Body Dysmorphic Disorder

The work group is recommending that this disorder be reclassified from Somatoform Disorders to Anxiety and Obsessive-Compulsive Spectrum Disorders

A.  Preoccupation with a perceived defect(s) or flaw(s) in physical appearance that is not observable or appears slight to others. 

C.  The preoccupation causes clinically significant distress (for example, depressed mood, anxiety, shame) or impairment in social, occupational, or other important areas of functioning (for example, school, relationships, household). *

D. The appearance preoccupations are not restricted to concerns with body fat or weight in an eating disorder.

Specify if:

Muscle dysmorphia form of body dysmorphic disorder (the belief that one’s body build is too small or is insufficiently muscular)

Specify whether BDD beliefs are currently characterized by:

Good or fair insight: Recognizes that BDD beliefs are definitely or probably not true, or that they may or may not be true

Poor insight: Thinks BDD beliefs are probably true

Absent insight (i.e., delusional beliefs about appearance): Completely convinced BDD beliefs are true

Criterion B: Examples are added to increase awareness of some of the common types of distress or impairment in functioning.

Criterion C: It is recommended that this criterion be limited to eating disorders, as to our knowledge, there are no other disorders that might easily be misdiagnosed as BDD. Before a final recommendation is made, it will be important to examine the DSM-V criteria for eating disorders, and examples of eating disorder NOS, to determine whether criterion C should or should not include eating disorder NOS.

The phrase “not better accounted for” appears to be confusing to some DSM users (for example, it is sometimes misconstrued to mean that BDD cannot be diagnosed if the patient also has an eating disorder, even if the patient also meets criteria for BDD). We recommend alternate wording, such as “is not restricted to,” which may be clearer.

Specifiers: The muscle dysmorphia form of BDD appears to have several important differences from other forms of BDD (e.g., higher rates of suicidality and substance use disorders), and the treatment approach may require some modification. Thus, adding this specifier may have clinical utility.

There appear to be far more similarities than differences between delusional and nondelusional BDD, and thus it is recommended to combine BDD’s delusional and nondelusional variants into a single disorder and to eliminate the delusional variant from the psychosis section. The proposed specifier reflects the broad range of insight (including delusional thinking) that can characterize BDD beliefs. The proposed levels of insight are similar to categories in widely used scales for BDD, and they are the same as those proposed for OCD and olfactory reference syndrome.

Reference: Phillips KA et al: Body Dysmorphic Disorder: Some Key Issues for DSM-V. Depression & Anxiety, 2010; 27: 573-591