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Introduction
Body dysmorphic disorder (BDD) is characterised by excessive and persistent preoccupation with perceived defects or flaws in appearance. These perceived flaws are unobservable or appear only slight to others, but nevertheless give rise to significant distress and impairment in the sufferer. 1 BDD sufferers can become preoccupied with any aspect of appearance, but the most common concerns relate to facial features, including nose, eyes, skin and hair. 2 To meet diagnostic criteria for BDD, the appearance preoccupation cannot be better explained by concerns with body fat or weight in an individual who fulfils diagnostic criteria for an eating disorder. 1 Diagnostic criteria for BDD also specify that at some point during the course of illness, the individual will have performed repetitive behaviours (eg, mirror checking, excessive grooming, skin picking, reassurance seeking) or mental acts (eg, comparing his or her appearance with that of others) in response to their appearance concerns. 1
BDD typically follows a chronic course 3 and is associated with marked functional impairment across multiple domains. Among adults, BDD results in high rates of occupational impairment, unemployment, social dysfunction and social isolation. 2 Similarly, BDD in youth is associated with major functional impairment, including reduced academic performance, social withdrawal and dropping out of school. 2 4 High comorbidity, for example with major depressive disorder, social anxiety disorder and obsessive-compulsive disorder (OCD), is frequently reported. BDD has also been associated with strikingly high rates of suicidality; reported rates of suicidal ideation range from 17%-77%, while rates of suicide attempts range from 3%-63%. 5
Despite the seriousness of the disorder, BDD has received little empirical attention to date compared with related conditions, such as OCD. However, in recent years, increased efforts have focused on understanding the phenomenology, aetiology and treatment of the disorder. This article, aimed at non-specialist hospital doctors and general practitioners, as well as psychiatry and clinical psychology trainees, will review some key recent developments, with a focus on implications for clinical practice and avenues for future research. The current article is based on a comprehensive literature review. Relevant literature was identified using PubMed and PsycINFO up to April 2017.
How is BDD classified?
A major advance in the field in recent years has been the reclassification of BDD in the diagnostic...