Abnormal Psychology

Dissociative and Somatoform Disorders 369

Social Factors: Stress Response

As with other somatoform disorders, stressful events can precipitate hypochondriasis

(Fallon & Feinstein, 2001). In addition, people with hypochondriasis are more

likely than people without the disorder to report having experienced traumatic sex-

ual contact, physical violence, or major familial upheaval (such as their parents’

divorce) (Barsky, Wool, et al., 1994). In addition, through attention and concern,

relatives and friends may unintentionally reinforce patients’ symptoms.

Body Dysmorphic Disorder

Body dysmorphic disorder (sometimes called dysmorphophobia) is diag-

nosed when someone is excessively preoccupied with a perceived defect

or defects in appearance. The preoccupation is excessive because a defect

is either imagined or slight. In this section we examine body dysmorphic

disorder in detail—the DSM-IV-TR criteria and the factors that contrib-

ute to the disorder.

What Is Body Dysmorphic Disorder?

It’s a common experience to believe that a pimple on your forehead

appears like a red beacon for others to see; many people will try to

cover up or hide a pimple. It’s also common for individuals with a

receding hairline to change their hairstyle to make the hair loss less

noticeable. What isn’t common—and, in fact, signals a psychological

disorder—is when an imperfection in appearance, even an imagined

one, causes signifi cant distress or takes up so much time and energy

that daily functioning is impaired. These are the signs of body dysmorphic disor-

der. Table 8.16 lists the specifi c DSM-IV-TR diagnostic criteria for this disorder.

Common preoccupations for people with body dysmorphic disorder are thin-

ning or excessive hair, acne, wrinkles, scars, complexion (too pale, too dark, too

red, and so on), facial asymmetry, or the shape or size of some part of the face or

body. The “defect” (or “defects”) may change over the course of the illness (Phillips,

2001). People with body dysmorphic disorder may think that others are staring at

them or talking about a “defect.” Up to half of those with body dysmorphic disor-

der are delusional—that is, they believe their perception of a “defect” is accurate

and not exaggerated (Phillips et al., 1994).

Table 8.16 • DSM-IV-TR Diagnostic Criteria

for Body Dysmorphic Disorder

A. Preoccupation with an imagined defect in appearance. If

a slight physical anomaly is present, the person’s concern is

markedly excessive.

B. The preoccupation causes clinically signifi cant distress

or impairment in social, occupational, or other important areas

of functioning.

C. The preoccupation is not better accounted for by another

mental disorder (e.g., dissatisfaction with body shape and size

in Anorexia Nervosa [discussed in Chapter 10]).

Source: Reprinted with permission from the Diagnostic and Statistical

Manual of Mental Disorders, Text Revision, Fourth Edition, (Copyright 2000)

American Psychiatric Association.

David Young-Wolff/PhotoEdit Inc

People with hypochondriasis fear that they have

a serious illness and do not believe their doctors

when told that they are healthy. Such patients

may then “doctor-shop”—consulting many

doctors in search of one who will confi rm the

presence of an illness.

Body dysmorphic disorder

A somatoform disorder characterized by

excessive preoccupation with a perceived

defect or defects in appearance.