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Dysmorphophobic disorder: causes, symptoms, diagnosis, treatment

Alexey Portnov, medical expert
Last reviewed: 23.04.2024

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Dysmorphophobic disorder is characterized by concern with imaginary or minor appearance defects, which causes severe distress or disrupts social, professional or other functioning. The diagnosis is based on anamnestic information. Treatment consists of drug therapy and psychotherapy.

Dysmorphophobic disorder usually begins in adolescence and occurs equally often in men and women.

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Symptoms of dysmorphophobic disorder

Symptoms can develop gradually or suddenly. The intensity of symptoms can vary. Symptoms usually affect the face or head, but may include other parts of the body or several parts and can move from one part of the body to the other. The patient may be worried about thinning hair, acne, wrinkles, scars, vascular asterisks, complexion, excessive facial hair growth, or can focus on the shape or size of the nose, eyes, ears, mouth, chest, buttocks or other parts of the body. Men can have a form of this disorder called muscular dysmorphophobia, which includes concern about the idea that their body is not very lean and muscular.

Patients usually spend many hours a day thinking about the perceived defect. The majority constantly examines themselves, looking in the mirror, others avoid the mirror, and the remaining alternate these two behaviors. Most try to hide their imaginary defect, for example, growing a beard to hide scars, or putting on a hat covering slightly thinning hair. Many are subjected to medical dental or surgical treatment to correct imaginary defects, but this treatment does not lead to the desired result and may increase their concern. Men with muscular dysmorphophobia can use androgen supplements.

Many patients avoid appearing in public. Some leave their homes only at night; others do not leave the house at all. As a result, social isolation, repeated hospitalizations and suicidal behavior are observed.

Diagnosis and treatment of dysmorphophobic disorder

Since patients with this disorder are reluctant to disclose their symptoms, the disorder may remain undiagnosed for years. It differs from normal anxiety about its appearance, because it absorbs a lot of time, causes pronounced distress and disrupts functioning.

The diagnosis is based on anamnestic information. If there is concern only with the figure and body weight, then the more accurate diagnosis is probably anorexia nervosa; if anxiety affects only sexual characteristics, then a breakdown of sexual identification is likely.

SSRIs are often effective, although high doses are usually recommended. Cognitive-behavioral therapy is also effective.

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