Other obsessive-compulsive and related disorders. The preoccupations and repetitive behaviors of body dysmorphic disorder differ from obsessions and compulsions in 0CD in that the former focus only on appearance. These disorders have other differences, such as poorer insight in body dysmorphic disorder. When skin picking is intended to improve the appearance of perceived skin defects, body dysmorphic disorder, rather than excoria- tion (skin-picking) disorder, is diagnosed. When hair removal (plucking, pulling, or other types of removal) is intended to improve perceived defects in the appearance of facial or body hair, body dysmorphic disorder is diagnosed rather than trichotillomania (hair- pulling disorder).
Illness anxiety disorder. Individuals with body dysmorphic disorder are not preoccu- pied with having or acquiring a serious illness and do not have particularly elevated levels of somatization.
Major depressive disorder. The prominent preoccupation with appearance and exces- pressive disorder. However, major depressive disorder and depressive symptoms are common in individuals with body dysmorphic disorder, often appearing to be secondary to the distress and impairment that body dysmorphic disorder causes. Body dysmorphic morphic disorder are met. ‘
Anxiety disorders. Social anxiety and avoidance are common in body dysmorphic dis- order. However, unlike social anxiety disorder (social phobia), agoraphobia, and avoidant personality disorder, body dysmorphic disorder includes prominent appearance-related preoccupation, which may be delusional, and repetitive behaviors, and the social anxiety and avoidance are due to concerns about perceived appearance defects and the belief or fear that other people will consider these individuals ugly, ridicule them, or reject them be- cause of their physical features. Unlike generalized anxiety disorder, anxiety and worry in body dysmorphic disorder focus on perceived appearance ﬂaws.
Psychotic disorders. Many individuals with body dysmorphic disorder have delu- sional appearance beliefs (i.e., complete conviction that their view of their perceived de- fects is accurate), which is diagnosed as body dysmorphic disorder, with absent insight/ delusional beliefs, not as delusional disorder. Appearance-related ideas or delusions of reference are common in body dysmorphic disorder; however, unlike schizophrenia or schizoaffective disorder, body dysmorphic disorder involves prominent appearance pre- occupations and related repetitive behaviors, and disorganized behavior and other psy— chotic symptoms are absent (except for appearance beliefs, which may be delusional).