positive, a clinical interview is required to establish the diagnosis.


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Literature review current through: Sep 2016. | This topic last updated: May 24, 2016.
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  1. Freudenreich O, Nejad SH, Francis A, Fricchione GL. Psychosis, mania, and catatonia. In: Textbook of Psychosomatic Medicine: Psychiatric Care of the Medically Ill, Second Edition, Levenson JL. (Ed), American Psychiatric Publishing, Washington, DC 2011. p.219.
  2. Work Group on Psychiatric Evaluation, American Psychiatric Association Steering Committee on Practice Guidlines. Psychiatric evaluation of adults. Second edition. American Psychiatric Association. Am J Psychiatry 2006; 163:3.
  3. American Psychiatric Association Practice Guideline for the Psychiatric Evaluation of Adults, Second Edition, 2006. http://www.psych.org/MainMenu/PsychiatricPractice/PracticeGuidelines_1.aspx (Accessed on July 18, 2011).
  4. Phillips KA. Understanding Body Dysmorphic Disorder: An Essential Guide, Oxford University Press, New York 2009.
  5. Grant JE, Kim SW, Crow SJ. Prevalence and clinical features of body dysmorphic disorder in adolescent and adult psychiatric inpatients. J Clin Psychiatry 2001; 62:517.
  6. Dufresne RG, Phillips KA, Vittorio CC, Wilkel CS. A screening questionnaire for body dysmorphic disorder in a cosmetic dermatologic surgery practice. Dermatol Surg 2001; 27:457.
  7. Dey JK, Ishii M, Phillis M, et al. Body dysmorphic disorder in a facial plastic and reconstructive surgery clinic: measuring prevalence, assessing comorbidities, and validating a feasible screening instrument. JAMA Facial Plast Surg 2015; 17:137.
  8. Brohede S, Wingren G, Wijma B, Wijma K. Validation of the Body Dysmorphic Disorder Questionnaire in a community sample of Swedish women. Psychiatry Res 2013; 210:647.
  9. Picavet V, Gabriëls L, Jorissen M, Hellings PW. Screening tools for body dysmorphic disorder in a cosmetic surgery setting. Laryngoscope 2011; 121:2535.
  10. Cash TF, Phillips KA, Santos MT, Hrabosky JI. Measuring "negative body image": validation of the Body Image Disturbance Questionnaire in a nonclinical population. Body Image 2004; 1:363.
  11. Conroy M, Menard W, Fleming-Ives K, et al. Prevalence and clinical characteristics of body dysmorphic disorder in an adult inpatient setting. Gen Hosp Psychiatry 2008; 30:67.
  12. Phillips KA, Hollander E. Treating body dysmorphic disorder with medication: evidence, misconceptions, and a suggested approach. Body Image 2008; 5:13.
  13. Phillips KA, Feusner J. Assessment and differential diagnosis of body dysmorphic disorder. Psychiatr Ann 2010; 40:317.
  14. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), American Psychiatric Association, Arlington 2013.
  15. Crerand CE, Franklin ME, Sarwer DB. MOC-PS CME Article: Patient Safety: Body dysmorphic disorder and cosmetic surgery. Plast Reconstr Surg 2008; 122:1.
  16. The ICD-10 Classification of Mental and Behavioral Disorders: Clinical Descriptions and Diagnostic Guidelines. http://www.who.int/classifications/icd/en/bluebook.pdf (Accessed on August 13, 2014).
  17. Buhlmann U, Reese HE, Renaud S, Wilhelm S. Clinical considerations for the treatment of body dysmorphic disorder with cognitive-behavioral therapy. Body Image 2008; 5:39.
  18. Mancuso SG, Knoesen NP, Castle DJ. The Dysmorphic Concern Questionnaire: A screening measure for body dysmorphic disorder. Aust N Z J Psychiatry 2010; 44:535.
  19. Phillips KA, Wilhelm S, Koran LM, et al. Body dysmorphic disorder: some key issues for DSM-V. Depress Anxiety 2010; 27:573.
  20. Phillips KA, Stein DJ, Rauch SL, et al. Should an obsessive-compulsive spectrum grouping of disorders be included in DSM-V? Depress Anxiety 2010; 27:528.
  21. Phillips KA, Pinto A, Menard W, et al. Obsessive-compulsive disorder versus body dysmorphic disorder: a comparison study of two possibly related disorders. Depress Anxiety 2007; 24:399.
  22. Phillips KA, Pinto A, Hart AS, et al. A comparison of insight in body dysmorphic disorder and obsessive-compulsive disorder. J Psychiatr Res 2012; 46:1293.