A patient with Body Dysmorphic Disorder (BDD) insists on consulting a dermatologist for a 'deformity' no one else can see. In DSM-5, which specifier distinguishes BDD with 'absent insight/delusional beliefs' from a primary psychotic disorder?

• A The BDD diagnosis is not given if delusions are present; the correct diagnosis becomes Delusional Disorder, somatic subtype
• B DSM-5 allows BDD to be diagnosed even when beliefs are held with delusional conviction, using the 'with absent insight/delusional beliefs' specifier; the diagnosis is not reclassified as a psychotic disorder ✓
• C BDD with delusional beliefs requires co-diagnosis of Delusional Disorder and BDD
• D BDD with complete absent insight is reclassified as Somatic Symptom Disorder in DSM-5

Explanation

DSM-5 introduced insight specifiers for BDD: 'good or fair insight,' 'poor insight,' and 'absent insight/delusional beliefs.' When a patient with BDD holds beliefs about perceived flaws with delusional conviction, DSM-5 instructs clinicians to diagnose BDD with the absent insight specifier rather than reclassifying to Delusional Disorder. This reflects evidence that absent-insight BDD and delusional BDD represent a spectrum of the same disorder and respond similarly to SSRIs (unlike typical psychotic disorders). An additional diagnosis of Delusional Disorder is not given if BDD better explains the presentation.

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

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Written and medically reviewed by the StethoPrep medical team.