Body dysmorphic disorder ( BDD), also known as dysmorphophobia, is an intriguing and sometimes difficult-to-treat condition that often mystifies clinicians. The disorder consists of a distressing and/or impairing preoccupation with a non-existent or slight defect in appearance, which is classified as a separate disorder in
DSM-IV and a type of hypochondriasis in ICD-10 (see Table 1). Although BDD symptoms may sound trivial, the disorder can cause severe distress and notably impaired functioning, and it can lead to suicide. BDD is typically under-recognized in clinical settings owing to patients' secrecy and clinicians' lack of familiarity with the disorder.
Table 1 DSM-IV and ICD-10 definitions of body dysmorphic disorder (dysmorphophobia)
Despite its under-recognition, BDD was first described by Morselli more than a century ago. (1) At the turn of the century it was discussed by Janet,(2) who described a young woman who worried that she would never be loved because she was 'ugly and ridiculous', and who for 5 years only rarely left her tiny apartment. BDD has since been consistently described around the world, but it has only recently been systematically studied. (3d)
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