A 24-year-old male engineering student becomes preoccupied with a perceived misalignment of his nose despite normal appearance. He spends 4 hours daily examining his face in mirrors, seeks repeated reassurance, and has dropped out of college. He believes 80% that the defect is real but acknowledges 20% uncertainty. What specifier applies in DSM-5?
- A With good or fair insight
- B With poor insight ✓
- C With absent insight/delusional beliefs
- D Muscle dysmorphia specifier
Explanation
DSM-5 specifies insight in body dysmorphic disorder (BDD) as: good/fair insight (recognises the BDD beliefs are probably not true), poor insight (thinks the BDD beliefs are probably true), or absent insight/delusional beliefs (completely convinced the BDD beliefs are true). A patient with 80% conviction that the defect is real but 20% doubt has poor insight. The muscle dysmorphia specifier applies when preoccupation is focused on the belief of being insufficiently muscular. First-line treatment for BDD is SSRI plus CBT with ERP; the insight level guides psychoeducation and treatment alliance strategies.
Reference: Kaplan & Sadock's Synopsis of Psychiatry, 11th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.