Body Dysmorphic Disorder in Children and Adolescents

ICD-10 code: F45.22

Body dysmorphic disorder (BDD) is part of a cluster of diagnoses called the obsessive-compulsive and related disorders.  Obsessive-compulsive and related disorders are a group of psychiatric conditions that include:

  • Obsessive-compulsive disorder
  • Body dysmorphic disorder
  • Hoarding disorder
  • Trichotillomania
  • Excoriation (skin picking) disorder

These disorders are characterized by the occurrence of repetitive behaviors, often called compulsions.  Individuals with obsessive-compulsive disorder might engage in compulsive behaviors such as excessive washing, checking, arranging, or counting.  Individuals with body dysmorphic disorder might engage in frequent checking of their appearance in the mirror, or excessive grooming-related behaviors.  Individuals with hoarding disorder may engage in excessive acquiring of objects, combined with a strong need to save items.  Individuals with trichotillomania engage in excessive hair pulling, and individuals with excoriation disorder engage in excessive skin picking.

In some cases, the obsessive-compulsive and related disorders are also characterized by intrusive, unwanted, or distressing thoughts, called obsessions, which come to mind again and again.  People with obsessive-compulsive disorder might have obsessive thoughts about dirt or germs, thoughts of harming others, fears of making mistakes, or distress about things being out of order.  People with body dysmorphic disorder have repetitive, negative thoughts about their own appearance.  However, people with certain other obsessive-compulsive and related disorders (such as trichotillomania or excoriation disorder) often do not experience obsessive thoughts.

What is body dysmorphic disorder?

BDD is a complex psychiatric condition that is thought to affect 1.7% to 2.4% of the general population. It is difficult to know how common BDD is because people with the disorder are often unwilling to talk about their concerns. However, estimates of the prevalence in youth indicate that approximately 2% of adolescents meet criteria. The condition usually begins in early adolescence. Available data are limited but indicate that the clinical features of BDD are very similar in adults and youth.

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Understanding Body Dysmorphic Disorder

Though the severity of BDD can vary, individuals with BDD are typically severely distressed and impaired, often to a debilitating degree. Youth with BDD often have very poor psychosocial functioning and quality of life. They may avoid activities, drop out of school, or stop working, and they often avoid dating and other social interactions. Some youth with BDD become extremely isolated and even housebound for years. Youth with BDD often have poor self-esteem. Compulsive skin picking aimed at improving the skin’s appearance can cause significant lesions and scarring, bodily injury, and even life-threatening injuries.

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How is body dysmorphic disorder treated?

The United Kingdom’s National Institute for Health and Clinical Excellence has published a treatment practice guideline for body dysmorphic disorder.

Currently, clinical research suggests that the most promising treatment for adults with BDD is cognitive-behavioral therapy (CBT).  CBT for body dysmorphic disorder involves building motivation, challenging unhelpful thoughts and beliefs, exposure to avoided situations, and response prevention (e.g., not seeking reassurance from others).

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