Body Dysmorphic Disorder Workup

Updated: Oct 03, 2019
  • Author: Iqbal Ahmed, MBBS, FRCPsych(UK); Chief Editor: David Bienenfeld, MD  more...
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Workup

Approach Considerations

No specific laboratory tests are used to diagnose body dysmorphic disorder (BDD). No specific imaging studies are indicated.

Patients undergoing cosmetic surgery should undergo a screening questionnaire to determine whether may have BDD. The Body Dysmorphic Disorder Questionnaire-Dermatology Version (BDDQ-DV) and the Dysmorphic Concern Questionnaire (DCQ) have been validated for the dermatologic surgery setting. [66, 67]

The Multidimensional Body-Self Relations Questionnaire is a self-reported measure of body image that assesses satisfaction with appearance and preoccupation with perceived defects. It is used in clinical trials and may not be practical in routine office settings. A study of 92 patients with BDD who took the questionnaire revealed that patients with this condition differ from population norms with respect to numerous aspects of body image, including perception of illness. [29]

The Body Dysmorphic Disorder Examination Self-Report measures the patient’s level of dissatisfaction with respect to the perceived defect. It is another tool that is used in clinical trials and may not be practical in routine office settings.

The Body Dysmorphic Disorder Symptom Scale (BDD-SS) is another self-report measure  designed to differentiate, for each group of symptoms, the number of symptoms endorsed and their severity. A study of 99 adults with BDD who completed the measure found it showed good reliability and convergent validity. [68]

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Mental Status Examination

Key findings from the mental status examination that may be associated with the experience of symptoms consistent with a diagnosis of body dysmorphic disorder (BDD) include the following:

  • Mood - Patients may describe feelings of depressed mood, as well as irritability and anxiousness

  • Thought process - Patients may demonstrate perseveration on their physical appearance, particularly in association with their perceived defect

  • Thought content - Patients’ thoughts about the perceived defect in their physical appearance may actually be so divorced from reality as to become delusional; assessing the presence of suicidal and homicidal ideation is crucial, especially because patients with BDD may be at particularly high risk for both after an “unsuccessful” surgery

Typical nondelusional patients with BDD display little or no insight. For a brief time, they may admit that they might be wrong about their preoccupation. Often, they have only come to see the psychiatrist because they were coerced by a family member or because they were told to do so by the plastic surgeon.

Delusional BDD patients are firmly attached to false beliefs that they cannot be talked out of, even with given adequate proof that these beliefs are mistaken. Such patients may believe that what they consider their abnormal body part is slowly worsening or that other people are always staring or know about it.

These considerations aside, findings from the mental status examination are usually within normal limits except for the amount of time and energy spent on the preoccupation. Auditory hallucinations or wide mood swings might point to additional diagnoses, such as schizophrenia or bipolar disorder.

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