Body Dysmorphic Disorder 101

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Body dysmorphic disorder, or body dysmorphia, is a mental health condition where a person becomes intensely focused on their appearance, spending a lot of time worrying about a perceived physical flaw or defect in the way they look. These flaws are often imagined or so minor that they are unnoticeable to other people. However, someone with BDD may be so worried, upset or anxious about their face or body that it gets in the way of their ability to live normally. These negative thoughts affect how the person feels and influence their behaviors. These might include constantly checking the mirror, grooming, seeking reassurance or isolating themselves from others. This can have a significant impact on their social and professional life.

Body dysmorphic disorder is a chronic condition that affects about 1 in 50 people. It is estimated that between 5-10 million people in the United States have this condition. However, it is likely to be even more common as many cases of BDD may go unreported and undiagnosed. It can affect people of any gender and tends to begin during the teen years or early adulthood.

What Are the Symptoms of BDD?

Most of us feel we have one or more “flaws” in our appearance. However, in people who have BDD, their thoughts, feelings, beliefs and behaviors in reaction to these perceived flaws can be extreme and overwhelming. Symptoms of BDD include abnormalities in:

  • How you think about yourself

o   Having a strong belief that you have a defect in your appearance that makes you ugly or deformed

o   Having negative thoughts about your body or face that are hard to control

o   Being preoccupied or worrying a lot about small or imaginary flaws, which to others can’t be seen or appear minor

  • How you feel

o   Feeling embarrassed, ashamed, anxious and depressed about the perceived flaw and spending a lot of time focusing on it

o   Feeling so much this way that you avoid social situations

o   Feeling overwhelmed by these negative and persistent thoughts until you begin to feel suicidal

  •  How you behave
  • Engaging in repetitive and time-consuming behaviors aimed at fixing or hiding the perceived flaw that are difficult to resist or control

o   Excessively grooming yourself (e.g., brushing or styling your hair obsessively, applying heavy makeup) to try and hide the area you are concerned about

o   Excessively exercising, often targeted at the area you’re concerned about

o   Frequently weighing yourself, or checking your body with your fingers

o   Constantly checking yourself in mirrors or avoiding mirrors altogether

o   Frequently picking at your skin with fingers or tweezers to make it “smooth”

o   Spending a long time choosing clothes to try and hide or conceal the perceived defect (e.g. with baggy clothes, a hat or a scarf)

o   Repeatedly seeking consultations with medical specialists such as such as plastic surgeons or dermatologists to find ways to “fix” your appearance

o   Having unnecessary cosmetic surgeries or spending money on other types of treatments

o   Often feeling unsatisfied with the results of these procedures

  • How you interact with others

o   Believing that others take notice of your appearance in a negative way and  mock you behind your back

o   Constantly seeking reassurance that the defect is not visible or obvious by asking other people how you look

o   Not believing other people when they compliment you or say you look fine

o   Constantly comparing your looks with other people, whether it’s people you know, strangers on the street or models in magazines

o   Not wanting to go out in public, particularly in the daytime

o   Feeling self-conscious and anxious when around other people

o   Avoiding social situations

o   Having problems at work, school, or in your personal relationships because you are so focused on the perceived defect and trying to hide it

What Causes BDD?

The exact cause of BDD is unknown. Like many other mental health conditions, BDD may result from a combination of biological, psychological and environmental factors.

  • Family history – you may be more likely to develop BDD if you have a close relative with the disorder or a related mental health condition such as depression, anxiety or obsessive-compulsive disorder.
  • Presence of other mental health conditions – similarly, BDD often occurs in people with other mental health conditions such as depression, anxiety or an eating disorder.
  • A chemical imbalance in the brain – there may be abnormalities with the chemicals in your brain that help nerve cells send messages to each other, affecting the way you think and behave.
  • Negative and traumatic life experiences – you may be more likely to develop BDD if you experienced teasing, bullying, neglect, abuse or emotional conflict as a child. These experiences often create or foster the feelings of inadequacy, shame and fear of ridicule.
  • Personality traits – certain personality traits like narcissism, perfectionism and low self-esteem may contribute to the development of BDD.
  • Peer or societal pressure – you experience negative evaluations and criticisms about your body or appearance from people in your life, or feel pressure from a society that equates physical appearance with beauty and value.

How Is BDD Diagnosed?

It can be difficult to diagnose BDD because often people do not recognise that their thoughts or behaviors are abnormal or they may be too embarrassed about their symptoms to seek professional help. BDD also shares symptoms with other mental health conditions (such as obsessive-compulsive disorder, social anxiety, depression and eating disorders), so many people with BDD may never be formally diagnosed with the condition.

If you believe you may have symptoms of BDD you should speak to your doctor or healthcare professional. They will ask you about your personal and family medical history and conduct a general physical exam. If they suspect BDD, they may refer you to a mental health professional for further assessment.

A person may be diagnosed with BDD if they:

  • Are abnormally concerned and preoccupied with a small or non-existent flaw in their appearance
  • Engage in repetitive behaviors (grooming, checking appearance in a mirror) because of this concern about their appearance
  • Have difficulty functioning normally because the thoughts about their body flaw are severe enough to interfere with their daily activities

A mental health professional can evaluate your attitudes, behaviors and symptoms and how much they are affecting your daily life. They also consider whether it is likely that any other mental health condition may be causing your symptoms.

What’s the Treatment for BDD?

There is no cure for BDD but there are treatment options available to help you improve symptoms and reduce the impact the disorder has on your life so that you can function normally at home, work and in social settings. Treatment plans for BDD may include one or a combination of the following:

  • Cognitive Behavioral Therapy – this form of talk therapy focuses on changing a person’s thinking (cognition) and the way they act on their thinking (behavior). CBT teaches you to replace negative thoughts and thought patterns with positive thoughts and encourages you to engage in more healthy behaviors. This can be done one on one or in a group therapy setting.
  • Exposure and response prevention – another less common form of therapy uses thoughts and real-life situations to prove to the person that their view of themselves is not accurate.
  •  Antidepressant medications such as selective serotonin reuptake inhibitors (SSRI)

A mental health professional can determine the best treatment plan for you based on your age, health, and medical history. They can also look at the extent of the problem and if it appears to be worsening, and the effectiveness of any past treatments, while taking into account your own opinion and preferences for treatment.

If you recognize any of the symptoms discussed here and think you or your child might have BDD, you should speak to your doctor or a mental health professional for further advice. Similarly, if you have been diagnosed with BDD and you notice your symptoms have become worse or you experience new symptoms, you should let your doctor know.

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