Body dysmorphic disorder and aesthetic dentistry

Requests for aesthetic dental treatment and the availability of such treatment options are increasing as expectations of the appearance of teeth change. Clinicians are rightly concerned about the patient who appears to be overly preoccupied and distressed by minor (or non-existent) defects; such patients may be suffering from a psychological disorder called body dysmorphic disorder (previously termed dysmorphophobia). This paper outlines the features of body dysmorphic disorder (BDD), and describes techniques for assessment and management.

The diagnostic criteria for BDD are outlined in the Diagnostic and Statistical Manual of Diseases, version 4.0.1 The criteria are:

The primary symptom of BDD is preoccupation with perceived defects. Concerns may be specific to particular body parts or a more pervasive vague concern about something ‘not being right’. The feature is felt to be unbearably ugly, leading to high levels of shame and distress2 and low levels of self-esteem.3 Individuals with BDD are convinced of the severity of the defect, no matter how minor it may seem to others.4 Aspects of appearance most commonly the focus of this preoccupation are the skin (eg blemishes and moles), hair and nose, thus the face is frequently involved. There is some suggestion of differences according to gender, men being more likely to be preoccupied with their genitals, height, hair and body build, while for women the focus is likely to be their weight, hips, legs and breasts.5 However, the focus often shifts between body parts over the course of the disorder. Individuals with BDD have thoughts and concerns about the body part (eg everyone is staring at it; this body part is ‘disgusting’) which are experienced as uncontrollable and intrusive. These thoughts are likely to be worse in social situations. Up to 77% of people with BDD could be said to be delusional in their beliefs at some point in their disorder.5