You are in: eMedicine Specialties > Dermatology > PSYCHOCUTANEOUS DISEASES

Dysmorphophobia
Article Last Updated: May 31, 2007

AUTHOR AND EDITOR INFORMATION

Authors and Editors

Introduction
Clinical
Differentials
Treatment
Medication
Follow-up
Miscellaneous
References

Author: Robert A Schwartz, MD, MPH, Professor and Head of Dermatology, Professor of
Medicine, Professor of Pediatrics, Professor of Pathology, Professor of Preventive Medicine
and Community Health, UMDNJ-New Jersey Medical School
Robert A Schwartz is a member of the following medical societies: Alpha Omega Alpha,
American Academy of Dermatology, American College of Physicians, and Sigma Xi
Coauthor(s): Wanda M Patterson, MD, Department of Dermatology, UMDNJ-New Jersey
Medical School; O Joseph Bienvenu, MD, PhD, Assistant Professor, Department of
Psychiatry, Johns Hopkins University School of Medicine; M Peter Chodynicki, MD, Staff
Physician, Department of Psychiatry, Johns Hopkins University School of Medicine; Camila K
Janniger, MD, Clinical Professor, Dermatology and Chief, Pediatric Dermatology, Clinical
Associate Professor, Pediatrics, University Medicine and Dentistry of New Jersey, New Jersey
Medical School
Editors: James J Nordlund, MD, Professor Emeritus, Department of Dermatology, University
of Cincinnati College of Medicine; Richard P Vinson, MD, Assistant Clinical Professor,
Department of Dermatology, Texas Tech University School of Medicine; Consulting Staff,
Mountain View Dermatology, PA; Jeffrey Meffert, MD, Assistant Clinical Professor of
Dermatology, Medicine, University of Texas Health Science Center-San Antonio; Joel M
Gelfand, MD, MSCE, Medical Director, Clinical Studies Unit, Assistant Professor, Department
of Dermatology, Associate Scholar, Center for Clinical Epidemiology and Biostatistics,
University of Pennsylvania; Dirk M Elston, MD, Director, Department of Dermatology,
Geisinger Medical Center
Author and Editor Disclosure
Synonyms and related keywords: dysmorphic syndrome, dermatological hypochondriasis,
dermatological nondisease, body dysmorphic disorder, BDD, monosymptomatic
hypochondriasis, delusions of dysmorphosis

INTRODUCTION

Background
Dysmorphophobia has been described for more than a century.1 This psychiatric condition,
also termed body dysmorphic disorder (BDD), is marked by a fixation on an imaginary flaw in
the physical appearance. In cases in which a minor defect truly exists, the individual with BDD
exhibits an inordinate amount of anguish. BDD often is encountered in dermatologic and
cosmetic surgery settings. This disorder traditionally has been labeled dysmorphic syndrome.
Dysmorphophobic symptoms in a dermatologic setting have been termed dermatological
hypochondriasis, and in individuals without apparent cutaneous lesions, the condition is
termed dermatologic nondisease.
BDD results in significant suffering, occupational dysfunction, and/or social malaise. Individuals
with BDD have variable degrees of awareness concerning the psychiatric nature of the illness.
Many people continue to agonize about an imagined defect although they are cognizant that
their concerns are excessive. Other people with dysmorphophobia are regarded as delusional
and have no insight into their unusual behavioral tendencies.

Frequency
United States
As much as 1% of the population may have dysmorphophobia. A recent study demonstrated
that the prevalence of BDD appears to be significantly higher among people receiving
dermatologic care. Of people receiving dermatologic care, 11.9% were diagnosed with this
condition.

Mortality/Morbidity
People with dysmorphophobia frequently develop major depressive episodes and are at risk
for suicide. They also may exhibit violent behavior toward their treatment providers.

In many cases, individuals with BDD experience drastic social and occupational
dysfunctions that may progress to the point of social isolation.
Embarrassment and fear of being scrutinized or mocked cause these individuals to
avoid social situations and intimate relationships. Often victims of poor self-image,
these individuals do not demonstrate sufficient social skills and frequently are single or
divorced.
People with dysmorphophobia may believe firmly that a marked change in their
perceived body defect is a prerequisite to their happiness and well-being.

Sex
Male-to-female ratio appears to be equal.

Age
Onset usually occurs in the teenage years; however, average age in people receiving
dermatologic care is 33.7 years.

CLINICAL

History
A typical case presentation of dysmorphophobia (illustrating a number of key features of BDD)
is a 32-year-old male stockbroker who presents to the dermatologist because of concerns
about excessive hair loss. The only evidence of this is a possibly receding hairline, which the
dermatologist would not have noticed if the patient had not reported it. The patient spends
hours each day checking his hair in the mirror and becomes upset when he finds fallen strands
in his shower drain. He is self-conscious around others, has dated only occasionally, and
currently is demoralized. He has seen numerous dermatologists and plastic surgeons and has
undergone 2 cosmetic rhinoplasty operations. When discussing his plight, he bursts into tears
and admits recent thoughts of suicide. He believes he is too hideous to attract a partner.
Typical presenting factors for the condition are as follows:

Dysmorphophobia usually takes a chronic course. A 12-month follow-up prospective

study of its course indicated that in studies with similar methods, it tends to be chronic,
with remission probabilities lower than reported for mood disorders, most anxiety
disorders, and personality disorders in studies with similar methods.2
People with dysmorphophobia often have a history of multiple visits to dermatologists
and cosmetic surgeons with resulting unsuccessful treatment.
Repeated visits may signify an attempt to gain reassurance concerning the individual's
appearance; however, explaining that the physical defect is either nonexistent or minor
is futile. Individuals with dysmorphophobia will continue to agonize over perceived
flaws.
Many people with dysmorphophobia go to great lengths to conceal their defect using
items such as wigs, hats, and makeup.
Individuals with BDD often develop compulsive habits (eg, frequent mirror checking,
exorbitant grooming, skin picking).
Recognizing the symptoms early is crucial, since repeated investigations can result in
needless use of resources, time, and money.
The presence of BDD in obsessive-compulsive disorder patients is associated with
poor insight into obsessional beliefs and higher morbidity, reflected by a higher number
of psychiatric comorbid disorders in general.3

Physical

Any body part can be a source of distress; however, the body areas noted most
frequently are the skin, hair, and nose.
Complaints vary widely, including preoccupation with wrinkles, spots, acne, and large
pores.
Vascular markings, greasiness, scars, paleness, redness, excessive hairiness, and
thinning of hair also are encountered commonly as complaints.
Folliculitis and scarring may be a product of skin picking and plucking of nonexistent
hairs; these often result in exacerbation of distress.

Causes
Heredity may contribute to development of the illness. The prevalence of dysmorphophobia is
4 times higher in first-degree relatives of people with dysmorphophobia than in relatives of
probands without the condition. This condition appears to be related to obsessive-compulsive
disorder, since it occurs frequently in people with obsessive-compulsive disorder and their
relatives, and it responds to the same medications.

DIFFERENTIALS
Other Problems to be Considered
Obsessive-compulsive disorder
Depression
Bipolar disease
Schizophrenia

TREATMENT
Medical Care
Individuals with BDD often refuse psychiatric referral because of poor insight into the
underlying psychiatric illness. Dermatologic or plastic surgery treatment frequently fails to
improve dysmorphophobic symptoms. If provided routine treatment, most people with
dysmorphophobia are displeased with therapy and may attest to increased preoccupation with
the flaw.

Serotonin reuptake inhibitors (SRIs) have proven to be the most effective medications
in the treatment of dysmorphophobia. The most widely used SRIs include clomipramine
(average dose approximately 175 mg/d), fluoxetine (approximately 50 mg/d), and
fluvoxamine (approximately 260 mg/d). These drugs often require high doses and
lengthy treatment periods before symptoms improve; drug trials should continue for
several months after the target dose is reached. Increase the dose gradually to prevent
possible adverse effects. Almost 58% of patients with dysmorphophobia achieve either
partial improvement or complete resolution of symptoms with an SRI regimen.
Efficacy of clomipramine (SRI) versus desipramine (selective norepinephrine reuptake
inhibitor) was compared in a recent study of BDD. Superior results were noted with
clomipramine treatment. Increased improvement occurred in obsessive characteristics,
depression, insight, social performance, and general severity of the disorder.
Selective serotonin reuptake inhibitors (SSRIs) also are used in the treatment of
dysmorphophobia. Fluoxetine is used most frequently.
People with delusional symptoms may benefit from a therapeutic regimen including
pimozide (antipsychotic) in addition to an SSRI.
Patient insight may improve using pimozide alone. A pimozide/clomipramine
combination may lengthen the QT interval on ECG; therefore, close monitoring of the
cardiogram is required.
Buspirone (30-60 mg/d) in addition to an SRI proves helpful to one third of patients who
do not respond to SRI treatment alone.
In some situations, patients who show resistance to normal treatment may have
positive results when treated with SSRIs in combination with clomipramine. In this
case, monitor clomipramine levels because SSRIs increase clomipramine
concentration in the blood.
If all else fails, monoamine oxidase inhibitors (MAOIs) may be used, although dietary
and other restrictions are necessary (ie, avoiding foods containing tyramine, use of
certain medications). These drugs probably should be prescribed only by experienced
specialists.

Consultations
Nonpharmacologic psychiatric treatment may prove effective in the treatment of people with
BDD; however, the patients are most likely to avoid psychiatric therapy.

An on-site psychiatric liaison may be used to bridge the gap between dermatologic and
psychological treatments.
Therapy using behavioral modification includes encouraging people with BDD to
discontinue or decrease compulsive behaviors such as skin picking. Gradual
desensitization to social situations that cause anxiety also is helpful.
Cognitive behavioral therapy, including encouragement of self-esteem, modification of
distorted thoughts, and formulation of coping strategies, may be most effective when
used in conjunction with SRIs.
Therapy within a group setting and supportive psychotherapy may be adequate for
people who are not truly delusional.

MEDICATION
SRIs are the medications of choice in this illness. Clomipramine is a tricyclic antidepressant
(TCA) and has adverse effects similar to other TCAs, in particular, sedation, anticholinergic
effects, orthostatic hypotension, sexual dysfunction, weight gain, cardiac conduction slowing,
and a potential for fatal overdose. Fluoxetine and fluvoxamine are SSRIs and usually have a
milder adverse effect profile than clomipramine; however, adverse effects of SSRIs include
initial anxiety or agitation, nausea or other GI disturbance, headache, sexual dysfunction (ie,
delayed orgasm, loss of libido), and occasional apathy. Pimozide has adverse effects common
to other typical high-potency antipsychotic medications (ie, extrapyramidal symptoms such as
dystonia, parkinsonism, akathisia, neuroleptic malignant syndrome, tardive dyskinesia).
Pimozide also can slow cardiac conduction and cause hyperprolactinemia.
SSRIs are widely used antidepressants and are often safer than alternatives, but they may be
associated with a variety of cutaneous reactions that can be disturbing to these patients.4
SSRIs may produce spontaneous bruising, pruritus, urticaria, angioedema, erythema
multiforme, Stevens-Johnson syndrome, toxic epidermal necrolysis, erythema nodosum,
alopecia, hypertrichosis, leukocytoclastic vasculitis, and an acneiform eruption. Because crossreactions may occur between SSRIs, even though they have different chemical structures,
using another family of antidepressants may be advisable if an SSRI is linked to a serious skin
eruption.
Drug Category: Tricyclic antidepressants
Have central and peripheral anticholinergic effects and sedative effects and block the active
reuptake of norepinephrine and serotonin.
Drug Name

Clomipramine (Anafranil)

Description

Affects serotonin uptake while it affects

norepinephrine uptake when converted into its
metabolite desmethylclomipramine. Nighttime
dosing is recommended because of sedative
properties. Initiate therapy at a low dose to
minimize adverse effects. Available in 25-, 50-,
and 75-mg caps.

Adult Dose

25 mg PO qhs; increase as tolerated and

indicated; average dose is 175 mg/d

Pediatric Dose

Not established

Contraindications

Documented hypersensitivity; recent myocardial

infarction; do not use within 14 d of MAOIs

Interactions

Barbiturates, phenytoin, and carbamazepine

decrease effects of clomipramine; clomipramine
increases effects of anticholinergics,
sympathomimetics, alcohol, and CNS
depressants; toxicity of MAOIs increases with
clomipramine

Pregnancy

C - Safety for use during pregnancy has not been

established.

Precautions

Therapeutic blood level monitoring of

clomipramine and active metabolite is helpful in
assessing whether patient is slow metabolizer;
because of TCAs' slow cardiac conduction, avoid
in patients with bifascicular block, left bundlebranch block, or prolonged QT interval; caution in
severe cardiopulmonary or renal impairment,
inability to metabolize sorbitol, and patients at
high risk for suicide

Drug Category: Selective serotonin reuptake inhibitors

Inhibit presynaptic serotonin reuptake.
Drug Name

Fluoxetine (Prozac)

Description

Selectively inhibits presynaptic serotonin reuptake

with minimal or no effect in the reuptake of
norepinephrine or dopamine. Available in 10- and
20-mg caps and in 20 mg/5 mL liquid form.
Because of fluoxetine's stimulating properties,
initiate dosing in the morning. If nausea is a
problem, it may be helpful to take the medication
with food.

Adult Dose

10 mg PO qam; increase dose as tolerated;

average dose is 50 mg/d

Pediatric Dose
Contraindications

Not established
Documented hypersensitivity; concurrent or
recent (within last 2 wk) administration of MAOIs

Interactions

Increases toxicity of diazepam and trazodone by

decreasing clearance; increases toxicity of MAOIs
and highly protein-bound drugs

Pregnancy

C - Safety for use during pregnancy has not been

established.

Precautions

Caution in hepatic impairment and history of

seizures; discontinue MAOIs at least 14 d before
initiating fluoxetine therapy

Drug Name

Fluvoxamine (Luvox)

Description

Potent selective inhibitor of neuronal serotonin

reuptake. Does not bind significantly to alphaadrenergic, histamine, or cholinergic receptors;
therefore, it has fewer adverse effects than TCAs.
Available in 50- and 100-mg tabs. If nausea is a
problem, it may be helpful to take the medication
with food.

Adult Dose

50 mg PO qd for substantial anxiety symptoms;

average dose is 260 mg/d

Pediatric Dose
Contraindications

Not established
Documented hypersensitivity; current or recent
(within last 2 wk) administration of MAOIs

Interactions

Risk of hypertensive crisis increases in

coadministration with MAOIs; fluvoxamine
potentiates effects of triazolam and alprazolam;
therefore, when administering concurrently,
reduce dose by at least 50%; also reduce dose of
theophylline by one third, and monitor plasma
levels if administered concurrently with
fluvoxamine; alcohol, cimetidine, sertraline,
phenothiazines, and warfarin increase toxicity of
fluvoxamine

Pregnancy

C - Safety for use during pregnancy has not been

established.

Precautions

Caution in liver dysfunction, cardiovascular

disease, history of seizures, or suicidal
tendencies

Drug Category: Neuroleptic agents

Reduce psychotic symptoms (hallucinations, delusions).
Drug Name

Pimozide (Orap)

Description

Centrally acting dopamine-receptor antagonist.

Pimozide is available in 2-mg scored tablets in the
United States; 2-, 4-, and 10-mg tabs are
available in Canada.

Adult Dose

1-2 mg PO qd initial; increase by 2-4 mg qwk; not

to exceed 10 mg/d or 200 mcg/kg/d (0.2 mg/kg/d)

Pediatric Dose

Not established

Documented hypersensitivity; history of cardiac

Contraindications arrhythmias or long QT syndrome;
coadministration with macrolide antibiotics
Interactions

Increases toxicity of MAOIs, alfentanil, CNS

depressants, and guanabenz

Pregnancy

C - Safety for use during pregnancy has not been

established.

Precautions

ECG recommended at initiation of therapy and

regular intervals thereafter; careful observation for
extrapyramidal symptoms, especially in geriatric
patients

FOLLOW-UP
Complications

People with dysmorphophobia frequently develop major depressive episodes and are
at risk for suicide. They also may exhibit violent behavior toward treatment providers.
In many cases, individuals with BDD experience drastic social and occupational
dysfunctions that may progress to the point of social isolation.
Embarrassment and fear of being scrutinized or mocked cause individuals with BDD to
avoid social situations and intimate relationships.
Often victims of poor self-image, individuals with BDD do not demonstrate sufficient
social skills and frequently are single or divorced.
People with dysmorphophobia may believe firmly that a marked change in the
perceived body defect is a prerequisite to their happiness and well-being.

Prognosis

BDD results in significant suffering, occupational dysfunction, and/or social malaise.

Individuals with BDD have variable degrees of awareness concerning the psychiatric
nature of the illness. Many continue to agonize about an imagined defect although they
are cognizant that their concerns are excessive.
Other people with dysmorphophobia are regarded as delusional and have no insight
into their unusual behavioral tendencies.
People with dysmorphophobia frequently develop major depressive episodes and are
at risk for suicide.

MISCELLANEOUS
Medical/Legal Pitfalls

Failure to recognize that people with dysmorphophobia frequently desire a cosmetic

medical or cosmetic surgical approach but demonstrate unrealistic expectations
Failure to recognize the disorder, since people with dysmorphophobia may blame the
physician for producing what is perceived as an unacceptable outcome
Failure to combine surgical treatment with psychiatric therapy when treating a person
with dysmorphophobia

REFERENCES
1. Thomas I, Patterson WM, Szepietowski JC, Chodynicki MP, Janniger CK, Hendel PM,
et al. Body dysmorphic disorder: more than meets the eye. Acta Dermatovenerol
Croat. 2005;13(1):50-3. [Medline].

2. Phillips KA, Pagano ME, Menard W, Stout RL. A 12-month follow-up study of the
course of body dysmorphic disorder. Am J Psychiatry. May 2006;163(5):90712. [Medline].
3. Nakata AC, Diniz JB, Torres AR, de Mathis MA, Fossaluza V, Bragancas CA, et
al. Level of insight and clinical features of obsessive-compulsive disorder with and
without body dysmorphic disorder. CNS Spectr. Apr 2007;12(4):295-303. [Medline].
4. Krasowska D, Szymanek M, Schwartz RA, Myslinski W. Cutaneous effects of the most
commonly used antidepressant medication, the selective serotonin reuptake
inhibitors. J Am Acad Dermatol. May 2007;56(5):848-53. [Medline].
5. Bienvenu OJ, Samuels JF, Riddle MA, Hoehn-Saric R, Liang KY, Cullen BA, et al. The
relationship of obsessive-compulsive disorder to possible spectrum disorders: results
from a family study. Biol Psychiatry. Aug 15 2000;48(4):287-93. [Medline].
6. Castle DJ, Rossell S, Kyrios M. Body dysmorphic disorder. Psychiatr Clin North
Am. Jun 2006;29(2):521-38. [Medline].
7. Cooper JE. On the publication of the Diagnostic and Statistical Manual of Mental
Disorders: Fourth Edition (DSM-IV). Br J Psychiatry. Jan 1995;166(1):4-8. [Medline].
8. Cotterill JA. Body dysmorphic disorder. Dermatol Clin. Jul 1996;14(3):45763. [Medline].
9. Cotterill JA. Dermatologic nondisease. Dermatol Clin. Jul 1996;14(3):439-45. [Medline].
10. Cotterill JA, Cunliffe WJ. Suicide in dermatological patients. Br J
Dermatol. Aug 1997;137(2):246-50. [Medline].
11. Cotterill, JA, Millard, LG. Psychocutaneous disorders. In: Champion RH, Rook A, Ebling
FJ, Wilkinson DS, eds. Rook/Wilkinson/Ebling Textbook of Dermatology. 6th
ed. London, England: Blackwell Science; 1998:2792-4.
12. Hollander E, Allen A, Kwon J, Aronowitz B, Schmeidler J, Wong C, et al. Clomipramine
vs desipramine crossover trial in body dysmorphic disorder: selective efficacy of a
serotonin reuptake inhibitor in imagined ugliness. Arch Gen
Psychiatry. Nov 1999;56(11):1033-9. [Medline].
13. Hollander E, Cohen LJ, Simeon D. Body dysmorphic disorder. Psychiatr
Ann. 1993;23:359-64.
14. Hunter-Yates J, Dufresne RG Jr, Phillips KA. Tanning in body dysmorphic disorder. J
Am Acad Dermatol. May 2007;56(5 Suppl):S107-9. [Medline].
15. Hyman SE, Arana GW, Rosenbaum JF. Antidepressant drugs. In: Handbook of
Psychiatric Drug Therapy. 3rd ed. Philadelphia, Pa: Lippincott-Raven; 1995:43-92.
16. Jakubietz M, Jakubietz RJ, Kloss DF, Gruenert JJ. Body dysmorphic disorder:
diagnosis and approach. Plast Reconstr Surg. May 2007;119(6):1924-30. [Medline].
17. Mackley CL. Body dysmorphic disorder. Dermatol Surg. May 2005;31(5):5538. [Medline].
18. McElroy SL, Phillips KA, Keck PE Jr, Hudson JI, Pope HG Jr. Body dysmorphic
disorder: does it have a psychotic subtype?. J Clin Psychiatry. Oct 1993;54(10):38995. [Medline].
19. Perugi G, Akiskal HS, Giannotti D, Frare F, Di Vaio S, Cassano GB. Gender-related
differences in body dysmorphic disorder (dysmorphophobia). J Nerv Ment
Dis. Sep 1997;185(9):578-82. [Medline].
20. Phillips KA. Body dysmorphic disorder and depression: theoretical considerations and
treatment strategies. Psychiatr Q. 1999;70(4):313-31. [Medline].
21. Phillips KA. Body dysmorphic disorder: clinical features and drug treatment. CNS
Drugs. 1995;3:30-40.
22. Phillips KA. Body dysmorphic disorder: the distress of imagined ugliness. Am J
Psychiatry. Sep 1991;148(9):1138-49. [Medline].
23. Phillips KA, Diaz SF. Gender differences in body dysmorphic disorder. J Nerv Ment
Dis. Sep 1997;185(9):570-7. [Medline].
24. Phillips KA, Dufresne RG. Body dysmorphic disorder. A guide for dermatologists and
cosmetic surgeons. Am J Clin Dermatol. Jul-Aug 2000;1(4):235-43. [Medline].

25. Phillips KA, Dufresne RG Jr, Wilkel CS, Vittorio CC. Rate of body dysmorphic disorder
in dermatology patients. J Am Acad Dermatol. Mar 2000;42(3):436-41. [Medline].
26. Phillips KA, McElroy SL. Insight, overvalued ideation, and delusional thinking in body
dysmorphic disorder: theoretical and treatment implications. J Nerv Ment
Dis. Nov 1993;181(11):699-702. [Medline].
27. Phillips KA, McElroy SL, Hudson JI, Pope HG Jr. Body dysmorphic disorder: an
obsessive-compulsive spectrum disorder, a form of affective spectrum disorder, or
both?. J Clin Psychiatry. 1995;56 Suppl 4:41-51; discussion 52. [Medline].
28. Phillips KA, McElroy SL, Keck PE Jr, Pope HG Jr, Hudson JI. Body dysmorphic
disorder: 30 cases of imagined ugliness. Am J Psychiatry. Feb 1993;150(2):3028. [Medline].
29. Phillips KA, Taub SL. Skin picking as a symptom of body dysmorphic
disorder. Psychopharmacol Bull. 1995;31(2):279-88. [Medline].
30. Przemyslaw P, Szepietowski J. Dysmorfofobia-zaburzenie psychiczne, z ktorym
pacjenci zwracaja sie do dermatologa. Przegl Dermatol. 1999;86:171-5.
31. Rabe-Jablonska J. [Body dysmorphic disorder: clinical picture, diagnostic criteria,
prevalence, course and treatment]. Psychiatr Pol. Mar-Apr 1998;32(2):13342. [Medline].
32. Rabe-Jablonska J. [Liaison between body dysmorphic disorder and eating
disorders]. Psychiatr Pol. Mar-Apr 1998;32(2):155-63. [Medline].
33. Rabe-Jablonska J. [Results of long-term observation (3-11 years) of patients with dual
diagnosis: body dysmorphic disorder and delusional disorder, somatic type]. Psychiatr
Pol. Mar-Apr 1998;32(2):143-53. [Medline].
34. Sheppard NP, O'Loughlin S, Malone JP. Psychogenic skin disease: a review of 35
cases. Br J Psychiatry. Nov 1986;149:636-43. [Medline].
35. Sondheimer A. Clomipramine treatment of delusional disorder-somatic type. J Am Acad
Child Adolesc Psychiatry. Mar 1988;27(2):188-92. [Medline].
36. Stein DJ, Hollander E. Dermatology and conditions related to obsessive-compulsive
disorder. J Am Acad Dermatol. Feb 1992;26(2 Pt 1):237-42. [Medline].
37. Stein DJ, Hollander E. The spectrum of obsessive-compulsive related disorders. In:
Hollander E, ed. Obsessive-Compulsive Related Disorders. Washington, DC: APA
Press; 1992:241-71.
38. Veale D, Boocock A, Gournay K, Dryden W, Shah F, Willson R, et al. Body dysmorphic
disorder. A survey of fifty cases. Br J Psychiatry. Aug 1996;169(2):196-201. [Medline].

Dysmorphophobia excerpt

Article Last Updated: May 31, 2007

Common locations of imagined defects

In research carried out by Dr. Katharine Philips, involving over 500 patients, the
percentage of patients concerned with the most common locations were as follows;

skin (73%)
hair (56%)
nose (37%)
weight (22%)

stomach (22%)
breasts/chest/nipples (21%)
eyes (20%)
thighs (20%)
teeth (20%)
legs (overall) (18%)
body build / bone structure (16%)
ugly face (general) (14%)
lips (12%)
buttocks (12%)
chin (11%)
fingers (11%)
eyebrows (11%)

source: The Broken Mirror, Katharine A Philips, Oxford University Press, 2005 ed,
p56
People with BDD often have more than one area of concern.