Treatment of imagined ugliness

Greek dysmorphia, meaning ugliness (expressly of the face) was first coined by Morselli in the late19th century. He described a subjective feeling of a physical defect which the patient feels is noticeable to others, although his appearance is within normal limits. Dysmorphophobia first appeared in the US psychiatric nosology (as an atypical somatoform disorder) in 1980, with the publication of DSM-III (American Psychiatric Association, 1980). However, the term was subsequently criticised both because the condition does not represent a phobia as such, and also because the use of the term had become so broad and imprecise (see Munro & Stewart, 1991). Responsive to this imprecision, DSM-III-R (American Psychiatric Association, 1987) scrapped the term 'dymorphophobia', replacing it with 'body dysmorphic disorder' (BDD), a term retained in DSM-IV (American Psychiatric Association, 1994), where again it appears with the somatoform disorders. DSM-IV requires that once the intensity of belief reaches delusional intensity, a separate classification should be made, under delusional disorder, somatic subtype. The World Health Organization (1992), in the Tenth Revision of the International Classification of Diseases (ICD-10), also differentiates between delusional and nondelusional forms of disorder, but has reverted to the older term 'dysmorphophobia'. Thus, 'delusional dysmorphophobia' is subsumed in the category 'persistent delusional disorders'; the symptoms