A 17-year-old girl is referred to the PMHNP after pulling her eyebrow hair out to the point of scarring. She says she has a "unibrow" and looks like a "Neanderthal" unless she pulls out the hair. The PMHNP asks to see a photo of the patient before she started pulling out her hair; it was not unusual. What is the most appropriate diagnosis?

Choice A reason: This is correct. The patient exhibits preoccupation with a perceived defect in her appearance that is not noticeable to others, accompanied by repetitive behaviors (hair-pulling) to correct the perceived flaw, consistent with body dysmorphic disorder. Choice B reason: Delusional disorder, somatic type involves fixed false beliefs about bodily functions or appearance. In this case, the belief is not delusional; the patient’s concern is excessive but recognized as distressing, fitting body dysmorphic disorder. Choice C reason: Trichotillomania involves hair-pulling without associated preoccupation with appearance. Here, the hair-pulling is directly related to perceived appearance defects. Choice D reason: Age-appropriate concerns would not include severe distress or scarring from repetitive hair-pulling.