202 Body Dysmorphic Disorder (300.7)
CNN Report With Behavioral Therapist Arie Winnograd
DSM-IV-TR criteria
A. Preoccupation with an imagined defect in appearance. If slight physical anomaly is present, the person’s concern is markedly excessive.
B. The preoccupation causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
C. The preoccupation is not better accounted for by another mental disorder (e.g., dissatisfaction with body shape and size in Anorexia Nervosa).
- BDD has a delusional form that is classified in the psychosis section of DSM-IV (Didie, Kelly, & Phillips, 2010).
Barlow and Durand (2009) give an example of BDD:
In his mid-20s, Jim was diagnosed with suspected social phobia; he was referred to our clinic by another professional. Jim had just finished rabbinical school and had been offered a position at a synagogue in a nearby city. However, he found himself unable to accept because of marked social difficulties. Lately he had given up leaving his small apartment for fear of running into people he knew and being forced to stop and interact with them.
Jim was a good-looking young man of about average height, with dark hair and eyes. Although he was somewhat depressed, a mental status exam and a brief interview focusing on current functioning and past history did not reveal any remarkable problems. There was no sign of a psychotic process (he was not out of touch with reality). We then focused on Jim’s social difficulties. We expected the usual kinds of anxiety about interacting with people or “doing something” (performing) in front of them. But this was not JIm’s concern. Rather, he was convinced that everyone, even his good friends, were staring at a part of his body that he found grotesque. He reported that strangers would never mention his deformity and his friends felt too sorry for him to mention it. Jim thought his head was square! Like the Beast in Beauty and the Beast who could not imagine people reacting to him with anything less than revulsion, Jim could not imagine people getting past his square head. To hide his condition as well as he could, Jim wore soft floppy hats and was most comfortable in winter, when he could all but completely cover his head with a large stocking cap. To us, Jim looked normal.
Associated features
Activities associated with preoccupations include:
- Obsessions in: grooming; mirror checking, hair brushing, hair styling, hair cutting, shaving, washing, and application of makeup.
- Camouflaging: wearing wigs, hats, make-up, sunglasses, extra clothing and changing body position to hide perceived defect.
- Medical procedures: numerous dermatological visits, and multiple cosmetic surgeries. Need for reassurance: mirror checking, asking others opinion, and excessive comparison to other people. Diet and exercise: excessive exercise, muscle dysmorphia, steroid usage; excessive diet, anorexia nervosa, and bulimia nervosa (eating disorders).
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