Body dysmorphic disorder has been reported internationally. It appears that the disorder values and preferences may inﬂuence symptom content to some degree. Taijin kyofusho, included in the traditional Japanese diagnostic system, has a subtype similar to body dys- morphic disorder: shubo—kyofu (”the phobia of a deformed body”).
Females and males appear to have more similarities than differences in terms of most clin- ical features— for example, disliked body areas, types of repetitive behaviors, symptom severity, suicidality, comorbidity, illness course, and receipt of cosmetic procedures for body dysmorphic disorder. However, males are more likely to have genital preoccupa- tions, and females are more likely to have a comorbid eating disorder. Muscle dysmorphia occurs almost exclusively in males.
Rates of suicidal ideation and suicide attempts are high in both adults and children/ado- lescents with body dysmorphic disorder. Furthermore, risk for suicide appears high in ad- olescents. A substantial proportion of individuals attribute suicidal ideation or suicide attempts primarily to their appearance concerns. Individuals with body dysmorphic dis- order have many risk factors for completed suicide, such as high rates of suicidal ideation and suicide attempts, demographic characteristics associated with suicide, and high rates of comorbid major depressive disorder.
Nearly all individuals with body dysmorphic disorder experience impaired psychosocial functioning because of their appearance concerns. Impairment can range from moderate (e.g., avoidance of some social situations) to extreme and incapacitating (e.g., being com- pletely housebound). On average, psychosocial functioning and quality of life are mark— edly poor. More severe body dysmorphic disorder symptoms are associated with poorer functioning and quality of life. Most individuals experience impairment in their job, aca- demic, or role functioning (e.g., as a parent or caregiver), which is often severe (e.g., per- forming poorly, missing school or work, not working). About 20% of youths with body dysmorphic disorder report dropping out of school primarily because of their body dys- morphic disorder symptoms. Impairment in social functioning (e.g., social activities, rela- tionships, intimacy), including avoidance, is common. Individuals may be housebound because of their body dysmorphic disorder symptoms, sometimes for years. A high pro- portion of adults and adolescents have been psychiatrically hospitalized.
Normal appearance concerns and cleady noticeable physical defects. Body dysmor- sive appearance-related preoccupations and repetitive behaviors that are time-consuming, are usually difficult to resist or control, and cause clinically significant distress or impair- ment in functioning. Physical defects that are clearly noticeable (i.e., not slight) are not diagnosed as body dysmorphic disorder. However, skin picking as a symptom of body dysmorphic disorder can cause noticeable skin lesions and scarring; in such cases, body dys- morphic disorder should be diagnosed.
Eating disorders. In an individual with an eating disorder, concerns about being fat are considered a symptom of the eating disorder rather than body dysmorphic disorder.
However, weight concerns may occur in body dysmorphic disorder. Eating disorders and body dysmorphic disorder can be comorbid, in which case both should be diagnosed.