Cognitive–behavioural therapy for body dysmorphic disorder

The DSM–IV classification of body dysmorphic disorder (BDD) refers to an individual’s preoccupation with an ‘imagined’ defect in his or her appearance or markedly excessive concern with a slight physical anomaly (American Psychiatric Association, 1994). An Italian psychiatrist, Morselli, first used the term ‘dysmorphophobia’ in 1886, although it is now falling into disuse, probably because ICD–10 (World Health Organization, 1992) has discarded it, subsuming the condition under hypochondriacal disorder. The most common preoccupations are with the nose, skin, hair, eyes, eyelids, mouth, lips, jaw and chin. However, any part of the body may be involved and the preoccupation is frequently focused on several body parts. Complaints typically involve perceived or slight flaws on the face, the size of body features (too small or too big), hair thinning, acne, wrinkles, scars, vascular markings, paleness or redness of the complexion, asymmetry or lack of proportion. Sometimes the complaint is extremely vague; it may amount to no more than the patient feeling generally ugly.