Body dysmorphic disorder (BDD) is characterised by a preoccupation with an imagined defect in one’s appearance or, in the case of a slight physical anomaly, the person’s concern is markedly excessive. The person must also be significantly distressed or handicapped in his or her occupational and social functioning (American Psychiatric Association, 1994). There is frequent comorbidity in BDD especially for depression, social phobia and obsessive–compulsive disorder (OCD) (Neziroglu et al., 1996 and Phillips and Diaz, 1997; Veale et al., 1996a). There is also heterogeneity in the presentation of BDD from individuals with borderline personality disorder with self-harming behaviours to others with muscle dysmorphia (Pope, Gruber, Choi, Olivardia, & Phillips, 1997), who are less handicapped. They share a common feature of a preoccupation with an imagined defect or minor physical anomaly. The most common preoccupations concern the skin, hair, nose, eyes, eyelids, mouth, lips, jaw and chin, however any part of the body may be involved and the preoccupation is frequently focussed on several body parts simultaneously (Phillips, McElroy, Keck, Pope, & Hudson, 1993). Complaints typically involve perceived or slight flaws on the face, asymmetrical or disproportionate body features, thinning hair, acne, wrinkles, scars, vascular markings and pallor, or ruddiness of complexion. Sometimes the complaint is extremely vague or amounts to no more than a general perception of ugliness. BDD is characterised by time consuming behaviours such as mirror gazing, comparing particular features to those of others, excessive camouflage, skin-picking and reassurance seeking. There is usually avoidance of social situations and of intimacy. Alternatively such situations are endured with the use of alcohol, illegal substances or safety behaviours similar to social phobia.
The prevalence rate of BDD in the community is reported as 0.7% in two studies (Faravelli et al., 1997; Otto, Wilhelm, Cohen, & Harlow, 2001) with a higher prevalence of milder cases in adolescents and young adults (Bohne et al., 2002). The prevalence of BDD is about 5% in a cosmetic surgery setting (Sarwer, Wadden, Pertschuk, & Whitaker, 1998) and 12% in a dermatology clinic (Phillips, Dufresne, Wilkel, & Vittorio, 2000). Surveys of BDD patients attending a psychiatric clinic tend to show an equal sex incidence and sufferers are usually single or separated (Neziroglu & Yaryura-Tobias, 1993; Phillips & Diaz, 1997; Phillips et al., 1993 and Veale et al., 1996a). Veale et al. (1996a) found a greater preponderance of women but this may be because of a referral bias. It is also possible that, in the community, while more women are affected overall, a greater proportion experience milder symptoms.
