246 Obsessive-Compulsive and Related Disorders
sive appearance-related preoccupations and re petitive behaviors that are time-consuming,
are usually difficult to resist or control, and ca use clinically significant distress or impair-
ment in functioning. Physical defects that ar e clearly noticeable (i.e., not slight) are not
diagnosed as body dysmorphic disorder. Ho wever, skin picking as a symptom of body
dysmorphic disorder can cause noticeable skin lesions and scarring; in such cases, body dys-
morphic disorder should be diagnosed.
Eating disorders. In an individual with an eating di sorder, concerns ab out being fat are
considered a symptom of the eating disorder  rather than body dysmorphic disorder.
However, weight concerns may occur in body  dysmorphic disorder. Eating disorders and
body dysmorphic disorder can be comorbid, in which case both should be diagnosed. 
Other obsessive-compulsive and related disorders. The preoccupations and repetitive
behaviors of body dysmorphic  disorder differ from obsessions and compulsions in OCD
in that the former focus only on appearance. These disorders have other differences, such
as poorer insight in body dysmorphic disorder. When sk in picking is intended to improve
the appearance of perceived skin defects, bo dy dysmorphic disorder, rather than excoria-
tion (skin-picking) disorder, is diagnosed. Wh en hair removal (plucking, pulling, or other
types of removal) is intended to improve pe rceived defects in the appearance of facial
or body hair, body dysmorphic disorder is diagnosed rather than trichotillomania (hair-
pulling disorder).
Illness anxiety disorder. Individuals with body dysmor phic disorder are not preoccu-
pied with having or acquiring a serious illness and do not have particularly elevated levels