Body Dysmorphic Disorder and Muscle Dysmorphia

Abstract

The expression body dysmorphic disorder (BDD) was first used as an official psychiatric diagnosis in 1987, in the Diagnostic and Statistical Manual of Mental Disorders, third edition revised (American Psychiatric Association, DSM-III-R). The term replaced the original word dysmorphophobia coined by Enrico Morselli in 1891. The core feature of BDD is a persistent preoccupation with some defect in one’s physical appearance that is unnoticeable or barely discernible to others. The classification of the excessive preoccupation with an absent or minimal physical abnormality has repeatedly changed over time and remains subject to debate. Classification of BDD fluctuated among somatoform disorders like hypochondriasis, delusional disorders, and obsessive-compulsive disorders. In 2013, DSM-5 reclassified BDD under the new section Obsessive-Compulsive and Related Disorders. Accordingly, DSM-5 included a second diagnostic criterion: compulsive (compelling and repetitive) behaviors and mental acts related to the appearance concerns. Furthermore, DSM-5 added in an “insight specifier” to classify delusional and non-delusional BDD as variants of the same illness. Like DSM-5, the eleventh edition of the International Classification of Diseases (World Health Organization, ICD-11), which is due by 2018, will probably contain a separate diagnostic category for BDD and will include it in the group of obsessive-compulsive-related disorders. BDD is a relatively common, often secret, usually long-lasting psychiatric syndrome. It mostly starts in adolescence, causes distress, functional impairment, and inappropriate use of plastic surgery and cosmetic treatments. Suicidal ideation is frequent, and suicide completion rates are high. BDD often remains undetected. Specific programs of cognitive-behavioral therapy (CBT-BDD) and some psychotropic drugs are recommended therapeutic interventions. However, BDD is hard to treat and significant residual symptoms frequently persist. This chapter investigates definition, classification, and differential diagnosis of BDD versus other clinical pictures such as eating disorders, taijin-kyofu-sho and body dysmorphic disorder by proxy. A lot of space is given to the muscle dysmorphia.