Body dysmorphic disorder in the cosmetic practice.

Body dysmorphic disorder (BDD) is a preoccupation with a slight or imagined flaw in appearance that causes significant distress and impairment in daily functioning. The disease is more prevalent among patients who seek aesthetic procedures as compared with population standards or individuals that are not interested in aesthetic surgery. Several studies have indicated that BDD symptoms typically worsen after an aesthetic procedure because the preoccupation shifts to a different body area. This review discusses the demographic and clinical features, psychiatric comorbidity, assessment, differential diagnosis, and management of BDD. Components of the assessment include the interview, patient observation in the office, and questionnaires. The article includes a detailed discussion on questionnaires, especially those that are most useful in the dermatology or cosmetic practice. Ethical considerations in the management of BDD are discussed. BDD should not be missed by health providers because of the associated high morbidity that includes an increased suicidality. The cosmetic provider's approach should motivate BDD patients to participate in treatment, a combination of psychotherapy and pharmacotherapy.