The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition Text Revision (DSM-5-TR) defines body dysmorphic disorder (BDD) as a condition in which a person is fixated on what they think is wrong with their appearance when in reality they look fine. BDD is a common mental illness that is often not recognized. It is marked by an overwhelming focus on perceived flaws in the body, which can lead to upsetting repeated behaviors and, in some cases, suicidal thoughts and actions. People who have BDD often seek surgery that is not necessary.

The Italian doctor Enrico Morselli first talked about BDD more than 100 years ago. He came up with the word “dysmorphophobia,” which comes from the Greek word “dysmorphia,” which means “ugliness.” However, there is evidence that it is still not being identified enough.

According to the empirical evidence, Due to the obsession, the stress that comes with it, and the worry that other people will reject them, there is almost always impairment in one or more areas of social, professional, academic, and role performance. Patients may avoid close relationships, stop going to school or work, stop doing social things, and even end up being unable to leave their homes at all. A lot of people with BDD also think about killing themselves. A new meta-analysis found that people with BDD were four times more likely than people without BDD to have suicidal thoughts and 2.6 times more likely to try to kill themselves. Additionally, sources report that 7.4% of people who work in mental health settings have BDD while in cosmetic and skincare settings, the rate of incidence is higher (20.0%).

A lot of different mental illnesses have been linked to BDD. The most common ones are major depressive disorder, social fear, obsessive-compulsive disorder, and drug abuse disorders. A person may be diagnosed with another problem along with their BDD, but the BDD may not be picked up, so they do not get the right care they need.

Not recognizing BDD can have bad effects on a person’s health and mental health, and if they don’t get help, BDD seems to last a long time. Hence timely diagnosis and management of the disorder is crucial. The following are the diagnostic criteria and features of BDD in light of DSM 5 TR.

Diagnostic Criteria

A. Being preoccupied with one or more flaws or faults in one’s look that others don’t see or think are not important.
B. At some point during the disorder, the person has done repeated actions or thoughts (like looking in the mirror, over-grooming, picking at their skin, or looking for confirmation) because they were worried about how they looked around other people.
C. The obsession causes pain or poor performance in social, professional, or other important areas of functioning that are clinically significant.
D. The obsession with looks cannot be explained by worries about body fat or weight in a person whose symptoms meet the standards for an eating disorder.

Specify if:

With muscle dysmorphia: When someone has muscle dysmorphia, they are obsessed with the idea that their body is too small or not strong enough. It is okay for the person to be focused on other parts of their body; this specifier is still used.  

Specify if:

Rate how much you understand about the beliefs that cause body dysmorphic disorder, such as “I look ugly” or “I look deformed.”
With good or fair insight: If someone has a good or fair understanding, they know that their body dysmorphic disorder views are either definitely false or probably false, or they know that they may or may not be true.
With poor insight: With little or no understanding, the person believes that the views about body dysmorphic disorder are most likely true.
With absent insight/delusional beliefs: If someone has missing understanding or delusional beliefs, they are sure that their body dysmorphic disorder beliefs are true.

Diagnostic Features

• Body dysmorphic disorder (previously dysmorphophobia) causes people to obsess about one or more physical imperfections they perceive make them ugly, unpleasant, strange, or deformed (Criterion A).
• People notice problems that are not there or appear small to others.
• People worry about looking “ugly”, “not right” “hideous” or “like a monster.”
• Most preoccupations include the skin (acne, scars, lines, wrinkles, or pallor), hair (“thinning” hair or “excessive” body or facial hair), or nose. However, it can be the eyes, teeth, weight, stomach, breasts, legs, etc.
• Some worry about their body’s unevenness.
• Preoccupations are irritating, unwelcome, and time-consuming (3–8 hours a day). They are difficult to avoid and manage.
• Concern causes excessive mental or behavioral behaviors like comparison (Criterion B).
• Despite being unpleasant and maybe harmful, the person must perform these tasks. They are time-consuming and difficult to handle.
• Common behaviors include comparing one’s appearance to others, looking at perceived flaws in mirrors or other reflective surfaces or directly, taking too many “selfies,” over-grooming (e.g., combing, styling, shaving, plucking, or pulling hair), wanting reassurance about perceived flaws, touching areas one does not like to check out, overworking out or lifting weights, and looking for cosmetic procedures.
• To disguise a “pale” complexion or acne, some people tan too much, change their clothes often, or spend too much on cosmetic goods.
• People regularly pick at their skin to repair defects, which can damage it, cause disease, or rupture blood vessels.
• Body dysmorphic disorder sufferers repeat actions to disguise perceived faults.
• They may repeatedly wear cosmetics, shirts, or caps or alter their hair to conceal their eyes or forehead.
• Criteria C requires clinically severe discomfort or impairment in social, professional, or other critical performance domains from the obsession.
• Body dysmorphic disorder and eating disorders must be distinguished.
• An obsession with imperfections in the appearance of someone else, generally a partner or spouse but sometimes a parent, child, sibling, or stranger, is called body dysmorphic disorder via proxy.