Body Dysmorphic Disorder (BDD) is categorized under OCD and Related Disorders in DSM-5. Which of the following features DISTINGUISHES BDD from OCD in terms of insight specifiers?

• A BDD patients always have good insight, unlike OCD
• B BDD can specify 'with absent insight/delusional beliefs', making it overlap with somatic delusions ✓
• C OCD does not have insight specifiers in DSM-5
• D BDD requires at least 2 hours of preoccupation daily, while OCD requires 1 hour

Explanation

Both OCD and BDD in DSM-5 include insight specifiers: good/fair insight, poor insight, and 'absent insight/delusional beliefs.' When BDD patients have absent insight (truly believing their perceived defect is real and severe), DSM-5 notes this overlap with delusional disorder somatic type and clarifies that a diagnosis of BDD with delusional beliefs should be made rather than adding a separate delusional disorder diagnosis. This was a significant DSM-5 change—previously, delusional dysmorphophobia was categorized separately. Both OCD and BDD require at least 1 hour of obsessional preoccupation daily for clinical significance.

Reference: Kaplan & Sadock's Synopsis of Psychiatry, 11th ed.

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