Psych · General adult psychiatry — OCRD
Body dysmorphic disorder
Also known as BDD · Body dysmorphia · Dysmorphophobia · Imagined ugliness · Muscle dysmorphia · BDD-YBOCS · OCRD
Exam-exhaustive fellowship reference on body dysmorphic disorder — DSM-5-TR/ICD-11 OCRD criteria; insight spectrum including delusional beliefs; differentials vs OCD and eating disorders; BDD-YBOCS; high suicide risk; CBT with ERP-style exposures; high-dose SSRI (fluoxetine RCT), clomipramine selectivity, relapse prevention; cosmetic surgery harms; muscle dysmorphia. FRANZCP-primary, globally tagged.
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Target exams
FRANZCPMRCPsychABPNMD-DNBNEET-SS
Red flags
- Active suicidal ideation, intent or plan — lifetime SI and attempt rates are markedly elevated in clinical BDD; same-day risk assessment and safety plan
- Self-surgery, cutting, acid, or other self-harm aimed at 'fixing' a perceived defect — emergency medical and psychiatric pathway
- Housebound severe avoidance, inability to work or attend school, or total social isolation driven by appearance shame
- Delusional-level appearance beliefs with secondary depression — treat as BDD with SRI/CBT-BDD; do not default to antipsychotic-only schizophrenia pathway without primary psychosis features
- Repeated cosmetic procedures with dissatisfaction or migrating concerns — stop colluding; redirect to evidence-based psychiatric care
- Muscle dysmorphia with anabolic steroid use, extreme exercise, or nutritional risk — medical complications plus psychiatric treatment
Meet the patient
A 23-year-old man arrives at his third rhinoplasty consultation. The surgeon, to her credit, refers him to you instead. He checks mirrors for four hours a day, wears a hat indoors, has not dated in two years, and knows — knows — his colleagues stare at his nose when he leaves the room. The nose is unremarkable. When you finish the risk questions, he mentions, almost politely, that some nights he thinks it would be easier not to be here.[22][12][15]
Two examiner lessons in one waiting room: the diagnosis hides behind shame, and the suicide risk is not a footnote — it is the topic.[15][16]
References24ShowHide
- [1]Phillips KA, Hollander E, Rasmussen SA, et al. A severity rating scale for body dysmorphic disorder: development, reliability, and validity of a modified version of the Yale-Brown Obsessive Compulsive Scale Psychopharmacol Bull, 1997.PMID 9133747
- [2]Phillips KA, Albertini RS, Rasmussen SA A randomized placebo-controlled trial of fluoxetine in body dysmorphic disorder Arch Gen Psychiatry, 2002.PMID 11926939
- [3]Hollander E, Allen A, Kwon J, et al. Clomipramine vs desipramine crossover trial in body dysmorphic disorder: selective efficacy of a serotonin reuptake inhibitor in imagined ugliness Arch Gen Psychiatry, 1999.PMID 10565503
- [4]Phillips KA, Keshaviah A, Dougherty DD, et al. Pharmacotherapy Relapse Prevention in Body Dysmorphic Disorder: A Double-Blind, Placebo-Controlled Trial Am J Psychiatry, 2016.PMID 27056606
- [5]Wilhelm S, Phillips KA, Didie E, et al. Modular cognitive-behavioral therapy for body dysmorphic disorder: a randomized controlled trial Behav Ther, 2014.PMID 24680228
- [6]Wilhelm S, Phillips KA, Greenberg JL, et al. Efficacy and Posttreatment Effects of Therapist-Delivered Cognitive Behavioral Therapy vs Supportive Psychotherapy for Adults With Body Dysmorphic Disorder: A Randomized Clinical Trial JAMA Psychiatry, 2019.PMID 30785624
- [7]Veale D, Anson M, Miles S, et al. Efficacy of cognitive behaviour therapy versus anxiety management for body dysmorphic disorder: a randomised controlled trial Psychother Psychosom, 2014.PMID 25323062
- [8]Enander J, Andersson E, Mataix-Cols D, et al. Therapist guided internet based cognitive behavioural therapy for body dysmorphic disorder: single blind randomised controlled trial BMJ, 2016.PMID 26837684
- [9]Harrison A, Fernández de la Cruz L, Enander J, et al. Cognitive-behavioral therapy for body dysmorphic disorder: A systematic review and meta-analysis of randomized controlled trials Clin Psychol Rev, 2016.PMID 27393916
- [10]Ipser JC, Sander C, Stein DJ Pharmacotherapy and psychotherapy for body dysmorphic disorder Cochrane Database Syst Rev, 2009.PMID 19160252
- [11]Castle D, Beilharz F, Phillips KA, et al. Body dysmorphic disorder: a treatment synthesis and consensus on behalf of the International College of Obsessive-Compulsive Spectrum Disorders Int Clin Psychopharmacol, 2021.PMID 33230025
- [12]Phillips KA, Kelly MM Body Dysmorphic Disorder: Clinical Overview and Relationship to Obsessive-Compulsive Disorder Focus (Am Psychiatr Publ), 2021.PMID 35747292
- [13]Phillips KA, Pinto A, Hart AS, et al. A comparison of insight in body dysmorphic disorder and obsessive-compulsive disorder J Psychiatr Res, 2012.PMID 22819678
- [14]Phillips KA, Gunderson CG, Mallya G, et al. A comparison study of body dysmorphic disorder and obsessive-compulsive disorder J Clin Psychiatry, 1998.PMID 9862601
- [15]Phillips KA, Menard W Suicidality in body dysmorphic disorder: a prospective study Am J Psychiatry, 2006.PMID 16816236
- [16]Phillips KA, Coles ME, Menard W, et al. Suicidal ideation and suicide attempts in body dysmorphic disorder J Clin Psychiatry, 2005.PMID 15960564
- [17]Koran LM, Abujaoude E, Large MD, et al. The prevalence of body dysmorphic disorder in the United States adult population CNS Spectr, 2008.PMID 18408651
- [18]Buhlmann U, Glaesmer H, Mewes R, et al. Updates on the prevalence of body dysmorphic disorder: a population-based survey Psychiatry Res, 2010.PMID 20452057
- [19]Crerand CE, Menard W, Phillips KA Surgical and minimally invasive cosmetic procedures among persons with body dysmorphic disorder Ann Plast Surg, 2010.PMID 20467296
- [20]Pope CG, Pope HG, Menard W, et al. Clinical features of muscle dysmorphia among males with body dysmorphic disorder Body Image, 2005.PMID 17075613
- [21]Phillips KA, Wilhelm S, Koran LM, et al. Body dysmorphic disorder: some key issues for DSM-V Depress Anxiety, 2010.PMID 20533368
- [22]Phillips KA Body dysmorphic disorder: recognizing and treating imagined ugliness World Psychiatry, 2004.PMID 16633443
- [23]Hong K, Nezgovorova V, Uzunova G, et al. Pharmacological Treatment of Body Dysmorphic Disorder Curr Neuropharmacol, 2019.PMID 29701157
- [24]Phillips KA Pharmacotherapy for Body Dysmorphic Disorder Psychiatr Ann, 2010.PMID 27761054