selves. Body dysmorphic disorder appears to respond poorly to  such treatments and
sometimes becomes worse. Some individuals ta ke legal action or are violent toward the
clinician because they are dissat isfied with the cosmetic outcome.
Body dysmorphic disorder has been associat ed with executive dysfunction and visual
processing abnormalities, with a bias for an alyzing and encoding details rather than ho-
listic or configural aspects of vi sual stimuli. Individuals with this disorder tend to have a
bias for negative and threatening interpretati ons of facial expressions and ambiguous sce-
narios. 
Prevalence 
The point prevalence among U.S.  adults is 2.4% (2.5% in females and 2.2% in males). Out-
side the United States (i.e., Germany), cu rrent prevalence is approximately 1.7%–1.8%,
with a gender distribution similar to that in  the United States. The current prevalence is
9%–15% among dermatology patients, 7%–8% am ong U.S. cosmetic surgery patients, 3%–
16% among international cosmetic surgery patients (most studies), 8% among adult orth-
odontia patients, and 10% among patients presenting for oral or maxillofacial surgery.
Development and Course 
The mean age at disorder onset is 16–17 years, the median age at onset is 15 years, and the
most common age at onset is 12–13 years. Two-thirds of individuals have disorder onset
before age 18. Subclinical body dysmorphic diso rder symptoms begin, on average, at age
12 or 13 years. Subclinical concerns usually ev olve gradually to the full disorder, although
some individuals experience abrupt onset of body dysmorphic disorder. The disorder