Differentials
Other specified obsessive compulsive and related disorder
SIGNS / SYMPTOMS
If appearance defects are clearly noticeable and more obvious than “slight” at conversational distance (for example, limb amputation, absence of head hair), these concerns count toward a diagnosis of “other specified obsessive compulsive and related disorder” rather than BDD. However, patients with BDD can create obvious skin lesions or scarring via skin picking that is intended to improve the appearance of their skin; these patients can receive a diagnosis of BDD. See Excoriation (skin picking) disorder, below.
Eating disorders
SIGNS / SYMPTOMS
Unlike eating disorders, BDD usually focuses on perceived flaws of the face or head.[34] When body image preoccupations involve an inaccurate perception of being overweight or an inaccurate belief that nonfacial parts of the body (such as stomach or legs) are too fat, and if the patient has an eating disorder, these body image concerns are considered symptoms of the eating disorder rather than BDD. But if the patient does not have an eating disorder, these concerns count towards a diagnosis of BDD.
However, there is an unclear area of overlap between BDD and “other specified feeding and eating disorder” (i.e., weight concerns that do not qualify for a diagnosis of anorexia nervosa or bulimia nervosa).
Major depressive disorder
SIGNS / SYMPTOMS
BDD is characterized by prominent preoccupation with perceived appearance defects and excessive compulsive behaviors, which are not symptoms of depression. However, major depressive disorder is commonly comorbid with BDD.
Obsessive-compulsive disorder
SIGNS / SYMPTOMS
Obsessive-compulsive disorder (OCD) should not be diagnosed if the preoccupations (obsessions) and repetitive behaviors (compulsions) focus on perceived defects in one's physical appearance. Distressing or impairing preoccupations with bodily asymmetry should be diagnosed as BDD, not as OCD.
Olfactory reference disorder (olfactory reference syndrome)
SIGNS / SYMPTOMS
BDD involves an inaccurate belief that one looks ugly, deformed, or physically abnormal. In contrast, olfactory reference disorder (olfactory reference syndrome) involves an inaccurate belief that one emits a foul or offensive body odor.
Trichotillomania (hair-pulling disorder)
SIGNS / SYMPTOMS
Hair removal as a symptom of BDD, such as pulling or plucking body hair, is done in response to appearance concerns (for example, perceived asymmetry of eyebrows or excessively thick head hair or body hair). In BDD, the goal of this behavior is to improve one's physical appearance. In contrast, hair pulling in trichotillomania is more purely motoric; it is not triggered by concerns about physical appearance.
Excoriation (skin-picking) disorder
SIGNS / SYMPTOMS
Skin picking as a symptom of BDD is done in response to appearance concerns (for example, perceived acne or blemishes). In BDD, the goal of this behavior is to improve one's physical appearance. In contrast, skin picking in excoriation (skin-picking) disorder is more purely motoric; it is not triggered by concerns about perceived defects of the skin’s appearance.
Social anxiety disorder (social phobia)
SIGNS / SYMPTOMS
People with social anxiety disorder fear being negatively evaluated by others because of how they act or what they say, whereas those with BDD fear being negatively evaluated because they look unattractive, abnormal, or ugly.
Agoraphobia
SIGNS / SYMPTOMS
Patients with agoraphobia are anxious about being in a variety of situations (for example, using public transportation, driving over a bridge, or standing in a line), and they avoid these situations if possible. BDD should be diagnosed rather than agoraphobia if situations are avoided because of fears that other people will see the person’s perceived appearance defects (and diagnostic criteria for BDD are met).
Panic disorder
SIGNS / SYMPTOMS
Nearly 30% of people with BDD have panic attacks as a symptom of BDD, which are triggered by negative, distressing thoughts about appearance “defects” (such as thinking that others are looking at or scrutinizing the perceived appearance defects, when looking in the mirror at perceived defects, or when in bright light where perceived defects may be more visible).[33] Panic attacks that are triggered by BDD symptoms are diagnosed as “BDD with panic attack specifier” rather than as panic disorder.
Generalized anxiety disorder
SIGNS / SYMPTOMS
Anxiety and worry in generalized anxiety disorder do not focus on perceived appearance flaws. If the patient has anxiety and worry that is due to distressing or impairing preoccupation with perceived appearance flaws, BDD is the correct diagnosis.
Illness anxiety disorder (hypochondriasis)
SIGNS / SYMPTOMS
BDD preoccupations focus on perceived ugliness, whereas illness anxiety disorder preoccupations focus on having or acquiring a serious illness.
Schizophrenia and other psychotic disorders
SIGNS / SYMPTOMS
Negative symptoms and psychotic symptoms such as hallucinations, grossly disorganized behavior, and disorganized thinking are not symptoms of BDD. Psychotic-like symptoms that may occur as a symptom of BDD should not be diagnosed as a psychotic disorder. Such symptoms include complete conviction that the person looks abnormal or ugly, and delusions of reference (the conviction that other people take special notice of the person in a negative way because of how they look).
Gender dysphoria
SIGNS / SYMPTOMS
Gender dysphoria involves dissatisfaction with one’s primary and secondary sex characteristics, which are experienced as incongruent with one’s expressed or experienced gender. Gender dysphoria can also involve other body areas that reflect natal gender (for example, facial hair or body build). BDD should not be diagnosed if the patient is preoccupied only with primary and secondary sex characteristics or physical features that reflect natal gender and meets other diagnostic criteria for gender dysphoria.
Avoidant personality disorder
SIGNS / SYMPTOMS
Social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation are common features of BDD. If these clinical features are due to embarrassment and shame about perceived appearance flaws, and if diagnostic criteria for BDD are met, BDD should be diagnosed rather than avoidant personality disorder.
Bipolar disorder
SIGNS / SYMPTOMS
If symptoms such as severe agitation, insomnia, and pressured speech are triggered by distress due to the patient’s perception of their appearance, they should count toward a diagnosis of BDD rather than bipolar disorder.
Use of this content is subject to our disclaimer