A teenager who spends hours scrutinizing her skin

Abstract

Body dysmorphic disorder (BDD) is an obsessive-compulsive and related disorder characterized by a preoccupation with a perceived defect or flaw in physical appearance that is not observable or appears slight to others. Individuals with BDD engage in repetitive behaviors or mental acts in response to appearance concerns such as comparing, excessive grooming, skin picking, mirror checking, or reassurance seeking. Females are much more likely to be affected and the disorder typically begins in adolescence. Many patients do not divulge their symptoms to medical providers unless specifically asked. The first-line medication class for BDD is selective serotonin reuptake inhibitors (SSRIs). Patients with BDD tend to require relatively high doses of SSRIs, and a relatively longer trial duration of 12 to 16 weeks is required to determine response. Research on the most effective psychotherapeutic treatments remains limited; however, cognitive behavioral therapy (CBT) may be a reasonable approach.