Appearance Dissatisfaction and Body Dysmorphic Disorder in the Dermatology Patient

Summary: Background: Dermatologists routinely see patients with inflammatory skin conditions and aesthetic concerns that involve substantial psychological comorbidity, including disorders of body image. However, most dermatologists do not receive formal training in this area and many are unsure how to best help treat certain patients holistically. A recent survey of 500 US dermatologists inquired about the current state of psychological wellness evaluation of dermatology patients, as well as the extent of mental health training in dermatology. While 75% of the dermatologists reported routinely asking their patients about their psychological health (including mood, quality of life, and face/body image), 60% of respondents reported having no formal training about mental health in the dermatology patient. 92% of surveyed respondents agreed with the statement that dermatology education should provide some training on the psychological health of the dermatology patient. Body dysmorphic disorder (BDD) is a common and distressing psychiatric condition that disproportionately impacts dermatology patients, including patients living with chronic inflammatory skin conditions such as acne and atopic dermatitis. Methods: We endeavored to provide a targeted review and practical guide to BDD for the general dermatologist, with special focus on the impact of social media and the utility of screening tools. We searched PubMed for search terms including "body dysmorphic disorder," "dermatology," "psychiatry," and "screening tools." Findings were synthesized through a narrative approach, categorizing key themes such as BDD impact, social media impact, and the effectiveness of screening tools in dermatological contexts. Results: BDD is characterized by preoccupation with nonexistent or minimally noticeable flaws in physical appearance that causes clinically significant distress or impairment in functioning. Adolescent populations may be particularly vulnerable to clinically significant body image dissatisfaction, including BDD, due to the high prevalence of acne and the pervasive role of social media platforms. The rise of social media may exacerbate body image issues through repetitive exposure to idealized and often unrealistic beauty standards. Validated screening questionnaires can assist dermatologists in recognizing BDD and providing essential diagnostic information to their patients. Conclusions: BDD is a distressing psychiatric disorder that is prevalent among dermatology patients and can be associated with impaired social functioning and psychological comorbidities. Dermatologists can play a significant role in detecting and addressing BDD. Validated screening questionnaires can be valuable tools for dermatologists in quickly identifying BDD. The recognition and management of BDD in dermatology practice requires a holistic approach that integrates education, awareness, screening, and collaboration with mental health providers. By addressing BDD effectively, dermatologists can make an important impact on the lives of their patients.