context: Body dysmorphic disorder ( BDD) is a distinct mental disorder in which a person is preoccupied with an imagined physical defect or a minor defect that others often cannot see. As a result, people with this disorder see themselves as "ugly" and often avoid social exposure or turn to plastic surgery to try to improve their appearance. BDD shares some features with eating disorders and obsessive-compulsive disorder. BDD is similar to eating disorders in that both involve a concern with body image. However, a person with an eating disorder worries about weight and the shape of the entire body, while a person with BDD is concerned about a specific body part. People with obsessive compulsive disorder ( OCD) have recurring and distressing thoughts, fears, or images (obsessions) that they cannot control. The anxiety (nervousness) produced by these thoughts leads to an urgent need to perform certain rituals or routines (compulsions). With BDD, a person's preoccupation with the defect often leads to ritualistic behaviors, such as constantly looking in a mirror or picking at the skin. The person with BDD eventually becomes so obsessed with the defect that his or her social, work, and home functioning suffers. BDD is a chronic (long-term) disorder that affects men and women equally. It usually begins during the teen years or early adulthood. The most common areas of concern for people with BDD include: Skin imperfections: These include wrinkles, scars, acne, and blemishes. Hair: This might include head or body hair or absence of hair. Facial features: Very often this involves the nose, but it also might involve the shape and size of any feature. Body weight: Sufferers may obsess about their weight or muscle tone. Other areas of concern include the size of the penis, muscles, breasts, thighs, buttocks, and the presence of certain body odors. Some of the warning signs that a person may have BDD include: Engaging in repetitive and time-consuming behaviors, such as looking in a mirror, picking at the skin, and trying to hide or cover up the perceived defect Constantly asking for reassurance that the defect is not visible or too obvious Repeatedly measuring or touching the perceived defect Experiencing problems at work or school, or in relationships due to the inability to stop focusing about the perceived defect Feeling self-conscious and not wanting to go out in public, or feeling anxious when around other people Repeatedly consulting with medical specialists, such as plastic surgeons or dermatologists, to find ways to improve his or her appearance The exact cause of BDD is not known. One theory suggests the disorder involves a problem with the size or functioning of certain brain areas that process information about body appearance. The fact that BDD often occurs in people with other mental health disorders, such as major depression and anxiety, further supports a biological basis for the disorder. Other factors that might influence the development of or trigger BDD include: Experience of traumatic events or emotional conflict during childhood Low self-esteem Parents and others who were critical of the person's appearance Pressure from peers and a society that equates physical appearance with beauty and value also can have an impact on the development of BDD. The secrecy and shame that often accompany BDD make its diagnosis difficult. Most experts agree that many cases of BDD go unrecognized. People with the disorder often are embarrassed and reluctant to tell their doctors about their concerns. As a result, the disorder can go unnoticed for years or never be diagnosed. One red flag to doctors is when patients repeatedly seek plastic surgery for the same or multiple perceived physical defects. In diagnosing BDD, the doctor will likely begin his or her evaluation with a complete history and focused physical exam. If the doctor suspects BDD, he or she might refer the person to a psychiatrist or psychologist, health care professionals who are specially trained to diagnose and treat mental illnesses. The psychiatrist or psychologist makes a diagnosis based on his or her assessment of the person's attitude, behavior, and symptoms. Treatment for BDD likely will include a combination of the following therapies: Psychotherapy: This is a type of individual counseling that focuses on changing the thinking (cognitive therapy) and behavior (behavioral therapy) of a person with body dysmorphic disorder. The goal is to correct the false belief about the defect and to minimize the compulsive behavior. Medication: Certain antidepressant medications called selective serotonin reuptake inhibitors ( SSRIs) are showing promise in treating body dysmorphic disorder, as are antipsychotic medicines such as olanzapine, aripiprazole, or pimozide (either alone or in combination with an SSRI). No drug is formally FDA-approved for the treatment of BDD. Group and/or family therapy: Family support is very important to treatment success. It is important that family members understand body dysmorphic disorder and learn to recognize its signs and symptoms. In cases of BDD, social isolation can occur if the person becomes too self-conscious to go out in public. This also can have a negative impact on school or work. People with BDD also are at high risk for developing major depression, and the distress associated with the disorder puts people with BDD at high risk for suicide. Further, people with this disorder might undergo many surgical procedures in an attempt to correct their perceived defect. The outlook is promising for people with BDD who receive and follow treatment. In addition, those with a strong support team tend to do better in the long run. There is no known way to prevent BDD. However, it might be helpful to begin treatment in people as soon as they begin to have symptoms. Teaching and encouraging healthy and realistic attitudes about body image also might help prevent the development or worsening of BDD. Finally, providing the person with an understanding and supporting environment might help decrease the severity of the symptoms and help him or her better cope with the disorder.