Someone who appears to have BDD based on his or her answers on the BDDQ should then be asked questions from the adolescent version of the BDD Module to determine whether BDD is really present (see Appendix C). Because it’s common for adolescents to think a lot about their appearance, it’s important to be sure the adolescent is thinking in a negative way about a minimal or nonexistent appearance defect. It may also be helpful to put greater emphasis on impairment in functioning when diagnosing BDD in adolescents, to be sure that the appearance concerns truly are problematic and not just normal concerns.Kristin’s, Eric’s, and Holly’s concerns were clearly excessive and characteristic of BDD. Kristin avoided social interactions and dating, and she failed some of her courses and dropped out of school. Her suicide attempt and hospitalization were painfully clear signs that what she was experiencing wasn’t just “normal adolescence” or something she’d “grow out of.” Early on, Eric’s grades dropped, and he became anxious and depressed. While these signs weren’t dramatic, they signaled that something problematic and serious was occurring—that he wasn’t just “going through a phase” or having normal adolescent difficulties. When he dropped out of school and stopped playing soccer, it became crystal clear that his concerns were a serious problem. While Holly’s case was milder, the fact that she worried about her appearance for several hours a day and avoided friends signaled the presence of BDD.All three adolescents also had some typical BDD behaviors—mirror checking, camouflaging, reassurance seeking, and excessive grooming. These behaviors provided additional clues to the disorder’s presence.It’s equally important to be aware that BDD can easily be underdiagnosed in adolescents. In fact, in my experience this error is far more common than overdiagnosing BDD. To avoid underdiagnosing BDD in children and adolescents, it’s important to be aware that they may minimize BDD symptoms because they’re embarrassed by their concerns and reluctant to reveal them. Holly felt that she was selfish and shallow because she was so focused on how she looked, and she was very reluctant to tell anyone about her worries. While adults also have these feelings, secrecy may be particularly common during the teenage years because adolescents may hesitate to confide in and trust adults. Often, adolescents must develop a trusting relationship with an adult before they’re willing to divulge their concerns. The best approach to this problem is to simply ask. When adolescents show any signs of BDD, ask them whether they have any appearance concerns. The adolescent versions of the BDDQ and BDD Module can be a useful guide. The most important thing is to not consider such concerns a normal phase of development that will simply pass. It’s also important not to tease or criticise the adolescent because of their concerns. BDD is a serious disorder that needs to be treated.*160\204\8*

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