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A 24-year-old male presents with a 2-year preoccupation that his jaw is asymmetrical and 'grotesquely misshapen.' He spends over 3 hours daily examining his jaw in mirrors and comparing it to photos of celebrities, and he has begun wearing a medical mask in public to conceal his face. He denies any concern about body weight, shape, or food intake and maintains a normal BMI. When asked whether his concerns feel excessive, he states, 'This isn't in my head, anyone can see how deformed I look.' His friends and family insist his jaw appears completely normal.
Explanation
BDD exists on an insight continuum from good insight to absent insight/delusional beliefs. Even when the patient is fully convinced the flaw is real, the diagnosis remains BDD, not delusional disorder. When the content involves perceived physical defects. Distinguishing BDD from OCD hinges on content specificity (appearance vs. broader obsessional themes) and from eating disorders on the absence of weight/shape preoccupation.
Key Takeaway
BDD with delusional conviction about a perceived physical flaw is classified as BDD with absent insight/delusional beliefs, not as delusional disorder somatic type.