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Body dysmorphic disorder

Nature Reviews Disease Primers volume 10, Article number: 92 (2024) Cite this article

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Abstract

Body dysmorphic disorder (BDD) is an obsessive–compulsive disorder-related psychiatric condition characterized by an intense preoccupation with perceived physical flaws that are not observable by others. BDD affects ~2% of the adult population but is underdiagnosed, partly owing to limited clinician awareness, and undertreated, partly due to limited access to treatment. Research on the aetiology of BDD is scarce but likely involves an interplay between genetic and environmental factors. A few studies suggest functional and structural brain differences (compared with controls) in the regions involved in visual and emotional processing, although firm conclusions about the pathophysiology of the disorder cannot be made at this stage. Diagnosis requires the presence of repetitive behaviours or mental acts typically aimed at checking, correcting or concealing perceived flaws. The disorder typically has its onset before 18 years of age, with a female preponderance in youth but no major gender disparity in adults. Quality of life is markedly impaired across multiple domains and suicide risk is considerable. Evidence-based treatments include cognitive behavioural therapy and selective serotonin reuptake inhibitors. Future research should focus on understanding the biological and environmental factors that increase the risk of BDD, and on improving access to effective treatments, thereby addressing a critical gap in care for this often misunderstood and overlooked disorder.

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Fig. 1: Psychiatric comorbidities in individuals with BDD.
Fig. 2: Brain systems and neurochemicals implicated in BDD.
Fig. 3: Treatment algorithm for body dysmorphic disorder.

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Acknowledgements

The authors thank L. Gunnarsson and S. Lindstedt for editorial assistance.

Author information

Authors and Affiliations

  1. Center for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Healthcare Services, Region Stockholm, Stockholm, Sweden

    Christian Rück, David Mataix-Cols & Lorena Fernández de la Cruz

  2. Department of Clinical Sciences, Lund University, Lund, Sweden

    David Mataix-Cols

  3. Centre for Addiction and Mental Health, Toronto, Ontario, Canada

    Jamie D. Feusner

  4. Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada

    Jamie D. Feusner

  5. Department of Women’s and Children’s Health, Karolinska Hospital, Karolinska Institutet, Stockholm, Sweden

    Jamie D. Feusner

  6. Obsessive-Compulsive Spectrum Disorders Program, LIM23, Hospital das Clinicas HCFMUSP, Instituto & Departamento de Psiquiatria da Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil

    Roseli Gedanke Shavitt

  7. South London and Maudsley NHS Foundation Trust, London, UK

    David Veale

  8. Institute of Psychiatry, Psychology, and Neursocience, King’s College London, London, UK

    David Veale

  9. Research Department of Clinical, Educational, and Health Psychology, University College London, London, UK

    Georgina Krebs

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  1. Christian Rück
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  2. David Mataix-Cols
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Contributions

Introduction (C.R.); Epidemiology (D.M.-C.); Mechanisms/pathophysiology (J.D.F.); Diagnosis, screening and prevention (L.F.d.l.C.); Management (G.K. and D.V.); Quality of life (R.G.S.); Outlook (C.R.); overview of the Primer (C.R.).

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Correspondence to Christian Rück.

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Competing interests

L.F.d.l.C. receives royalties for contributing articles to UpToDate, Wolters Kluwer Health and for editorial work from Elsevier, outside the current work. D.M.-C. receives royalties for contributing articles to UpToDate, Wolters Kluwer Health and is part owner of Scandinavian E-Health, all outside the current work. J.D.F. has received consultation fees and stock options from NOCD, Inc. C.R. has received royalties from Studentlitteratur, Natur och Kultur and Albert Bonniers Förlag, all outside the current work. G.K. receives royalties from Elsevier for editorial work. All other authors declare no competing interests.

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Peer review information

Nature Reviews Disease Primers thanks H. M. Weingarden; D. J. Castle; G. Grennan, who co-reviewed the article with A. Fang; and the other anonymous reviewer(s) for their contribution to the peer review of this work.

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Glossary

Acceptance and commitment therapy

A type of cognitive behavioural therapy that focuses on acceptance and mindfulness strategies along with commitment to action based on the patient’s own values and goals.

Cytoarchitectonically defined

Regions defined using previously created brain maps based on microscopically-defined boundaries rather than macroscopic landmarks184.

Dwell time

The number of visual fixations times the duration of each fixation185.

Global efficiency

In the context of brain structural or functional networks, this applies to having many short and direct paths for information to flow quickly between different brain areas186.

Global visual stimuli

Features that are processed as a whole, as opposed to being analysed by their individual components187.

Local visual stimuli

Visual elements processed based on their finer details, individual components or smaller features rather than the overall structure or shape, or as a whole187.

Scanpaths

Traces of the directions and extent of eye movements during viewing of complex visual stimuli over time, typically comprised of a series of fixations and saccades188.

Visual working memory

A cognitive function that actively maintains visual information to serve the need of ongoing tasks189.

White matter integrity

The degree that white matter nerve fibres (axons) are well-myelinated, have intact membranes and are well-organized, enabling efficient communication in the brain190.

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Rück, C., Mataix-Cols, D., Feusner, J.D. et al. Body dysmorphic disorder. Nat Rev Dis Primers 10, 92 (2024). https://doi.org/10.1038/s41572-024-00577-z

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