A 16-Year-Old Girl Is Brought to the Office by Her

A 16-year-old girl is brought to the office by her mother because she has been increasingly reluctant to go to school because of her appearance. The mother reports that her daughter has been worried about her weight and a light brown mark she has on her face. She spends up to 1 hour daily looking at herself in the mirror and meticulously putting on makeup to disguise the mark. The patient says, "I look disgusting with this mark, and I know everyone thinks the same, especially with me being so fat." She has recently quit the dance team, stopped meeting with her friends, and has been avoiding public events out of embarrassment. She has been reading articles on cosmetic surgery and says that she plans to have the mark removed. She appears anxious. She is 162 cm (5 ft 4 in) tall and weighs 55 kg (121 lb) ; BMI is 21 kg/m2. Vital signs are within normal limits. After removing her makeup, examination shows a 4-mm, light brown macule on the left cheek. Which of the following is the most likely diagnosis?

A) Agoraphobia
B) Anorexia nervosa
C) Avoidant personality disorder
D) Body dysmorphic disorder
E) Bulimia nervosa
F) Delusional disorder
G) Obsessive-compulsive disorder
H) Social anxiety disorder