Case of Body dysmorphic disorder 

(BDD)

Introduction

This defined as occasionally still called dysmorphophobia, is a mental disorder characterized by

the obsessive idea that some aspect of one's own body part or appearance is severely flawed and
therefore warrants exceptional measures to hide or fix it.

In 1886, Enrico Morselli reported a disorder that he termed dysmorphophobia, which described

the disorder as a feeling of being ugly even though there does not appear to be anything wrong
with the person's appearance.

B.HISTORY COLLECTION

IDENTIFICATION INFORMATION

- Patient Name : P.U

- Gender: male
- Address : MVKProvince/Gasabo District
- occupation : none
- Education: Secondary school
- Marital status : single
- Religion:Adventiste
- Medical diagnosis: Body dysmorphic disorder (BDD)
- Date of admission :

CHIEF COMPLAINTS

My bclient complaints are:Hallucinations,Delusions,Thought disorders (unusual or dysfunctional

ways of thinking),Movement disorders (agitated body movements)

PRESENT HISTORY

The patient is having agitation,thought disorder and delusions.

PAST HISTORY

Past medical history

No history of chronic illness like diabetes, cancer, hypertension and others
Past surgical history
No surgical history.

FAMILY HISTORY
 The patient is coming from the family of 5 persons: he has Father, 2 sisters and 2 brothers. They
are no chronic diseases in the family
Family tree

This client is the lastborn of the family and is having only mother as parent.

LIFESTYLEHISTORY

He has history of drinking alcohol, using tobacco or drug abuse.

SOCIO ECONOMICHISTORY

This single client coming from the family of 7 persons. They have their own house with one toilet
outside. They have also medical insurance.

ALLERGIC HISTORY

Noknown allergic reaction either to medication, dust,food,or animal hair.

PHYSICAL EXAMINATION

Vital signs

SNO PARAMETER BOOK PICTURE (normal PATIENT REMARKS

ranges ) PICTURE
TEMPERATURE (‘c/) 36.5- 37.5oc 37oc normal
PULSE RATE (/MIN) 60-100beats/min 86beats/min normal
RESPIRATION 12-20movement/min 20movement/min normal
RATE /MIN
BLOOD PRESSURE Systolic 140-90mmhg 120/90mmhg Normal
mmHg Diastolic 90-60mmhg

 General appearance of the patient: weak

 Level of consciousness: is oriented to time place and people Gsc scale15/15
 Head : size and shape are normal
Hair
- Color: normal
- Texture: normal
- Distribution: well distributed
- Ring worms: no ring worms
- Lice : no lice
- Dandruff: no dandruff
- Scalp: no wound ,lesion or scars
 Face
 Size: normal
 Shape :long
 Edema : absent
 Skin color : dark
 No Lesions
 Scars: absent
Eye
 Is Symmetry
 No Eyelid presence edema /sunken
 Eyelashes; presence distribution is normal
Nose
 Is Symmetry
 No discharge
 No polyps
 sense of smell is present
Mouth
Lips
 size normal
 shape round
Mucus membranes
 no Lesions /bleeding/
 Gingival

Teeth
 color –yellow –poor hygiene

 Number of teeth 32
 Distribution is disorganised
Tongue
 Size normal
 Shape normal
 Color pink
 Range of motion normal range in all direction
 No Lesions
No Tonsils –swelling
Sense of testing present
EAR
 Size normal
 shape normal
 no discharge
 no wounds
 sense of hearing present
 Neck
  no Scars / lesion.
 Range of motion –normal
 No Palpate for swollen lymph node /tonsils

 Chest
 Is Symmetry
 Lung sound is clear no wheezing or crackles
 Heart sounds s1 and s2 is audible
 Size normal
 Shape normal

 Abdomen
 Size normal
 Shape long
 Skin –color black
 Back
 Shape normal
 Is Symmetry
 No Deformities
- Scoliosis
- Lordosis
- Kyphosis
 Scars present Extremities
Upper
 No fracture
 No Wound
 Shape normal
 Size normal
 Fingers
- No clubbing
- capillary refilling is less than 2sec
- no extra fingers
Lower
 no fracture
 Wound present on thighs and buttocks.
 Shape normal
 Size is small
 feet – sole present
- color black
- cracks is present
- no club foot
- no Valgus
 toes
- no clubbing
- capillary refilling normal
  Perineum
 No Discharge –color /smell
 Presence of hair /distribution /color /texture is normal
 Penis
- Size normal
- No Hypospadiasis
- No Epispadiasis
Anus
- Wound present
- No Hemorrhoids
- No Prolapsed

Signs and symptoms

Symptoms can vary according to which body part (or parts) is targeted, but general symptoms of
BDD include:

 thinking about the perceived defect for hours every day

 worrying about their failure to match the ‘physical perfection’ of models and celebrities
 distress about their preoccupation
 constantly asking trusted loved ones for reassurance about their looks, but not believing
the answer
 constantly looking at their reflection or taking pains to avoid catching their reflection (for
example, throwing away or covering up mirrors)
 constant dieting and overexercising

THE CAUSES

The cause of BDD is unknown. Theories include:

 A person with BDD has a genetic tendency to develop this type of mental illness. The
trigger may be the stress of adolescence.
  Particular drugs, such as ecstasy, may trigger onset in susceptible people.
 BDD could be caused by chemical imbalances in the brain.
 A person with low self-esteem who has impossible standards of perfection judges some
part of their body as ugly. Over time, this behaviour becomes more and more compulsive.
 Western society’s narrow standards of beauty may trigger BDD in vulnerable people.

Diagnosis

Diagnosis of BDD is difficult for many reasons, including:

 People with BDD are more likely to seek help from dermatologists and cosmetic
surgeons than psychologists and psychiatrists.
 People with BDD are ashamed and don’t want to seek help from mental health
professionals.
 This type of mental illness doesn’t get much publicity, so some health professionals may
not even be aware that BDD exists.
 BDD is similar to many other conditions and misdiagnosis is possible.

Treatment

Anti-depressant medication, such as selective serotonin reuptake inhibitors (SSRIs),

and cognitive-behavioral therapy (CBT) are considered effective.SSRIs can help relieve
obsessive-compulsive and delusional traits, while cognitive-behavioral therapy can help patients
recognize faulty thought patterns.Before treatment, it can help to provide psychoeducation, as
with self-help books and support websites.[

Self-improvement

For many people with BDD cosmetic surgery does not work to alleviate the symptoms of BDD
as their opinion of their appearance is not grounded in reality. It is recommended that cosmetic
surgeons and psychiatrists work together in order to screen surgery patients to see if they suffer
from BDD, as the results of the surgery could be harmful for them

Assessment Nursing diagnosis Objectives Planning Rationale Evalua

 I’m surrounded People with BDD are After 3 hours 1 . Establish rapp ➢ To gain client’s After 3
with too many more likely to seek help of nursing ort cooperation interve
people either I from dermatologists and intervention the 2 . Discuss acknow
know them or not I cosmetic surgeons than client will client’s ➢ Promote recogn
still feel scared psychologists and acknowledge and perception/fearfu atmosphere of fears a
and restless” as psychiatrists. discuss fears, l feelings. Listen caring and permits 1.State
verbalized by the recognizing healthy to client’s concern explanation/correcti 2.Sum
patient People with BDD are versus unhealthy on of misperception Goal p
ashamed and don’t want fears as manifested 3. ➢ Facilitates time
to seek help from by State at least 3/5 Provideinformati understanding and
mental health example of fears onin verbal and retention
professionals. Understanding written form. of information
of what have Speak in simplest ➢ Enhances sense
This type of mental discussed by sentences. of trust and nurse-
illness doesn’t get much summarization 4 . Provideoppor client relationship
publicity, so some tunity for
health professionals questions and
may not even be aware answer honestly
that BDD exists. BDD
is similar to many other
conditions and
misdiagnosis is
possible.

Assessment Nursing Goals Intervention Rationale Evaluation

Diagnosis

Subjective data Social Short term Ask what client These Shows respect and After nursing
She says” it is better anxiety After five would like to be acknowledge the person. intervention,
to die, I do not know disorder and days of called. The manner in which one patient
why am still alive let BDD are interventio Assess degree to is treated by others may improving and
me die”
Objective data
highly n ,she will which patient feels influence her self-esteem. show a
She has low self-esteem comorbid identify loved and respect by Helps the client to adapt confidence
with negative insight, (within one or two others. to change, and reduces some. Continue
has also logorrhea and those with strengths Encourage anxiety about altered monitoring a
agitation to her mother BDD, 12– owned verbalization of function/lifestyle patient and
who brought to
hospital.
68.8% also feelings, accepting Promotes feelings of giving a
have SAD; Long term what is said. safety, encouraging prescribed drugs.
within those After three Provide non- verbalization
with SAD, weeks of threatening
Vital signs 4.8-12% interventio environment, listen Age is an indicator of the
BP=119/78 mmHg
also have n the client and accept client as stage of life patient is
Pls= 72 BpM BDD will presented. experiencing, e.g.,
T0=37.2 0C identify the Identify age and adolescence, middle age.
RR=18 BpM
skills and developmental level Clarification and
positive verification of what has
aspect that Reflect back to client been heard promotes
are owned what has been said understanding and allows
by the client to validate
patient information, otherwise
assumptions may be
inaccurate.
Acknowledge efforts Provides encouragement
at problem solving and reinforces
and future planning. continuation of desired
behaviors.
Conveys confidence in
Determine client client’s ability to cope.
awareness of own When client acknowledges
responsibility for own part in planning and
dealing with situation carrying out treatment plan,
he has more investment in
following through on
decisions that have been
made.

HEALTH EDUCATION

Body dysmorphic disorder (BDD) is a mental illness characterised by constant worrying over a

perceived or slight defect in appearance. Repetitive behaviours are performed in response to
these concerns about appearance. BDD usually starts in the teenage years, when concern over
physical appearance is common.