Body Dysmorphic Disorder by Proxy

Body dysmorphic disorder (BDD) by proxy is a relatively understudied condition characterized by an intense preoccupation with perceived physical flaws in another person, typically a close family member or significant other. Individuals with BDD by proxy hold maladaptive appearance-related beliefs and engage in ritualistic behaviors intended to alter the perceived flaws and alleviate their own distress. Perceptual and attentional biases, personality factors, and early life experiences may contribute to the onset of these symptoms, which can cause significant emotional and functional impairment in patients’ lives. Although treatment research is limited, preliminary evidence supports the use of cognitive behavioral therapy (CBT), including cognitive techniques, exposure and ritual prevention, and attention retraining for BDD by proxy. Future research should focus on establishing the prevalence of BDD by proxy, understanding the experiences of persons of concern, investigating underlying etiological factors, and building support for evidence-based interventions to address this complex condition.