frequency: it is common being present in:

  • – 11.9% of people in dermatology offices
  • – 8-15% of people in a cosmetic setting
  • – 1-2% of individuals in the population



Cases which can resemble Body Dysmorphoc Disorder (BDD):

  • -Stigmatization feelings in objective dematological (skin) disorders
  • -BDD behaviour in eating disorders (eg anorexia)
  • -BDD aspects in somatization disorders (eg somatoform hair loss)



Personality profiles of patients with BDD

  • -Paranoid type: Focused on symptoms. Has no doubts about being disfigured.
  • -Narcisstic type: High level of attractiveness. Body surface always visible. Narcisstic behaviour
  • -Social phobic type: Social phobia evident, Doesn’t require contact with other individuals, Isolation (Social withdrawal)
  • -Obsessive type: Obsessive behaviour. Mirror checking behaviour evident. Anxiety
  • -Schizoid type: Schizoid isolation. Resistance to empathy. Difficulty in interaction (socially distant)
  • -Posttraumatic type: Traumatic events in early childhood or puberty. Onset after life events.



For patients with BDD, Depression versus non depression is 4 times more likely in dermatology and cosmetic patients. In plastic surgery, the odds are three times more likely.



Symptoms of BDD:

  • -Mirror checking
  • -Avoidance behaviour
  • -Skin picking
  • -Low self esteem
  • -Dermatological/ plastic surgery treatment seeking
  • -Camouflaging
  • -Life style drugs
  • -Social Phobia
  • -Suicidal Ideation



What patients say that should raise suspicion that the patient could have BDD:

  • -“I cannot live with those symptoms”
  • -“I cannot present myself to others”
  • -“If the skin problem wasn’t there, I am quite normal and have no psychological problems”
  • -“My partner will not accept my symptoms”
  • -“Is there a cosmetic or surgical treatment ?”
  • -“Other people are looking at my skin symptoms”



Treatments are aimed at treating the symptoms 0f the perceived skin disorder:

  • -If there is no influence on normal life function: treat the skin
  • -Shame stigmatization: relaxation, communication skills training, psychotherapy
  • -Depression: relaxation, communication skills training, psychotherapy, antidepressants
  • -Somatization…



Source of information: Gieler U. Body dysmorphic disorder. 19th Congress of the European Academy of Dermatology and Venereology (EADV) – Gothenburg (Göteborg), Sweden (Sverige)

Photo credit: wikipedia