Differentiating Body Dysmorphic Disorder from Normal Appearance Concerns and Other Mental Disorders

Abstract

This chapter discusses differentiation of body dysmorphic disorder (BDD) from disorders that may be misdiagnosed as BDD or that present differential diagnosis challenges: eating disorders, major depressive disorder, obsessive-compulsive disorder, trichotillomania (hair-pulling disorder), excoriation (skin-picking) disorder, illness anxiety disorder, social anxiety disorder, agoraphobia, panic disorder, generalized anxiety disorder, schizophrenia and other psychotic disorders, gender dysphoria, avoidant personality disorder, olfactory reference syndrome, and several other constructs. This chapter also discusses how to differentiate BDD from normal appearance concerns and from problematic preoccupation with obvious physical defects.BDD is commonly misdiagnosed as another mental disorder. Sometimes misdiagnosis occurs because patients are too embarrassed and ashamed to reveal their appearance concerns; in such cases, BDD symptoms that are more readily observable (such as social anxiety) may be assigned an incorrect diagnosis while BDD goes undetected. In other cases, BDD symptoms are recognized but are misdiagnosed as another disorder. BDD must be differentiated from other conditions so appropriate treatment can be instituted.