According to the DSM-IV, the following must be present to meet the criteria for the diagnosis of BDD:
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 significant 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).
Body Dysmorphic Disorder should also be considered a possible diagnosis when individuals express signs of referential thinking, are housebound, or are undergoing a series of unnecessary cosmetic procedures. Additionally, BDD may be considered when individuals present with social anxiety, depression, or suicidal thoughts and behaviors. As is appropriate for psychological disorders, a diagnosis of BDD is not made unless a patient’s problems are causing significant distress (see criteria B). Unfortunately, shame and embarrassment often prevent sufferers from revealing the true extent of their suffering, making BDD more difficult for clinicians to diagnose. Sometimes, BDD goes completely undiagnosed or is otherwise misdiagnosed for another psychological condition, such as obsessive-compulsive disorder (OCD), social phobia, agoraphobia, panic disorder, trichotillomania, or psychosis.