Descriptive Psychopathology: The Signs and Symptoms of ...

304 Section 3: Examination domainsstructures, stomach, hair, teeth, buttocks and hips, and thighs and legs. Mostsufferers will also exhibit repetitive self-injurious behavior including skin pickingand excessive grooming. About 25% make a suicide attempt. 79The classification of body dysmorphic disorder among the somatoformdisorders is not supported by evidence. A better term is body dysmorphic ideas.The preoccupation with imagined or slight defects in appearance is content, notform. In half of such patients, the preoccupation is delusional and mood orpsychotic disorder the likely illness. Patients with a body dysmorphic delusionare also more likely to have abused illicit drugs than those whose preoccupationis due to other causes. 80 In rare instances, an over-valued idea takes the form of adesire to have a healthy limb amputated (apotemnophilia) and in pretending to bean amputee. Associated sexual arousal is not necessarily present in such patients. 81Many patients with body dysmorphic ideas have many other associatedobsessive–compulsive features, 82 and the preoccupation with body image is seenas obsessive rumination. 83 Sufferers also exhibit many repetitive, behaviors such asmirror checking, excessive measuring and touching of body parts, and excessivetanning. 84About one-third of persons with body dysmorphic preoccupations also haveco-occurring social phobia and many anxious–fearful personality traits. 85 Somehave associated eating disorder. 86 In Japan, body dysmorphic ideas are seen as aphobic disorder, the content being anxiety over the perceived deformity of one’sbody part. 87The thalamus and parietal lobes are commonly involved in BDD associatedwith structural brain disease. Patients experience body parts as being the wrongsize, shape, color, weight, or composition (e.g. made of wood rather than fleshand bone). 88 Phantom limb and phantom breast is commonly associated withsurgical amputation of these body parts and result from both continued peripheralnerve afferentation and a preserved sensory cortex schema for the body part.HypochondriasisHypochondriasis is a symptom not a syndrome. 89 Its present-day definition refersto a persistent preoccupation with exaggerated concerns about one’s health. 90The patient is preoccupied with bodily sensations, is phobic for disease, andis convinced of ill-health. Minor body sensations and ailments are consideredominous and the patient repeatedly seeks medical attention.Hypochondriasis occurs in persons with anxious–fearful and negative affecttemperament traits, obsessive–compulsive disorder, and depressive illness. Whensevere, hypochondriasis can represent the content of the ruminations and delusionstypical of psychotic depression. 91 When an aspect of OCD, hypochondriasisoften involves a single focus: the potential dire consequences of a minor body