Table 1

Common differential diagnoses in BDD

Similarity with BDDKey differentiating features
OCDTime consuming, repetitive behaviours which can include grooming ritualsUnlike in BDD, grooming rituals in OCD are not driven by an attempt to correct perceived appearance flaws. They may instead be driven by contamination fears or ‘just right’ urges.
Excoriation disorderRepetitive skin pickingSkin picking in excoriation disorder is not driven by an attempt to improve appearance, whereas skin picking in BDD is intended to improve the appearance of perceived defects in the skin.
TrichotillomaniaRepetitive hair pullingHair pulling in trichotillomania is not driven by an attempt to improve appearance, whereas hair pulling in BDD is intended to improve the appearance of perceived defects in facial or body hair.
Eating disordersDistressing and impairing preoccupation with appearanceAppearance preoccupation in eating disorders is focused on body weight and shape, leading to dysfunctional eating behaviours in an attempt to lose weight.
Social anxiety disorderAvoidance of and distress in social situationsSocial avoidance in social anxiety disorder is driven by a fear of saying or doing something to embarrass oneself. In BDD, social anxiety is exclusively linked to a fear of negative judgements about perceived appearance defects.
DepressionCan involve feelings of ugliness as part of pervasive low self-esteemConcerns about appearance are not the primary preoccupation in depression and not typically associated with the repetitive behaviours that are characteristic of BDD (eg, mirror checking, grooming).
  • BDD, body dysmorphic disorder; OCD, obsessive–compulsive disorder.