The essential feature of body dysmorphic disorder is a preoccupation with some imagined defect in appearance or markedly excessive concern with a minor physical anomaly (Table 13–12). Such preoccupation persists even after reassurance. Common complaints include a diversity of imagined flaws of the face or head, such as various defects in the hair (too much or too little), skin, shape of the face, or facial features. However, any body part may be the focus, including genitals, breasts, buttocks, extremities, shoulders, and even overall body size. De Leon et al. (1989) stated that the nose, ears, face, and sexual organs are most often involved. It is not surprising, then, that patients with body dysmorphic disorder are found most commonly among persons seeking cosmetic surgery.