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When a patient presents requesting correction of certain physical imperfections, it is important to be able to discern what is objective reality and what seems to be only imaginary. Body dysmorphic disorder (BDD, or dysmorphophobia) is often seen in patients with depression, obsessive-compulsive disorder (OCD), and social phobia. It is characterised by an anxious preoccupation with an imaginary or very slight imperfection in physical appearance, which is out of proportion to its severity and causes significant and disabling suffering or impairment. This preoccupation is associated with compulsive behaviours, which can be very significant in this disorder. It is often focused on visible areas of the body (such as the face or scalp) although not exclusively. Cases of body dysmorphic disorder consist of a set of symptoms that are difficult to assess because they are often wrapped up in a general feeling of discontent that is related to the patient’s low opinion of their own physical appearance.
The term “dysmorphophobia” was introduced into the literature in 1886 by E. Morselli, to refer to “an obsessive manifestation of fear about being or becoming deformed”, but it is only in 1980 that the syndrome was designated as an individual nosologic entity in its own right by the American Psychiatric Association, and it entered the DSM-III-R in 1987. This entity brings together a collection of preoccupations with the body that are imaginary, or possibly real but exaggerated to the point that they engender psychological problems that have significant social or professional consequences.
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