Body dysmorphic disorder Quiz: Ace Your Exams

A 20-year-old woman comes to the physician to discuss the possibility of undergoing rhinoplasty. The patient tells the physician her nose looks “twisted” and “not symmetrical,” and she would like to have surgery to correct it. When in public, she explains that she frequently tries to cover her nose with a scarf because she feels “embarrassed by the way it looks.” Additionally, she also thinks her “skin tone is not even,” and she feels that her friends’ skin is much better than hers. She adds that although she was told by her friends and family that there are no issues with her nose or her skin, she feels ashamed of her appearance. She reports checking the mirror every hour, which she says “consumes a lot of time” in her day. The patient is not reassured by the physician’s comments that her nose and skin appear healthy and symmetric, and she insists that she looks “ugly.” She has not experienced suicidal ideation or attempts of self-harm. Physical examination reveals skin picking in multiple areas of the patient’s body. Which of the following is the most likely diagnosis in this patient?