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BDD versus real ugliness

Where is the line drawn at a person having unrealistic preoccupations with certain parts of their bodies and actually seeing ugliness in themselves at a rational level? Is it still BDD if they are indeed as ugly as they say they are but are just obsessed to a certain extent (ie: it interferes with their life and functioning); or only if they see something that is exaggerated in their mind or just not there? I might e-mail Dr. Robert this question too, with a bit of background.