Perceived ugliness: an update on treatment-relevant aspects of body dysmorphic disorder

Despite increased awareness of body dysmorphic disorder (BDD) during the past two decades, it is still a relatively unknown and understudied disorder. Its hallmark is a preoccupation with perceived defects or flaws in one's own appearance, often tied to the face (eg, nose, skin). BDD sufferers often think about their appearance "flaws" for up to several hours daily and frequently engage in ritualistic behaviors such as mirror checking, hair combing, comparing, asking for reassurance, makeup application, or skin picking. Furthermore, avoidance behaviors such as mirror avoidance or the avoidance of social activities are also common. In this paper, we provide an overview of BDD's unique symptomatology, its prevalence, and the comorbidities associated with it. A further aim is to provide an overview of effective treatments and possible obstacles and barriers to seeking or adhering to appropriate mental health care.