A 24-year-old man spends three hours daily checking mirrors, picks at his facial skin, and avoids social gatherings because he is completely certain his skin is grossly scarred, although dermatological examination is normal. When asked whether his belief might be exaggerated, he says the scarring is absolutely real and refuses further discussion. In DSM-5, how should this be classified?

• A Delusional disorder, somatic type, exclusively
• B Body dysmorphic disorder with absent insight ✓
• C Obsessive-compulsive disorder with poor insight
• D Schizotypal personality disorder

Explanation

DSM-5 classifies this as body dysmorphic disorder with the absent insight specifier, allowing the diagnosis even when the belief about the perceived defect is held with complete conviction. The earlier separation between delusional and non-delusional variants was dropped, so coding it solely as delusional disorder is no longer required. Preoccupation plus repetitive behaviours such as mirror checking and skin picking distinguish it from obsessive-compulsive disorder.

Reference: Diagnostic and Statistical Manual of Mental Disorders (DSM-5), 5th ed.

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