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Background Individuals with body dysmorphic disorder ( BDD) are highly distressed and impaired owing to perceived defects in their physical appearance that are not noticeable to others. They are frequently concerned about their skin and often present to dermatologists rather than psychiatrists. However, BDD patients attending dermatology clinics may be at risk of not receiving an appropriate assessment and beneficial treatment. The aims of this study were to estimate the BDD prevalence rate among Swedish female dermatology patients and to assess the psychological condition of BDD patients compared to that of other dermatology patients. Methods The occurrence of BDD was estimated using the Body Dysmorphic Disorder Questionnaire ( BDDQ), a validated self-report measure for BDD. Symptoms of depression and anxiety were measured by the Hospital Anxiety and Depression Scale ( HADS), and quality of life was assessed using the Dermatology Life Quality Index ( DLQI). Results The prevalence rate of BDD among female Swedish dermatology patients was 4.9% (95% CI 3.2-7.4). Anxiety ( HADS A ≥ 11) was 4-fold more commonly reported by patients with positive BDD screening (48% vs. 11%), and depression ( HADS D ≥ 11) was over 10-fold more common in patients with positive BDD screening (19% vs. 1.8%) ( P < 0.001). The median DLQI score was 18 in the BDD group, compared to a score of 4 in the non- BDD group ( P < 0.001). Conclusions Our results indicate that BDD is fairly common among female Swedish dermatology patients (4.9%) and that BDD patients have high levels of depression and anxiety and severely impaired quality of life. [ABSTRACT FROM AUTHOR]