North Texas Research Forum 2025
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Division
North Texas
Hospital
Medical City Fort Worth
Specialty
Dermatology
Document Type
Poster
Publication Date
2025
Keywords
body dysmorphic disorder, BDD, alopecia, anxiety, biopsy, psychology, therapy
Disciplines
Dermatology | Medicine and Health Sciences | Psychiatry and Psychology | Skin and Connective Tissue Diseases
Abstract
Background: Body dysmorphic disorder (BDD) involves a preoccupation with a nonexistent or insignificant physical defect that causes clinically significant distress and impacts a patient's daily functioning. We present a case of a patient with body dysmorphia that manifested as anxiety about hair loss. Case Information: A 48-year-old otherwise healthy female presented to the dermatology clinic with the chief complaint of 8 months of hair loss. She had been seen previously by 2 other dermatologists. She brought 28 pages of paperwork to her first appointment detailing previous work-up, including four separate skin punch biopsies consistent with androgenetic, non-cicatricial (non-scarring) alopecia. Other lab work was largely unremarkable. This patient counted each hair she lost, reporting about 100 strands daily. This was severely distressing, and she was losing sleep worrying that her hair loss would scar, sleeping only 4 hours the night before her first appointment. She sees a therapist regularly and feels they have a therapeutic relationship. Despite multiple biopsies suggesting non-scarring alopecia, and a normal appearance of the hair and scalp, this patient continued to worry that she may have scarring alopecia, and she continued to request more biopsies. The patient was scheduled for close interval follow ups to monitor her condition and regularly address concerns. Despite this, she continued to call the office and presented for multiple emergency work-in visits without clinical change. She presented to yet another Dermatologists office and underwent an additional scalp biopsy. The result was limited by the superficial nature of the sample. It was read as likely an acneiform or folliculitis-like process, however an inflammatory condition such as frontal fibrosing alopecia could not be ruled out. The report recommended correlating the findings clinically, but the patient has anchored on this statement, disregarding prior work-up and the clinically reassuring picture. Conclusions: The prevalence of Body Dysmorphic Disorder (BDD) is estimated to be between 11-13% among dermatology patients. In many cases, the imperfection of concern is imperceptible to other people. Consequently, patients may lack sympathy from their family and friends, leading to social friction and isolation. Studies indicate that individuals with BDD are more likely to experience suicidal thoughts and to make suicide attempts compared to healthy individuals and patients with eating disorders, OCD, or anxiety disorders. Thus, it is imperative for clinicians to assess for signs of psychiatric distress and evaluate risk of harm to self or others.
Original Publisher
HCA Healthcare Graduate Medical Education
Recommended Citation
Lim, Henry; Loux, Paige; Felicitas, Arianne; Hall, Marshall; Scheufele, Christian; Furth, Garrett; Carletti, Michael; and Weis, Stephen, "Body Dysmorphic Disorder Presenting as Alopecia Anxiety: A Case Report" (2025). North Texas Research Forum 2025. 29.
https://scholarlycommons.hcahealthcare.com/northtexas2025/29
Included in
Dermatology Commons, Psychiatry and Psychology Commons, Skin and Connective Tissue Diseases Commons