The importance of detecting body dysmorphic disorder (BDD) has been emphasized in the literature. Nonetheless, BDD is underrecognized and underdiagnosed despite its severity, the availability of effective treatments, and its prevalence. Indeed, BDD is relatively common; in fact, it appears to be more common than schizophrenia, anorexia nervosa, and many other psychiatric disorders (see Di-die et al., page 310).Five studies have found that mental health clinicians fail to diagnose BDD, even when BDD is a major problem or the primary diagnosis. These studies systematically screened patients for BDD. In all five studies, no patient whom the investigators identified as having BDD had the diagnosis in their clinical record. In one study, the most common reasons patients did not disclose BDD symptoms to their clinician were: the patient was too embarrassed, feared being negatively judged, felt their clinician would not understand their appearance concerns, or did not know treatment for their body image concerns was available. Instead, patients may mention only their depressed mood, anxiety, or discomfort in social situations. Thus, clinicians need to systematically screen patients for BDD and recognize clues to its presence.
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