Body dysmorphic disorder by proxy: a case report and literature review

Body dysmorphic disorder (BDD) is a distressing and/or impairing preoccupation with a perceived defect in physical appearance which is minimal or unnoticeable to others. It affects approximately 1.6% to 2.4% of the general population. According to DSM-5, BDD is characterized by significant distress and repetitive behaviour. It is sometimes associated with anxiety, obsessive-compulsive disorder (OCD), depression or impaired functioning. BDD by proxy (BDDBP), an overlooked variant, involves obsessive concern with another individual’s appearance rather than one’s own. It leads to assurance seeking and attempts to correct the flaws. A 23-year-old man presented with anxiety and depressive symptoms due to his concern regarding his wife's protruding chin. The patient's preoccupation began early in the relationship and intensified over the period. The wife’s refusal to pursue corrective measures caused marked distress, anxiety and thoughts of divorce. He underwent a mental status examination and psychiatric evaluation for further analysis. Body dysmorphic disorder (BDD) and body dysmorphic disorder by proxy (BDDBP) are serious but often overlooked mental health issues that can lead to significant emotional distress and impairment in daily life. These disorders can strain relationships, cause obsessive behaviors and severely affect quality of life. Effective treatment usually includes cognitive-behavioral therapy (CBT) and SSRIs, along with education and lifestyle changes.