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Body dysmorphic disorder: Epidemiology, pathogenesis, and clinical features

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

INTRODUCTION

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 and 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 epidemiology, pathogenesis, and clinical manifestations of BDD. The assessment, diagnosis, differential diagnosis, treatment, and prognosis of BDD are discussed separately. (See "Body dysmorphic disorder: Assessment, diagnosis, and differential diagnosis" and "Body dysmorphic disorder: Treatment and prognosis".)

EPIDEMIOLOGY

The point prevalence of body dysmorphic disorder (BDD) in the general population is approximately 2 percent [1-3], and the prevalence in females and males appears to be comparable or slightly higher in females [2,3]. The point prevalence in clinical settings is generally higher, ranging from about 3 to 40 percent, depending upon the study sample [4-7]. Mean age of onset is approximately 17 years [8], and onset is usually gradual rather than abrupt [9]. BDD has been reported in many countries.

General population — The point prevalence of BDD is roughly 2 percent (1 of 50 people), based upon two nationally representative surveys in Germany [2,3] and a random nationwide survey in the United States [1].

                    

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Literature review current through: Nov 2016. | This topic last updated: Tue May 24 00:00:00 GMT+00:00 2016.
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