How can I differentiate between BDD and other mental health disorders in a primary care setting?

To differentiate body dysmorphic disorder (BDD) from other mental health disorders in a primary care setting, healthcare professionals should:

• Consider BDD in patients who have excessive preoccupation with perceived defects or flaws in their appearance that are not observable or appear slight to others, especially if they seek cosmetic or dermatological procedures.
• Ask targeted screening questions such as: "Do you worry a lot about the way you look and wish you could think about it less?"; "What specific concerns do you have about your appearance?"; "On a typical day, how many hours is your appearance on your mind?" (More than 1 hour a day is considered excessive); and "What effect does it have on your life? Does it impair work or social functioning?"
• Assess for comorbid conditions such as depression, social phobia, OCD, eating disorders, and substance misuse, which are common in BDD and may complicate diagnosis.
• Evaluate the risk of self-harm and suicide, particularly if depression is also present, and conduct a full risk assessment especially in children and young people.
• Recognize that BDD patients often feel ashamed and may find it difficult to discuss symptoms, so sensitive and supportive questioning is essential.
• Refer patients suspected of having BDD who seek cosmetic or dermatological treatment to mental health professionals with expertise in BDD for specialist assessment and management.
• Differentiate BDD from OCD by focusing on the nature of preoccupations: BDD involves distressing appearance-related thoughts and behaviours, whereas OCD involves a broader range of obsessions and compulsions such as checking, washing, or ordering.

These steps help distinguish BDD from other mental health disorders by focusing on the specific content, duration, and impact of appearance-related concerns, associated comorbidities, and risk factors, enabling appropriate referral and management in primary care ¹.