In pursuit of perfection: A primary care physician's guide to body dysmorphic disorder

Body dysmorphic disorder is an under-recognized chronic problem that is def ined as an excessive preoccupation with an imagined or a minor defect of a localized facial feature or body part, resulting in decreased social, acade mic and occupational functioning. Patients who have body dysmorphic disorde r are preoccupied with an ideal body image and view themselves as ugly or m isshapen. Comorbid psychiatric disorders may also be present in these patie nts. Body dysmorphic disorder is distinguished from eating disorders such a s anorexia nervosa that encompass a preoccupation with overall body shape a nd weight. Psychosocial and neurochemical factors, specifically serotonin d ysfunction, are postulated etiologies. Treatment approaches include cogniti ve-behavioral psychotherapy and psychotropic medication. To relieve the sym ptoms of body dysmorphic disorder, selective serotonin reuptake inhibitors, in higher dosages than those typically recommended for other psychiatric d isorders, may be necessary. A trusting relationship between the patient and the family physician may encourage compliance with medical treatment and b ridge the transition to psychiatric intervention.