pied with having or acquiring a serious illness and do not have particularly elevated levels
of somatization. 
Major depressive disorder. The prominent preoccupation with appearance and exces-
sive repetitive behaviors in body dysmorphi c disorder differentiate it from major de-
pressive disorder. However, major depressi ve disorder and depressive symptoms are
common in individuals with body dysmorphic disorder, often appearing to be secondary
to the distress and impairment that body dysmorphic disorder causes. Body dysmorphic
disorder should be diagnosed in  depressed individuals if diag nostic criteria for body dys-
morphic disorder are met. 
Anxiety disorders. Social anxiety and avoidance are common in body dysmorphic dis-
order. However, unlike social anxiety disorder (social phobia), agoraphobia, and avoidant
personality disorder, body dy smorphic disorder includes prominent appearance-related
preoccupation, which may be delusional, and repetitive behaviors, and the social anxiety
and avoidance are due to concerns about perceived appearance defects and the belief or
fear that other people will consider these indivi duals ugly, ridicule them, or reject them be-
cause of their physical features. Unlike gene ralized anxiety disorder, anxiety and worry in
body dysmorphic disorder focus on  perceived appearance flaws. 
Psychotic disorders. Many individuals with body dy smorphic disorder have delu-
sional appearance beliefs (i.e., complete convic tion that their view of their perceived de-
fects is accurate), which is diagnosed as body dysmorphic disorder, with absent insight/
delusional beliefs, not as delusional disorder. Appearance-related ideas or delusions of
reference are common in body dysmorphic di sorder; however, unlike schizophrenia or
schizoaffective disorder, body dysmorphic disorder involves  prominent appearance pre-