This patient's preoccupation with an imagined deficit in the appearance of a body part is consistent with body dysmorphic disorder (BDD). While BDD is clinically distinct from other disorders, there is a high rate of comorbid clinical depression and suicidality.
BDD is a somatoform disorder that causes clinically significant stress, impairment, and dysfunction. The preoccupation with an imagined defect is not explained by any other psychiatric disorder. Patients often seek aesthetic or cosmetic procedures which rarely serve as an effective treatment. The disease distribution is equally split between male and female patients.
Hunt et al. review the recommended treatment for BDD with selective serotonin reuptake inhibitors (SSRIs) and cognitive behavior therapy (CBT). Several small-scale, open-label studies and a few RCTs have shown the benefits of SSRIs. The SSRIs were shown to reduce symptoms and subjective distress in 63-73% of patients. Dosages were higher than customarily used in the treatment of depressive disorders, and treatment response often took up to 12 weeks.
Sarwer et al. were the first to conduct an empirical investigation of body image dissatisfaction and BDD in cosmetic surgery patients. They found that 7% of cosmetic surgery patients met diagnositc criteria for BDD.
Illustration A contains a table from Hunt et al. showing the gender predominance of different symptoms of BDD.
Answer 1: Malingering refers to when a patient lies about (or fakes) an illness for secondary, often financial, gain. It is not associated with BDD.
Answer 2: Munchausen's syndrome is a disorder in which an individual invents symptoms or falsifies an illness in order to gain attention and medical treatment. It is not associated with BDD.
Answer 3: While some patients with BDD can have comorbid eating disorders, this patient with a normal BMI is unlikely to have anorexia.
Answer 4: Trichotillomania is the compulsive urge to pull out one's own hair leading to noticeable hair loss. It is frequently associated with obsessive-compulsive disorder.
None of these disorders are associated with BDD.
Hunt TJ, Thienhaus O, Ellwood A. The mirror lies: body dysmorphic disorder. Am Fam Physician. 2008 Jul 15;78(2):217-22. PubMed PMID: 18697504.
PMID:18697504 (Link to Abstract)
Sarwer DB, Wadden TA, Pertschuk MJ, Whitaker LA. Body image dissatisfaction and body dysmorphic disorder in 100 cosmetic surgery patients. Plast Reconstr Surg. 1998 May;101(6):1644-9. PubMed PMID: 9583501.
PMID:9583501 (Link to Abstract)