With good or fair insight: The individual recognizes that the body dysmorphic disor- der beliefs are definitely or probably not true or that they may or may not be true.
With poor insight: The individual thinks that the body dysmorphic disorder beliefs are probably true.
With absent insight/delusionai beliefs: The individual is completely convinced that the body dysmorphic disorder beliefs are true.
Individuals with body dysmorphic disorder (formerly known as dysmorphophobia) are pre- occupied with one or more perceived defects or ﬂaws in their physical appearance, which they believe look ugly, unattractive, abnormal, or deformed (Criterion A). The perceived ﬂaws are not observable or appear only slight to other individuals. Concerns range from looking ”unattractive" or "not right” to looking ”hideous" or ”like a monster.” Preoccu- pations can focus on one or many body areas, most commonly the skin (e.g., perceived acne, scars, lines, wrinkles, paleness), hair (e.g., ”thinning" hair or ”excessive” body or fa— cial hair), or nose (e.g., size or shape). However, any body area can be the focus of concern (e.g., eyes, teeth, weight, stomach, breasts, legs, face size or shape, lips, chin, eyebrows, genitals). Some individuals are concerned about perceived asymmetry of body areas. The preoccupations are intrusive, unwanted, time-consuming (occurring, on average, 3—8 hours per day), and usually difficult to resist or control.
Excessive repetitive behaviors or mental acts (e.g., comparing) are performed in re— sponse to the preoccupation (Criterion B). The individual feels driven to perform these be- haviors, which are not pleasurable and may increase anxiety and dysphoria. They are typically time-consuming and difficult to resist or control. Common behaviors are com- paring one's appearance with that of other individuals; repeatedly checking perceived grooming (e.g., combing, styling, shaving, plucking, or pulling hair); camouﬂaging (e.g., repeatedly applying makeup or covering disliked areas with such things as a hat, clothing, makeup, or hair); seeking reassurance about how the perceived ﬂaws look; touching dis- liked areas to check them; excessively exercising or weight lifting; and seeking cosmetic procedures. Some individuals excessively tan (e.g., to darken ”pale” skin or diminish per- ceived acne), repeatedly change their clothes (e.g., to camouﬂage perceived defects), or compulsively shop (e.g., for beauty products). Compulsive skin picking intended to improve perceived skin defects is common and can cause skin damage, infections, or ruptured blood vessels. The preoccupation must cause clinically significant distress or im- pairment in social, occupational, or other important areas of functioning (Criterion C); usually both are present. Body dysmorphic disorder must be differentiated from an eating disorder.
Muscle dysmorphia, a form of body dysmorphic disorder occurring almost exclusively in males, consists of preoccupation with the idea that one’s body is too small or insuffi- ciently lean or muscular. Individuals with this form of the disorder actually have a nor- mal-looking body or are even very muscular. They may also be preoccupied with other body areas, such as skin or hair. A majority (but not all) diet, exercise, and/ or lift weights excessively, sometimes causing bodily damage. Some use potentially dangerous anabolic- androgenic steroids and other substances to try to make their body bigger and more mus- cular. Body dysmorphic disorder by proxy is a form of body dysmorphic disorder in which individuals are preoccupied with defects they perceive in another person’s appear- ance.