Body Dysmorphic Disorder (BDD) is a complex and multifactorial condition that has continuously eluded those who work in the mental health field. As such, there has been a lack of uniformity regarding accepted treatment and understanding of this disorder. Moreover, too much focus has remained on describing the clinical symptomology of BDD (via the DSM), and far less on the underlying constructs and subjective nature of the condition. This research is rooted in the belief that by understanding how to think about BDD psychoanalytically, clinicians will be able to cultivate more in-depth conceptualizations and better inform interventions. This study first explores the current state of understanding in regard to BDD, through presenting a comprehensive, critical review of the existing literature. Next, it looks at Freudian (intrapsychic) and Winnicottian (interpersonal) perspectives about the body and body image, with a consideration of how the core postulates elucidate how and why certain individuals develop distorted perceptions of their body. The theoretical literature is integrated with the empirical findings to develop hypotheses about the core dynamics of BDD. Conceptual understanding of BDD is illustrated using a hypothetical clinical case that exemplifies the common developmental influences, symptoms and relational dynamics of BDD. The conceptualization serves as a benchmark for a psychoanalytic treatment orientation of BDD based almost exclusively based on the internal experience, not the body. By making psychoanalytic perspectives on BDD more accessible, this study contributes to advances in the diagnosis, understanding and treatment of BDD by providing a more holistic diagnostic "tool" that extends beyond the categorical diagnostic paradigm through outlining an in-depth way of understanding why certain symptoms develop, as well as how the symptoms and psychological organization that generated them develop over time.