body dysmorphic disorder (redirected from Dysmorphobia)

Body Dysmorphic Disorder 

Definition

Body dysmorphic disorder (BDD) is defined by DSM-IV-TR as a condition marked by excessive pre-occupation with an imaginary or minor defect in a facial feature or localized part of the body. The diagnostic criteria specify that the condition must be sufficiently severe to cause a decline in the patient's social, occupational, or educational functioning. The most common cause of this decline is the time lost in obsessing about the "defect"—one study found that 68 percent of patients in a sample of adolescents diagnosed with BDD spent three or more hours every day thinking about the body part or facial feature of concern. DSM-IV assigns BDD to the larger category of somatoform disorders, which are disorders characterized by physical complaints that appear to be medical in origin but that cannot be explained in terms of a physical disease, the results of substance abuse, or by another mental disorder.

The earliest known case of BDD in the medical literature was reported by an Italian physician named Enrique Morselli in 1886, but the disorder was not defined as a formal diagnostic category until DSM-III-R in 1987. The World Health Organization (WHO) did not add BDD to the International Classification of Diseases (ICD) until 1992. The word dysmorphic comes from two Greek words that mean "bad" or "ugly" and "shape" or "form." BDD was previously known as dysmorphophobia.

Description

BDD is characterized by an unusual degree of worry or concern about a specific part of the face or body, rather than the general size or shape of the body. It is distinguished from anorexia nervosa and bulimia nervosa in that patients with eating disorders are preoccupied with their overall weight and body shape. As many as 50 percent of patients diagnosed with BDD undergo plastic surgery to correct their perceived physical defects.

Since the publication of DSM-IV in 1994, some psychiatrists have suggested that there is a subtype of BDD, namely muscle dysmorphia. Muscle dysmorphia is marked by excessive concern with one's muscularity and/or fitness. Persons with muscle dysmorphia spend unusual amounts of time working out in gyms or exercising rather than dieting obsessively or seeking plastic surgery. DSM-IV-TR added references to concern about body build and excessive weight lifting to DSM-IV's description of BDD in order to cover muscle dysmorphia.

BDD and muscle dysmorphia can both be described as disorders resulting from the patient's distorted body image. Body image refers to a person's mental picture of his or her outward appearance, including size, shape, and form. It has two major components: how the person perceives their physical appearance, and how they feel about their body. Significant distortions in self-perception can lead to intense dissatisfaction with one's body and dysfunctional behaviors aimed at improving one's appearance. Some patients with BDD are aware that their concerns are excessive, but others do not have this degree of insight; about 50 percent of patients diagnosed with BDD also meet the criteria for a delusional disorder.

The usual age of onset of BDD is late childhood or early adolescence; the average age of patients diagnosed with the disorder is 17. BDD has a high rate of comorbidity, which means that people diagnosed with the disorder are highly likely to have been diagnosed with another psychiatric disorder—most commonly major depression, social phobia, or obsessive-compulsive disorder (OCD). About 29% of patients with BDD eventually try to commit suicide.

BDD is thought to affect 1-2 percent of the general population in the United States and Canada, although some doctors think that it is underdiagnosed because it coexists so often with depression and other disorders. In addition, patients are often ashamed of grooming rituals and other behaviors associated with BDD, and may avoid telling their doctor about them. BDD is thought to affect men and women equally; however, there are no reliable data as of the early 2000s regarding racial or ethnic differences in the incidence of the disorder.

Causes and symptoms

Causes

The causes of BDD fall into two major categories, neurobiological and psychosocial.

NEUROBIOLOGICAL CAUSES. Research indicates that patients diagnosed with BDD have serotonin levels that are lower than normal. Serotonin is a neurotransmitter—a chemical produced by the brain that helps to transmit nerve impulses across the junctions between nerve cells. Low serotonin levels are associated with depression and other mood disorders.

PSYCHOSOCIAL CAUSES. Another important factor in the development of BDD is the influence of the mass media in developed countries, particularly the role of advertising in spreading images of physically "perfect" men and women. Impressionable children and adolescents absorb the message that anything short of physical perfection is unacceptable. They may then develop distorted perceptions of their own faces and bodies.

Key terms

Body image — A term that refers to a person s inner picture of his or her outward appearance. It has two components: perceptions of the appearance of one's body, and emotional responses to those perceptions.

Delusion — A false belief that is resistant to reason or contrary to actual fact. Common delusions include delusions of persecution, delusions about one s importance (sometimes called delusions of grandeur), or delusions of being controlled by others. In BDD, the delusion is related to the patient's perception of his or her body.

Displacement — A psychological process in which feelings originating from one source are expressed outwardly in terms of concern or preoccupation with an issue or problem that the patient considers more acceptable. In some BDD patients, obsession about the body includes displaced feelings, often related to a history of childhood abuse.

Muscle dysmorphia — A subtype of BDD, described as excessive preoccupation with muscularity and body building to the point of interference with social, educational, or occupational functioning.

Serotonin — A chemical produced by the brain that functions as a neurotransmitter. Low serotonin levels are associated with mood disorders, particularly depression. Medications known as selective serotonin reuptake inhibitors (SSRIs) are used to treat BDD and other disorders characterized by depressed mood.

Somatoform disorders — A group of psychiatric disorders in the DSM-IV-TR classification that are characterized by external physical symptoms or complaints. BDD is classified as a somatoform disorder.

A young person's family of origin also has a powerful influence on his or her vulnerability to BDD. Children whose parents are themselves obsessed with appearance, dieting, and/or body building, or who are highly critical of their children's looks, are at greater risk of developing BDD.

An additional factor in some young people is a history of childhood trauma or abuse. Buried feelings about the abuse or traumatic incident may emerge in the form of obsession about a part of the face or body. This "reassignment" of emotions from the unacknowledged true cause to another issue is called displacement. For example, an adolescent who frequently felt overwhelmed in childhood by physically abusive parents may develop a preoccupation at the high school level with muscular strength and power.

Symptoms

The central symptom of BDD is excessive concern with a specific facial feature or body part. Research indicates that the features most likely to be the focus of the patient's attention are (in order of frequency) complexion flaws (acne, blemishes, scars, wrinkles); hair (on the head or the body, too much or too little); and facial features (size, shape, or lack of symmetry). The patient's concerns may, however, involve other body parts, and may shift over time from one feature to another.

Other symptoms of body dysmorphic disorder include:

• Ritualistic behavior. Ritualistic behavior refers to actions that the patient performs to manage anxiety and that take up excessive amounts of his or her time. Patients are typically upset if someone or something interferes with or interrupts their ritual. Ritualistic behaviors in BDD may include exercise or makeup routines, assuming specific poses or postures in front of a mirror, etc.
• Camouflaging the "problem" feature or body part with makeup, hats, or clothing. Camouflaging appears to be the single most common symptom among patients with BDD; it is reported by 94%.
• Abnormal behavior around mirrors, car bumpers, large windows, or similar reflecting surfaces. A majority of patients diagnosed with BDD frequently check their appearance in mirrors or spend long periods of time doing so. A minority, however, react in the opposite fashion and avoid mirrors whenever possible.
• Frequent requests for reassurance from others about their appearance.
• Frequently comparing one's appearance to others.
• Avoiding activities outside the home, including school and social events.

Diagnosis

The diagnosis of BDD in children or adolescents is often made by physicians in family practice because they are more likely to have developed long-term relationships of trust with young people. At the adult level, it is often specialists in dermatology, cosmetic dentistry, or plastic surgery who may suspect that the patient suffers from BDD because of frequent requests for repeated or unnecessary procedures. Reported rates of BDD among dermatology and cosmetic surgery patients range between 6 and 15 percent. The diagnosis is made on the basis of the patient's history together with the physician's observations of the patient's overall mood and conversation patterns. People with BDD often come across to others as generally anxious and worried. In addition, the patient's dress or clothing styles may suggest a diagnosis of BDD. It is not unusual, however, for patients with BDD to take offense if their primary care doctor suggests referral to a psychiatrist.

Some physicians may use a self-report question-naire, such as the Multidimensional Body-Self Relations Questionnaire (MBSRQ) or the short form of the Situational Inventory of Body-Image Dysphoria (SIBID), to evaluate patients during an office visit.

There are no brain imaging studies or laboratory tests as of the early 2000s that can be used to diagnose BDD.

Treatment

The standard course of treatment for body dysmorphic disorder is a combination of medications and psychotherapy. Surgical, dental, or dermatologic treatments have been found to be ineffective.

The medications most frequently prescribed for patients with BDD are the selective serotonin reuptake inhibitors, most commonly fluoxetine (Prozac) or sertraline (Zoloft). Other SSRIs that have been used with this group of patients include fluvoxamine (Luvox) and paroxetine (Paxil). In fact, it is the relatively high rate of positive responses to SSRIs among BDD patients that led to the hypothesis that the disorder has a neurobiological component related to serotonin levels in the body. An associated finding is that patients with BDD require higher dosages of SSRI medications than patients who are being treated for depression with these drugs.

The most effective approach to psychotherapy with BDD patients is cognitive-behavioral restructuring. Since the disorder is related to delusions about one's appearance, cognitive-oriented therapy that challenges inaccurate self-perceptions is more effective than purely supportive approaches. Thought-stopping and relaxation techniques also work well with BDD patients when they are combined with cognitive restructuring.

Some doctors recommend couples therapy or family therapy in order to involve the patient s parents, spouse, or partner in his or her treatment. This approach may be particularly helpful if family members are critical of the patient s looks or are reinforcing his or her unrealistic body image.

Alternative treatment

Although no alternative or complementary form of treatment has been recommended specifically for BDD, such herbal remedies for depression as St. John's wort have been reported as helping some BDD patients. Aromatherapy appears to be a useful aid to relaxation techniques as well as a pleasurable physical experience for BDD patients. Yoga has helped some persons with BDD acquire more realistic perceptions of their bodies and to replace obsessions about external appearance with new respect for their body's inner structure and functioning.

Prognosis

As of early 2005, the prognosis of BDD is considered good for patients receiving appropriate treatment. On the other hand, researchers do not know enough about the lifetime course of body dysmorphic disorder to offer detailed statistics. DSM-IV-TR notes that the disorder "has a fairly continuous course, with few symptom-free intervals, although the intensity of symptoms may wax and wane over time."

Prevention

Given the pervasive influence of the mass media in contemporary Western societies, the best preventive strategy involves challenging their unrealistic images of attractive people. Parents, teachers, primary health care professionals, and other adults who work with young people can point out and discuss the pitfalls of trying to look "perfect." In addition, parents or other adults can educate themselves about BDD and its symptoms, and pay attention to any warning signs in their children's dress or behavior.

Resources

Books

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 4th edition, text revision. Washington, DC: American Psychiatric Association, 2000.

"Body Dysmorphic Disorder," Section 15, Chapter 186 in The Merck Manual of Diagnosis and Therapy, edited by Mark H. Beers, MD, and Robert Berkow, MD. Whitehouse Station, NJ: Merck Research Laboratories, 2004.

Johnston, Joni E., Psy D. Appearance Obsession: Learning to Love the Way You Look. Deerfield Beach, FL: Health Communications, Inc., 1994.

Rodin, Judith, PhD. Body Traps: Breaking the Binds That Keep You from Feeling Good About Your Body. New York: William Morrow, 1992.

Periodicals

Arthur, Gary K., MD, and Kim Monnell, DO. "Body Dysmorphic Disorder." eMedicine, 3 September 2004. http://www.emedicine.com/med/topic3124.htm.

Cafri, G., J. K. Thompson, L. Ricciardelli, et al. "Pursuit of the Muscular Ideal: Physical and Psychological Consequences and Putative Risk Factors." Clinical Psychology Review 25 (February 2005): 215-239.

Kirchner, Jeffrey T. "Treatment of Patients with Body Dysmorphic Disorder." American Family Physician 61 (March 2000): 1837-1843.

Slaughter, James R. "In Pursuit of Perfection: A Primary Care Physician's Guide to Body Dysmorphic Disorder." American Family Physician 60 (October 1999): 569-580.

Organizations

American Academy of Child and Adolescent Psychiatry. 3615 Wisconsin Avenue, NW, Washington, DC 20016-3007. (202) 966-7300. Fax: (202) 966-2891. www.aacap.org.

American Psychiatric Association (APA). 1000 Wilson Boulevard, Suite 1825, Arlington, VA 22209-3901. (800) 368-5777 or (703) 907-7322. Fax: (703) 907-1091. http://www.psych.org.

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disorder /dis·or·der/ (dis-or´der) a derangement or abnormality of function; a morbid physical or mental state.

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acute stress disorder  an anxiety disorder characterized by development of anxiety, dissociative, and other symptoms within one month following exposure to an extremely traumatic event. If persistent, it may become posttraumatic stress disorder.

adjustment disorder  maladaptive reaction to identifiable stress (e.g., divorce, illness), which is assumed to remit when the stress ceases or when the patient adapts.

affective disorders  mood d's.

amnestic disorders  mental disorders characterized by acquired impairment in the ability to learn and recall new information, sometimes accompanied by inability to recall previously learned information.

anxiety disorders  mental disorders in which anxiety and avoidance behavior predominate, i.e., panic disorder, agoraphobia, social phobia, specific phobia, obsessive-compulsive disorder, posttraumatic stress disorder, acute stress disorder, generalized anxiety disorder, and substance-induced anxiety disorder.

attention-deficit/hyperactivity disorder  a controversial childhood mental disorder with onset before age seven, and characterized by inattention (e.g., distractibility, forgetfulness, not appearing to listen), by hyperactivity and impulsivity (e.g., restlessness, excessive running or climbing, excessive talking, and other disruptive behavior), or by a combination of both types of behavior.

autistic disorder  autism; a severe pervasive developmental disorder with onset usually before three years of age and a biological basis; it is characterized by qualitative impairment in reciprocal social interaction, verbal and nonverbal communication, and capacity for symbolic play, by restricted and unusual repertoire of activities and interests, and often by cognitive impairment.

behavior disorder  conduct d.

binge-eating disorder  an eating disorder characterized by repeated episodes of binge eating, as in bulimia nervosa, but not followed by inappropriate compensatory behavior such as purging, fasting, or excessive exercise.

bipolar disorders  mood disorders with a history of manic, mixed, or hypomanic episodes, usually with present or previous history of one or more major depressive episodes; included are bipolar I d., characterized by one or more manic or mixed episodes, bipolar II d., characterized by one or more hypomanic episodes but no manic episodes, and cyclothymic disorder. The term is sometimes used in the singular to denote either bipolar I disorder, bipolar II disorder, or both.

body dysmorphic disorder  a somatoform disorder characterized by a normal-looking person's preoccupation with an imagined defect in appearance.

breathing-related sleep disorder  any of several disorders characterized by sleep disruption due to some sleep-related breathing problem, resulting in excessive sleepiness or insomnia.

brief psychotic disorder  an episode of psychotic symptoms with sudden onset, lasting less than one month.

catatonic disorder  catatonia due to the physiological effects of a general medical condition and neither better accounted for by another mental disorder nor occurring exclusively during delirium.

character disorders  personality d's.

childhood disintegrative disorder  pervasive developmental disorder characterized by marked regression in various developmental skills, including language, play, and social and motor skills, after two to ten years of initial normal development.

circadian rhythm sleep disorder  a lack of synchrony between the schedule of sleeping and waking required by the external environment and that of a person's own circadian rhythm.

collagen disorder  an inborn error of metabolism involving abnormal structure or metabolism of collagen, e.g., Marfan syndrome, cutis laxa. Cf. collagen disease.

communication disorders  mental disorders characterized by difficulties with speech or language, severe enough to interfere academically, occupationally, or socially.

conduct disorder  a type of disruptive behavior disorder of childhood and adolescence marked by persistent violation of the rights of others or of age-appropriate societal norms or rules.

conversion disorder  a somatoform disorder characterized by conversion symptoms (loss or alteration of voluntary motor or sensory functioning suggesting physical illness) with no physiological basis and not produced intentionally or feigned; a psychological basis is suggested by exacerbation of symptoms during psychological stress, relief from tension (primary gain), or gain of outside support or attention (secondary gains).

cyclothymic disorder  a mood disorder characterized by alternating cycles of hypomanic and depressive periods with symptoms like those of manic and major depressive episodes but of lesser severity.

delusional disorder  a mental disorder marked by well-organized, logically consistent delusions of grandeur, persecution, or jealousy, with no other psychotic feature. There are six types: persecutory, jealous, erotomanic, somatic, grandiose, and mixed.

depersonalization disorder  a dissociative disorder characterized by intense, prolonged, or otherwise troubling feelings of detachment from one's body or thoughts, not secondary to another mental disorder.

depressive disorders  mood disorders in which depression is unaccompanied by manic or hypomanic episodes.

developmental coordination disorder  problematic or delayed development of gross and fine motor coordination skills, not due to a neurological disorder or to general mental retardation, resulting in the appearance of clumsiness.

disruptive behavior disorders  a group of mental disorders of children and adolescents consisting of behavior that violates social norms and is disruptive.

dissociative disorders  mental disorders characterized by sudden, temporary alterations in identity, memory, or consciousness, segregating normally integrated parts of one's personality from one's dominant identity.

dissociative identity disorder  a dissociative disorder characterized by the existence in an individual of two or more distinct personalities, with at least two of the personalities controlling the patient's behavior in turns. The host personality usually is totally unaware of the alternate personalities; alternate personalities may or may not have awareness of the others.

dream anxiety disorder  nightmare d.

dysthymic disorder  a mood disorder characterized by depressed feeling, loss of interest or pleasure in one's usual activities, and other symptoms typical of depression but tending to be longer in duration and less severe than in major depressive disorder.

eating disorder  abnormal feeding habits associated with psychological factors, including anorexia nervosa, bulimia nervosa, pica, and rumination disorder.

expressive language disorder  a communication disorder occurring in children and characterized by problems with the expression of language, either oral or signed.

factitious disorder  a mental disorder characterized by repeated, intentional simulation of physical or psychological signs and symptoms of illness for no apparent purpose other than obtaining treatment.

factitious disorder by proxy  a form of factitious disorder in which one person (usually a mother) intentionally fabricates or induces physical (Munchausen syndrome by proxy) or psychological disorders in another person under their care (usually their child) and subjects that person to needless diagnostic procedures or treatment, without any external incentives for the behavior.

female orgasmic disorder  consistently delayed or absent orgasm in a female, even after a normal phase of sexual excitement and adequate stimulation.

female sexual arousal disorder  a sexual dysfunction involving failure by a female either to attain or maintain lubrication and swelling during sexual activity, after adequate stimulation.

functional disorder  a disorder of physiological function having no known organic basis.

gender identity disorder  a disturbance of gender identification in which the affected person has an overwhelming desire to change their anatomic sex or insists that they are of the opposite sex, with persistent discomfort about their assigned sex or about filling its usual gender role.

generalized anxiety disorder  (GAD) an anxiety disorder characterized by excessive, uncontrollable worry about two or more life circumstances for six months or more.

hypoactive sexual desire disorder  a sexual dysfunction consisting of persistently or recurrently low level or absence of sexual fantasies and desire for sexual activity.

impulse control disorders  a group of mental disorders characterized by repeated failure to resist an impulse to perform some act harmful to oneself or to others.

induced psychotic disorder  shared psychotic d.

intermittent explosive disorder  an impulse control disorder characterized by multiple discrete episodes of loss of control of aggressive impulses resulting in serious assault or destruction of property that are out of proportion to any precipitating stressors.

learning disorders  a group of disorders characterized by academic functioning that is substantially below the level expected on the basis of the patient's age, intelligence, and education.

lymphoproliferative disorders  a group of malignant neoplasms arising from cells related to the common multipotential lymphoreticular cell, including lymphocytic, histiocytic, and monocytic leukemias, multiple myeloma, plasmacytoma, and Hodgkin's disease.

lymphoreticular disorders  a group of disorders of the lymphoreticular system, characterized by the proliferation of lymphocytes or lymphoid tissues.

major depressive disorder  a mood disorder characterized by the occurrence of one or more major depressive episodes and the absence of any history of manic, mixed, or hypomanic episodes.

male erectile disorder  a sexual dysfunction involving failure by a male to attain or maintain an adequate erection until completion of sexual relations.

male orgasmic disorder  consistently delayed or absent orgasm in a male, even after a normal phase of sexual excitement and stimulation adequate for his age.

manic-depressive disorder  former name for a mood disorder now known as bipolar I d. or bipolar II d. and often called bipolar d. (q.v.).

mendelian disorder  a genetic disease showing a mendelian pattern of inheritance, caused by a single mutation in the structure of DNA, which causes a single basic defect with pathologic consequences.

mental disorder  any clinically significant behavioral or psychological syndrome characterized by the presence of distressing symptoms, impairment of functioning, or significantly increased risk of suffering death, pain, or other disability.

minor depressive disorder  a mood disorder closely resembling major depressive disorder and dysthymic disorder but intermediate in severity between the two.

mixed receptive-expressive language disorder  a communication disorder involving both the expression and the comprehension of language, either spoken or signed.

monogenic disorder  mendelian d.

mood disorders  mental disorders characterized by disturbances of mood manifested as one or more episodes of mania, hypomania, depression, or some combination, the two main subcategories being bipolar disorders and depressive disorders.

motor skills disorder  any disorder characterized by inadequate development of motor coordination severe enough to restrict locomotion or the ability to perform tasks, schoolwork, or other activities.

multifactorial disorder  one caused by the interaction of genetic and sometimes also nongenetic, environmental factors, e.g., diabetes mellitus.

multiple personality disorder  dissociative identity d.

myeloproliferative disorders  a group of usually neoplastic diseases possibly related histogenetically, including granulocytic leukemias, myelomonocytic leukemias, polycythemia vera, and myelofibroerythroleukemia.

neurotic disorder  neurosis.

nightmare disorder  repeated episodes of nightmares that awaken the sleeper, with full orientation and alertness and vivid recall of the dreams.

obsessive-compulsive disorder  (OCD) an anxiety disorder characterized by recurrent obsessions or compulsions, which are severe enough to interfere significantly with personal or social functioning. Cf. obsessive-compulsive personality disorder, under personality .

obsessive-compulsive personality disorder  see under personality.

oppositional defiant disorder  a type of disruptive behavior disorder characterized by a recurrent pattern of defiant, hostile, disobedient, and negativistic behavior directed toward those in authority.

organic mental disorder  a term formerly used to denote any mental disorder with a specifically known or presumed organic etiology. It was sometimes used synonymously with organic mental syndrome.

orgasmic disorders  sexual dysfunctions characterized by inhibited or premature orgasm; see female orgasmic d., male orgasmic d., and premature ejaculation.

pain disorder  a somatoform disorder characterized by a chief complaint of severe chronic pain which is neither feigned nor intentionally produced, but in which psychological factors appear to play a major role in onset, severity, exacerbation, or maintenance.

panic disorder  an anxiety disorder characterized by attacks of panic (anxiety), fear, or terror, by feelings of unreality, or by fears of dying, or losing control, together with somatic signs such as dyspnea, choking, palpitations, dizziness, vertigo, flushing or pallor, and sweating. It may occur with or, rarely, without agoraphobia.

paranoid disorder  older term for delusional d.

personality disorders  a category of mental disorders characterized by enduring, inflexible, and maladaptive personality traits that deviate markedly from cultural expectations and either generate subjective distress or significantly impair functioning. For specific disorders, see under personality.

pervasive developmental disorders  disorders in which there is impaired development in multiple areas, including reciprocal social interactions, verbal and nonverbal communications, and imaginative activity, as in autistic disorder.

phagocytic dysfunction disorders  a group of immunodeficiency conditions characterized by disordered phagocytic activity, occurring as both extrinsic and intrinsic types. Bacterial or fungal infections may range from mild skin infection to fatal systemic infection.

phobic disorders  see phobia.

phonological disorder  a communication disorder characterized by failure to use age- and dialect-appropriate sounds in speaking, with errors occurring in the selection, production, or articulation of sounds.

plasma cell disorders  see under dyscrasia.

postconcussional disorder  see under syndrome.

posttraumatic stress disorder  (PTSD) an anxiety disorder caused by an intensely traumatic event, characterized by mentally reexperiencing the trauma, avoidance of trauma-associated stimuli, numbing of emotional responsiveness, and hyperalertness and difficulty in sleeping, remembering, or concentrating.

premenstrual dysphoric disorder  premenstrual syndrome viewed as a psychiatric disorder.

psychoactive substance use disorders  substance use d's.

psychosomatic disorder  one in which the physical symptoms are caused or exacerbated by psychological factors, as in migraine headaches, lower back pain, or irritable bowel syndrome.

psychotic disorder  psychosis.

reactive attachment disorder  a mental disorder of infancy or early childhood characterized by notably unusual and developmentally inappropriate social relatedness, usually associated with grossly pathological care.

rumination disorder  excessive rumination of food by infants, after a period of normal eating habits, potentially leading to death by malnutrition.

schizoaffective disorder  a mental disorder in which symptoms of a mood disorder occur along with prominent psychotic symptoms characteristic of schizophrenia.

schizophreniform disorder  a mental disorder with the signs and symptoms of schizophrenia but of less than six months' duration.

seasonal affective disorder  (SAD) depression with fatigue, lethargy, oversleeping, overeating, and carbohydrate craving recurring cyclically during specific seasons, most commonly the winter months.

separation anxiety disorder  prolonged, developmentally inappropriate, excessive anxiety and distress in a child concerning removal from parents, home, or familiar surroundings.

sexual disorders 

1. any disorders involving sexual functioning, desire, or performance.

2. specifically, any such disorder that is caused at least in part by psychological factors; divided into sexual dysfunctions and paraphilias.

sexual arousal disorders  sexual dysfunctions characterized by alterations in sexual arousal; see female sexual arousal d. and male erectile d.

sexual aversion disorder  feelings of repugnance for and active avoidance of genital sexual contact with a partner, causing substantial distress or interpersonal difficulty.

sexual desire disorders  sexual dysfunctions characterized by alteration in sexual desire; see hypoactive sexual desire d. and sexual aversion d.

sexual pain disorders  sexual dysfunctions characterized by pain associated with intercourse; it includes dyspareunia and vaginismus not due to a general medical condition.

shared psychotic disorder  a delusional system that develops in one or more persons as a result of a close relationship with someone who already has a psychotic disorder with prominent delusions.

sleep disorders  chronic disorders involving sleep, either primary (dyssomnias, parasomnias) or secondary to factors including a general medical condition, mental disorder, or substance use.

sleep terror disorder  a sleep disorder of repeated episodes of pavor nocturnus.

sleepwalking disorder  a sleep disorder of the parasomnia group, consisting of repeated episodes of somnambulism.

social anxiety disorder  social phobia.

somatization disorder  a somatoform disorder characterized by multiple somatic complaints, including a combination of pain, gastrointestinal, sexual, and neurological symptoms, and not fully explainable by any known general medical condition or the direct effect of a substance, but not intentionally feigned or produced.

somatoform disorders  mental disorders characterized by symptoms suggesting physical disorders of psychogenic origin but not under voluntary control, e.g., body dysmorphic disorder, conversion disorder, hypochondriasis, pain disorder, somatization disorder, and undifferentiated somatoform disorder.

somatoform pain disorder  pain d.

speech disorder  defective ability to speak; it may be either psychogenic (see communication d. ) or neurogenic. See also aphasia, aphonia, dysphasia, and dysphonia.

stereotypic movement disorder  a mental disorder characterized by repetitive nonfunctional motor behavior that often appears to be driven and can result in serious self-inflicted injuries.

substance-induced disorders  a subgroup of the substance-related disorders comprising a variety of behavioral or psychological anomalies resulting from ingestion of or exposure to a drug of abuse, medication, or toxin. Cf. substance use d's.

substance-related disorders  any of the mental disorders associated with excessive use of or exposure to psychoactive substances, including drugs of abuse, medications, and toxins. The group is divided into substance use d's and substance-induced d's .

substance use disorders  a subgroup of the substance-related disorders, in which psychoactive substance use or abuse repeatedly results in significantly adverse consequences. The group comprises substance abuse and substance dependence.

undifferentiated somatoform disorder  one or more physical complaints, not intentionally produced or feigned and persisting for at least six months, that cannot be fully explained by a general medical condition or the direct effects of a substance.

unipolar disorders  depressive d's.

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body,

n any mass or collection of material.

body burden,

n the activity of a radiopharmaceutical retained by the body at a specified time after administration.

body dysmorphic disorder (BMD),

n See disorder, body dysmorphic.

body fluid,

n a liquid portion of the body such as plasma, lymph, tears, saliva, and urine.

body, foreign,

n an object or material that is not normal for the area in which it is located.

body height,

n the overall length of the body from the crown to the bottom of the feet, usually taken in the standing position. Body length refers to the overall length taken in the supine position.

body image,

n a person's subjective concept of personal physical appearance. The loss of a limb, breast, or tooth may cause psychologic trauma because of unresolved conflict in the change of body image. A distorted body image may be a causal factor in anorexia nervosa and bulimia. See also disorder, body dysmorphic (BDD).

body, ketone,

n any of the compounds acetoacetic acid, betahydroxybutyric acid, and acetone that are formed in the liver and released in the blood. Elevated levels occur during excessive fat use such as in diabetes or starvation. See also ketoacidosis.

body mass index (BMI) calculation,

n a method for assessing obesity and determining optimal weight, which involves dividing body weight in kilograms by height in square meters.

body mechanics,

n the field of physiology that investigates actions and functions of the muscular system relating to body posture maintenance.

body, Schaumann's

n.pr a round to oval cytoplasmic inclusion composed of concentric deposits of an amorphous material. Present in the giant cells of sarcoidosis, in beryllium lesions, and sometimes in other giant cells.

body shields,

n.pl protective coverings patients are sometimes legally required to wear during radiographic examinations; usually a leaded apron containing lead 0.25 mm thick. The protective surface covers the torso and gonads.

body temperature,

n the level of heat produced and sustained by body processes. Variations and changes in body temperature are major indicators of disease and other abnormalities.

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disorder(s),

n derangement of function.

disorder, bipolar,

n a major mood disorder characterized by alternating periods of mania or elation and depression. Formerly called
manic-depressive disorder.

disorder, body dysmorphic (BBD)

(dismôr´fik),
n a mental disorder in which an otherwise physiologically healthy person obsesses about an imaginary physical defect.

disorder(s), coagulation,

n any one of the hemorrhagic diseases caused by a deficiency of plasma thromboplastin formation (deficiency of antihemophilic factor, plasma thromboplastic antecedent, Hageman factor, Stuart factor), deficiency of thrombin formation (deficiency of prothrombin, factor V, factor VII, Stuart factor), and deficiency of fibrin formation (afibrinogenemia, fibrinogenopenia).

disorder, conversion,

n uncontrolled change or loss of control of physical function due to a mental, not physical, need or conflict.

disorder, cumulative trauma,

n a disorder of the musculature and skeleton after repetitive strain injuries to muscles, tendons, joints, bones, and nerves.

disorder, panic,

n a disorder marked by repeated panic attacks and fear, which interrupts normal functioning.

disorder(s), periodic,

n.pl a variety of disorders of unknown cause that have in common periodic recurrence of manifestations. Such disorders are usually benign, resist treatment, often begin in infancy, and occasionally have a hereditary pattern. Included are periodic sialorrhea, neutropenia, arthralgia, fever, purpura (anaphylactoid purpura), edema (angioneurotic edema), abdominalgia, and periodic parotitis (recurrent parotitis).

disorder, pervasive developmental,

n a disorder of behavioral and sensory impairment that generally appears during infancy or early childhood and continues to affect the individual's ability to communicate and interact with others throughout his or her life. See also autism.

disorder(s), platelet,

n.pl a hemorrhagic disease caused by an abnormality of the blood platelets (e.g., thrombocytopenia, thrombasthenia).

disorder, posttraumatic stress,

n a condition characterized by acute or recurring anxiety which has been brought about as the result of experiencing a traumatic event, such as a natural disaster, automobile accident, terrorist attack, military combat, rape, physical torture, or childhood sexual abuse. Symptoms may include flashbacks, nightmares, mild to severe depression, and panic attacks.

disorder(s), psychophysiologic, autonomic, and visceral,

n the standard psychiatric nomenclature for what are commonly known as psychomotor disorders. The disorders are disturbances of visceral function, secondary to chronic attitude and long-continued reaction to stress. These disorders may occur in any organ innervated by the autonomic nervous system, since overactivity or underactivity of that system as a result of stress appears to trigger the disorder. See also disease, psychosomatic.

disorder(s), visual,

n.pl disorders that may result from injury or disease to the eyeball and its adnexa, the retina, or the cornea (e.g., contusions of the orbit and eyelids, opacities of the lens, corneal scars, vascular changes to the retina). These peripheral disorders are effective in causing partial or total loss of vision in one or both eyes. They are simple, concrete, and fundamental. One sees or one does not see, and gray visions are generally quantitative differences that affect the perception of light and shadow and color and form. They may also result from injury or disease to the optic tract fibers, optic chiasma, cerebral pathways, and visual cortex in the occipital region of the cerebrum. These are qualitative deviations from normal, and the symptoms include visual field defects such as tubular vision found in hysteria, complete blindness in one or both eyes as a result of optic nerve injury, and hemianopsia, in which vision may be lost in one half of the visual field of one or both eyes. Others include night and day blindness, color blindness, and the serious visual agnosia that results from trauma, tumor, or vascular disorders in the visual cortex of the cerebrum.

disorder(s), cognitive impairment,

n.pl the mental disorders distinguished by a limitation of mental functions (e.g., memory, comprehension, and judgment).

disorder(s), dissociative,

n.pl the mental disorders distinguished by the psychologically induced, distinct partition of separate mental functions from normal behavior or consciousness (e.g., dissociative amnesia and depersonalization disorder).

disorder(s), factitious

(faktish´s),
n.pl the mental disorders distinguished by the self-induced creation of artificial physical or mental symptoms to assume the role of a sick individual.

disorder(s), feeding,

n.pl conditions distinguished by an inability to eat sufficiently, a continual need to consume abnormal items of food or substances lacking nutrients, or frequent vomiting episodes without any indications of a gastrointestinal infection.

disorder(s), impulse control,

n.pl the mental disorders distinguished by an uncontrollable tendency to commit an unplanned behavior (e.g., pathologic gambling, kleptomania, and pyromania).

disorder(s), sexual,

n.pl disorders of sexual performance or desire, which may include sexual dysfunction, feelings of discomfort about one's gender, and perverse sexual urges or activities. Also called paraphilia.

disorder(s), sleep,

n.pl conditions characterized by a disruption in normal sleeping patterns, which may be the result of serious medical conditions, including breathing difficulties or thyroid disorders, or external factors such as stress or substance abuse. Manifestations include insomnia, sleep apnea, and narcolepsy.

disorder(s), somatoform

n.pl disorders characterized by symptoms that seem to suggest the presence of an illness, but for which there is no physical proof. Often may be attributed to unresolved emotional conflicts. Types include conversion disorder, hypochondriasis, body dysmorphic disorder, and pain disorder.

disorder(s), substance-related,

n.pl conditions or illnesses that may be directly attributed to overuse of drugs, alcohol, nicotine, or caffeine and may also include nutritional deficiencies, cardiovascular disease, oral lesions, liver disease, and sleep disorders.

disorder(s), tic,

n.pl conditions characterized by involuntary and sometimes violent muscle spasms, including Tourette's syndrome and chronic motor or vocal tic disorders.

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body dysmorphic disorder

Beauty hypochondria, dysmorphophobia Psychiatry A psychiatric condition in which the Pt has a profound negative distortion of his or her body image, which may hinge on a perceived craniofacial flaw; Pts with BDD have obsessive body-image concerns, leading to compulsive checking of appearance in the mirror, intense self-consciousness, social avoidance and isolation, and depression. See Body image. Cf Anorexia nervosa.