What Is Body Dysmorphic Disorder?
Body Dysmorphic Disorder (also known as BDD) is defined by the DSM-IV-TR as a preoccupation with an imagined defect in appearance, in a normal-appearing person. It can also be excessive concern over a slight physical defect. The preoccupation produces marked clinical distress and is often under-diagnosed because many who suffer from Body Dysmorphic Disorder are too ashamed to talk about the disorder.
The individual's symptoms must not be accounted for by another disorder, although it may co-exist with other types of mental illness.
Common Concerns For Those With BDD:
The body part or perceived defect that the individual focuses upon may change over time. Some of the more common concerns include:
- Excessive hair or lack of hair
- Size and shape of eyes, face or nose
- Acne or other blemishes
- Breast size
- Muscle size
Symptoms of Body Dysmorphic Disorder:
- Preoccupation with physical appearance
- Frequent "mirror checks" or avoidance of mirrors entirely
- Certainty that others notice perceived flaw
- Need for reassurance about appearance from others
- Frequent cosmetic surgeries without satisfaction with the results
- Extreme grooming
- Extreme self-consciousness
- Skin picking (dermatillomania)
- Frequent hair-plucking (trichotillomania)
- Refusal to sit for pictures
- Avoiding social situations due to anxiety about perceived flaw
- Wearing extreme amounts of makeup to hide perceived flaw
Causes of Body Dysmorphic Disorder:
It's not known precisely what causes BDD; it's likely to be a result of many different factors.
Genetics - studies have shown that people with a genetic relative who have BDD are more apt to develop BDD themselves.
Environment - life experiences, culture and environment may lead to the development of BDD, especially if experiences about body image or self-image were negative.
Brain Chemistry - evidence suggests that neurotransmitters - which are linked to mood - may play a role in the development of BDD.
Structural Differences in the Brain - parts of the brain of those with BDD may not have developed properly.
Risk Factors for Developing BDD:
While the cause of body dysmorphic disorder remains unknown, several risk factors have been identified as increasing the likelihood of developing the condition:
- Genetic relatives with BDD
- Societal pressures of the ideal beauty
- Low self-esteem
Complications of Body Dysmorphic Disorder:
- Suicidal behaviors
- Difficulty maintaining personal relationships
- Low self-esteem
- Frequent hospitalizations
- Difficulty going to school or work
- Unnecessary medical procedures
Diagnosis of Body Dysmorphic Disorder:
It may be difficult to pinpoint a diagnosis of BDD, as it may present as another mental illness or the sufferer may hide their symptoms from medical professionals.
In order for a diagnosis of BDD to be made, the individual must meet the criteria laid out in the DSM-IV:
- Extreme preoccupation with imagined defect or minor flaw in appearance
- Preoccupation with appearance so intense that it causes significant distress in areas of functioning such as work, school and personal relationships.
Treatment of Body Dysmorphic Disorder:
The most successful treatment of BDD is cognitive behavioral therapy and medication or a combination of the two.
Medication to treat BDD: While the FDA hasn't approved any medications specifically for BDD, off-label usage of antidepressants (especially the SSRIs) can be very helpful. It may take up to twelve weeks to notice improvement in symptoms. Occasionally several medications must be tried to see a relief in symptoms.
CBT (Cognitive Behavioral Therapy): The focus of CBT is to teach healthy behaviors - learning to be social and overcoming obsessions - while learning about feelings, thoughts and behaviors. The negative behaviors and thoughts can be replaced - with time and therapy - with more positive, realistic thoughts and actions.
In severe cases of BDD, hospitalization may be necessary.
Do I Have Body Dysmorphic Disorder?
- Do you believe you have a "defect" in part of your body or appearance?
- Do you spend a lot of time checking this "defect?"
- Do you hide or cover up this "defect" or fix it through diets, exercise or surgery?
- Does this belief cause you embarrassment, distress, or torment?
- Does this "flaw" interfere with your ability to function at work, school or in social situations?
- Do friends and family tell you this "defect" is minor or that there is nothing wrong with you?
If you agree with these statements, you may have characteristics of body dysmorphic disorder and should talk to your doctor.
Resources for Body Dysmorphic Disorder:
BDD Central is a safe and supportive place to communicate and learn, educate the public through outreach programs, and offer updated resources (such as an up-to-date treatment provider directory and recommended literature) to help sufferers and their loved ones.
BDD Foundation is a UK site available in French or English designed to increase awareness and understanding of Body Dysmorphic Disorder (BDD), taking the focus away from current stigmas that can perceive BDD as narcissistic, self-indulgent or purely a result of modern western ideals. We also aim to dispel the belief of many people affected by BDD that the disorder cannot be overcome.
The Broken Mirror: Understanding and Treating Body Dysmorphic Disorder - the first and most definitive book on BDD, Dr. Katharine Phillips draws on years of clinical practice, scientific research, and professional evaluations of over 700 patients to bring readers her expertise and experience with this often debilitating illness.
Body Image Gallery is a site where women can see what real women look like - what we really look like. Most women have spent so many years looking at themselves in mirrors that we can no longer see what's really there. The My Body Gallery project's goal is to help women objectively see what we look like and come to some acceptance that we are all beautiful.