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A 21-year-old college student presents requesting a referral for rhinoplasty. She spends 3-4 hours daily examining her nose in mirrors and takes elaborate photographs from different angles. She frequently asks her roommate if her nose looks 'deformed,' though her roommate and family see nothing abnormal. She has missed multiple classes because she feels too self-conscious to be seen in public, has switched to online courses, and has consulted three plastic surgeons, all of whom declined to operate, stating her nose appears normal. The PMHNP suspects body dysmorphic disorder. Which feature most strongly supports that diagnosis?
Explanation
BDD diagnosis rests on two pillars: (1) preoccupation with perceived appearance flaws that are not observable or appear slight to others, and (2) repetitive behaviors or mental acts in response (mirror checking, reassurance seeking, comparing, skin picking, camouflaging). A third criterion, clinically significant distress or functional impairment. Must also be present. Clinicians should not apply invented criteria such as time minimums or surgical consultations.
Key Takeaway
Body dysmorphic disorder requires preoccupation with a perceived appearance flaw not observable to others plus repetitive behaviors in response. There is no minimum time threshold or requirement for specialist confirmation.