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Body dysmorphic disorder BDD , also known as dysmorphophobia, is a severe psychiatric disorder that occurs around the world. However, the diagnosis is usually missed in clinical settings. It is important to recognize and diagnose BDD, because this disorder is relatively common and causes significant distress and impairment in functioning.

It is also associated with markedly poor quality of life. Although research on effective treatment is still limited, serotonin reuptake inhibitors SRIs are currently considered the medication treatment of choice. For symptoms to improve, a relatively high SRI dose and at least 12 weeks of treatment is often needed.

The psychosocial treatment of choice is cognitive behavioral therapy, consisting of elements such as exposure, response prevention, behavioral experiments, and cognitive restructuring. Although knowledge of BDD is rapidly increasing, further research is needed on all aspects of this disorder, including treatment studies, epidemiology studies, and investigation of its cross-cultural features and pathogenesis.

Body dysmorphic disorder BDD , also known as dysmorphophobia, is an underrecognized yet relatively common and severe mental disorder that occurs around the world. Patients with BDD believe they look ugly or deformed thinking, for example, that they have a large and 'repulsive' nose, or severely scarred skin , when in reality they look normal. As a result of their appearance concerns, they may stop working and socializing, become housebound, and even commit suicide 1 , 2.

Enrico Morselli, a psychiatrist in Italy, first described BDD more than years ago 3 , noting that "The dysmorphophobic, indeed, is a veritably unhappy individual, who in the midst of his daily affairs, in conversations, while reading, at table, in fact anywhere and at any hour of the day, is suddenly overcome by the fear of some deformity DSM-IV classifies BDD as a separate disorder, defining it as a preoccupation with an imagined defect in appearance; if a slight physical anomaly is present, the person's concern is markedly excessive 6.

The preoccupation causes clinically significant distress or impairment in social, occupational, or other important areas of functioning, and it cannot be better accounted for by another mental disorder, such as anorexia nervosa. DSM-IV classifies BDD as a somatoform disorder, but classifies its delusional variant as a psychotic disorder a type of delusional disorder, somatic type.

However, delusional patients may be diagnosed with both BDD and delusional disorder, reflecting clinical impressions and empirical evidence that delusional and nondelusional BDD are probably the same disorder, which spans a spectrum of insight [ 7 ]. Individuals with BDD obsess that there is something wrong with how they look, even though the perceived appearance flaw is actually minimal or nonexistent 1 , 2 , 9 - They may describe themselves as looking unattractive or deformed, or even hideous or like a monster.

Concerns most often focus on the face or head e. The appearance preoccupations are difficult to resist or control, and on average consume 3 to 8 hours a day. They are often associated with fears of rejection and feelings of low self-esteem, shame, embarrassment, unworthiness, and being unlovable. Insight is usually poor, and nearly half of patients are delusional i. In addition, a majority have ideas or delusions of reference, thinking that others take special notice of the 'defect', perhaps staring at it, talking about it, or mocking it.

Most patients perform repetitive, compulsive behaviors aimed at examining, improving, or hiding the 'defect' 1 , 2 , 9 - Common behaviors include mirror checking, comparing with others, excessive grooming e. These behaviors typically occur for many hours a day and are difficult to resist or control.

Some studies report an approximately equal gender ratio 15 , whereas others report a preponderance of men 11 or women 12 , 16 although referral biases are evident in some reports. A majority of patients have never been married, and a relatively high proportion are unemployed 7 , The disorder's clinical features appear generally similar in women and men, although several differences are apparent 15 , BDD usually begins during early adolescence and can occur in childhood.

Although there is a dearth of research in this age group, BDD's clinical features in children and adolescents appear similar to those in adults Prospective studies of BDD are lacking, but available data indicate that the disorder is typically chronic, often with waxing and waning symptoms Most BDD patients seen in psychiatric settings have other mental disorders.

In this study, onset of major depression most often occurred after onset of BDD, consistent with clinical impressions that depression is often although not always secondary to BDD.

Substance use disorders, social phobia, obsessive compulsive disorder OCD , and personality disorders most often, avoidant also commonly co-occur with BDD 10 , Although level of functioning varies, BDD nearly always causes impaired functioning - often to a marked degree - as well as other complications 1 , 2 , 7 , 9 , 13 , Social impairment is nearly universal.

Individuals with BDD may have few or no friends, and may avoid dating and other social interactions. Most patients also have impaired academic, occupational, or role functioning. BDD obsessions, behaviors, or self-consciousness about being seen often diminish concentration and productivity.

Patients not uncommonly drop out of school or stop working. A study of dermatology patients who committed suicide reported that most had acne or BDD BDD patients experience unusually high levels of perceived stress 21 and markedly poor quality of life. More severe BDD symptoms were associated with poorer mental health-related quality of life. Thus, reports from these countries have shaped much of our knowledge of BDD's clinical features.

No cross-cultural studies have compared BDD's clinical features in community or clinical samples. Nonetheless, published case reports and series from around the world suggest that BDD's clinical features are generally similar across cultures, but that culture may produce nuances and accents on an apparently invariant, or universal, expression of BDD.

For example, case series from Japan suggest that BDD's clinical features in that country are generally similar to those in other countries; however, concern with the eyelids and with causing others displeasure by appearing unattractive may be more common than in Western cultures.

Questions have been raised as to whether koro is related to BDD. Koro, a culture-related syndrome occurring primarily in Southeast Asia, is characterized by a preoccupation that the penis labia, nipples, or breasts in women is shrinking or retracting and will disappear into the abdomen, resulting in death While koro has similarities to BDD, it differs in its usually brief duration, different associated features usually fear of death , response to reassurance, and occasional occurrence as an epidemic.

Although large epidemiologic surveys of BDD's prevalence have not been done, studies to date indicate that BDD is relatively common in both nonclinical and clinical settings Studies in community samples have reported current rates of 0. In one study of atypical depression, BDD was more than twice as common as OCD 31 , and in another 32 it was more common than many other disorders, including OCD, social phobia, simple phobia, generalized anxiety disorder, bulimia nervosa, and substance abuse or dependence.

BDD is underdiagnosed, however. Two studies of inpatients 2 , 30 , as well as studies in general outpatients 33 and depressed outpatients 31 , systematically assessed a series of patients for the presence of BDD and then determined whether clinicians had made the diagnosis in the clinical record. All four studies found that BDD was missed by the clinician in every case in which it was present. Thus, underdiagnosis of BDD appears very common. BDD may be difficult to diagnose because many patients are too ashamed to reveal their symptoms, fearing that their concerns will be trivialized or considered vain 9.

Unless BDD is specifically asked about, the diagnosis is easily missed. Not diagnosing BDD is problematic because treatment may be unsuccessful, and the patient may feel misunderstood and inadequately informed about the diagnosis and treatment options. Are you very worried about your appearance in any way?

OR : Are you unhappy with how you look? If yes : what is your concern? Does this concern preoccupy you? That is, do you think about it a lot and wish you could worry about it less? How much time do you spend thinking about fill in body areas of concern? Significantly interfered with your social life, school work, job, other activities, or other aspects of your life?

BDD is diagnosed in people who are 1 concerned about a minimal or nonexistent appearance flaw, 2 preoccupied with the perceived flaw think about it for at least an hour a day , and 3 experience clinically significant distress or impaired functioning as a result of their concern. BDD should be inquired about when patients have referential thinking, are housebound, have unnecessary surgery or dermatologic treatment, or present with social anxiety, depression or suicidal ideation.

To diagnose BDD, ICD and certain diagnostic instruments require that patients refuse to accept the advice and reassurance of one or more doctors.

This requirement will result in underdiagnosis of BDD, because many patients, despite having severe symptoms, do not seek medical help or reveal their symptoms because of shame, limited access to health care, or other reasons. Furthermore, screening measures for the somatoform disorders that are based on the presence of physical symptoms are also likely to underdiagnose BDD, because BDD only rarely presents with physical symptoms typical of other somatoform disorders.

In fact, preliminary data suggest that BDD patients do not have elevated levels of somatization Patients may present to clinicians revealing only anxiety, depression, or suicidal ideation 9. Consequently, BDD may be misdiagnosed as social phobia or agoraphobia due to secondary social anxiety and isolation or as panic disorder because situational panic attacks may occur, for example, when looking in the mirror.

Often, BDD is missed in depressed patients, in whom only depression is diagnosed. BDD is commonly misdiagnosed as OCD because both disorders are characterized by obsessions and compulsive behaviors and may also be misdiagnosed as trichotillomania in patients who cut or pluck their hair to improve their appearance. Delusional BDD is sometimes misdiagnosed as schizophrenia or psychotic depression. Although treatment research is still limited, serotonin reuptake inhibitors SRIs and cognitive-behavioral therapy CBT are currently the treatments of choice 34 , Available data indicate that SRIs, but not other medications or electroconvulsive therapy, are often efficacious for BDD, even for delusional patients Two prospective open-label studies of the SRI fluvoxamine found that two thirds of patients responded 38 , In a prospective study of the SRI citalopram, 11 of 15 patients responded; functioning and quality of life, as well as BDD symptoms, significantly improved Only two controlled pharmacotherapy studies have been done; additional controlled studies are needed.

Of note, available data consistently indicate that SRIs are effective even for delusional BDD 7 , 39 , 41 , 42 , whereas delusional BDD does not appear to respond to antipsychotics alone Although dose-finding studies are lacking, BDD appears to often require higher doses than typically used for depression.

Some patients respond only to doses higher than the maximum recommended dose e. In most studies, which used fairly rapid dose titration, the average time required for BDD to respond was weeks, with some patients requiring 12 or even 14 weeks It is therefore recommended that patients receive an SRI for at least 12 weeks before switching to another SRI, and that the highest SRI dose recommended by the manufacturer if tolerated be reached if lower doses are ineffective.

Long-term treatment appears often necessary There are only limited data on SRI augmentation strategies Adding an antipsychotic to an SRI is worth considering for delusional patients, although this strategy has received limited investigation. Agitated or highly anxious patients often benefit from a benzodiazepine in addition to an SRI. If none of these strategies is effective, an MAO inhibitor may be worth trying. Although psychotherapy research is also limited, CBT appears to often be effective Most studies have combined cognitive components e.

Early case reports indicated a successful outcome with exposure therapy 44 and cognitive plus behavioral techniques In a subsequent series of 17 patients who received 4 weeks of daily individual minute CBT sessions 20 total sessions , BDD symptom severity significantly decreased In an open series of 13 patients treated with group CBT, BDD significantly improved in twelve minute group sessions


2020 Dismorfofobia del pene o Trastorno dismórfico corporal

The importance of diagnosing body dysmorphic disorder in the Aesthetic Surgery consultation. Rochefort-Ciscutti, G. Along with the boom in Cosmetic Surgery, interest has increased in understanding the patients' motivations for attending an Aesthetic Surgery consultation. Controversy has risen among experts about the possible negative outcomes that Aesthetic Surgery could have in them. Our objective is to conduct a systematic review of the published literature about BDD and Aesthetic Surgery, considering prevalence, comorbidities and consequences of surgical procedures in their mental health. Most common comorbidities are: depressive disorders, anxiety and impulse control disorders. These patients usually present intrusive egodistonic thoughts and overvalued body image ideas, associated with poor insight, which leads to higher incidence of suicide attempts.


Body dysmorphic disorder: recognizing and treating imagined ugliness



Cognitive Behavior


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