A 27-year-old woman comes to the office due to concerns about her weight. She is frustrated about gaining a few pounds, although she maintains a well-balanced diet and exercises for an hour 3 times a week. The patient has been worried for years that her thighs are "huge" and "covered in cellulite." She always wears loose-fitting pants and spends hours a day researching leg exercises and measuring the circumference of her thighs. The patient generally stays at home and avoids social activities as she feels people tend to stare at her. She weighs 58 kg (127.9 lb) and is 170 cm (5 ft 7 in) tall. Physical examination is normal. Which of the following is the most likely diagnosis?

Question

A 27-year-old woman comes to the office due to concerns about her weight.  She is frustrated about gaining a few pounds, although she maintains a well-balanced diet and exercises for an hour 3 times a week.  The patient has been worried for years that her thighs are "huge" and "covered in cellulite."  She always wears loose-fitting pants and spends hours a day researching leg exercises and measuring the circumference of her thighs.  The patient generally stays at home and avoids social activities as she feels people tend to stare at her.  She weighs 58 kg (127.9 lb) and is 170 cm (5 ft 7 in) tall.  Physical examination is normal.  Which of the following is the most likely diagnosis?

Quizplus · Accepted Answer

11ec160b_360a_c6de_9249_df2a4370d51f_MD0001_00 Body dysmorphic disorder (BDD) involves a fixation with a perceived defect in appearance that is not evident or appears slight to others. Patients may believe that they look ugly or hideous due to their appearance concerns, which results in the performance of repetitive behaviors (eg, excessive mirror checking, grooming) or mental acts (eg, comparison with others). The disorder causes significant distress and/or psychosocial impairment, often resulting in unnecessary plastic surgery, avoidance behavior, and interpersonal problems. Patient insight ranges from good to absent (absolute conviction that beliefs about their appearance are true). (Choice A) Avoidance of public areas is present in both agoraphobia and BDD; however, in agoraphobia, avoidance is motivated by thoughts about not being able to escape if a panic attack were to occur as opposed to concerns about appearance. (Choices B and E) Weight concerns may occur in both body dysmorphic and eating disorders. However, this patient does not meet diagnostic criteria for either anorexia or bulimia nervosa (eg, normal weight, no evidence of binges or inappropriate compensatory behaviors). (Choices C and H) Although patients with BDD are frequently socially anxious and avoidant, the feelings result from their distorted beliefs about their appearance. In avoidant personality disorder and social anxiety disorder, social avoidance is related to fears of rejection and criticism from others. (Choice F) Patients with BDD can have delusional beliefs about their appearance, with a firm conviction that their perception is accurate. However, this is diagnosed as BDD with absent insight, rather than delusional disorder, because it involves only fixed, false beliefs about appearance. (Choice G) Obsessive-compulsive disorder is characterized by intrusive obsessions and/or time-consuming compulsions. When obsessions and compulsions are limited to concerns about physical appearance, BDD is the appropriate diagnosis. Educational objective: Body dysmorphic disorder involves fixation on a perceived defect in appearance and repetitive behaviors in response to the fixation. It can present with absent insight/delusional beliefs and result in significant psychosocial dysfunction. __________ References: A review of body dysmorphic disorder and its presentation in different clinical settings. (http://www.ncbi.nlm.nih.gov/pubmed/24392251) Body dysmorphic disorder. (http://www.ncbi.nlm.nih.gov/pubmed/25150563)

A 27-Year-Old Woman Comes to the Office Due to Concerns