A 25-year-old married woman explains to the PMHNP that she spends an inordinate amount of time tweezing her eyebrows every evening. She says she has anxiety when she looks in the mirror and sees asymmetry in her eyebrows. She tries to pull every hair that is out of place. This can take more than an hour each evening, and it is becoming problematic because she is still unhappy after tweezing. She only stops when her husband demands it, after telling her how beautiful she is and that the asymmetry is "all in her head." She still feels an urge to tweeze her eyebrows every night in an attempt to "fix" them. What diagnosis is the most appropriate?

Choice A reason: Trichotillomania involves hair-pulling, but it is typically focused on the act of pulling as a tension-relieving behavior rather than an appearance-focused compulsion driven by perceived flaws. Choice B reason: This is the correct answer. Body dysmorphic disorder involves preoccupation with perceived physical flaws, leading to repetitive behaviors (such as tweezing) to "correct" perceived imperfections. The patient’s anxiety about eyebrow asymmetry and time-consuming compulsive behavior aligns with BDD. Choice C reason: Delusional disorder, somatic type, involves fixed false beliefs about bodily functioning or appearance, but the patient demonstrates insight that the asymmetry is “all in her head,” ruling out delusional disorder. Choice D reason: Obsessive-compulsive disorder involves intrusive thoughts and compulsions but is not specifically focused on perceived physical flaws, which distinguishes it from BDD in this scenario.