Body Dysmorphic Disorder (BDD)
What is Body Dysmorphic Disorder?
Body Dysmorphic Disorder (BDD) is defined as a preoccupation with an imagined 'defect' in appearance. The preoccupation is markedly excessive and causes significant impairment, including personal isolation. Most people with BDD experience their thoughts as intrusive and difficult to resist or control. Ritualistic behaviours are common and include checking the defect over and over in a mirror, frequent requests for reassurance, and avoidance.
People with BDD tend to have low self-esteem. If their appearance deviates from 'perfection', they can view themselves as worthless or unlovable. They may even drop out of school, stop working, or avoid social activities. Their attention is almost exclusively focused on their 'defect' and so they become extremely vigilant and discerning about any minor changes that deviate from their high standards.
There can be some overlap between BDD and OCD (Obsessive Compulsive Disorder) - sufferers of OCD sometimes have BDD - and vice versa. However, people with BDD are less likely to be married, have more comorbid depression, and make more suicide attempts than a comparison group of OCD sufferers. Social phobia and social anxiety may also be predisposing factors in the development of BDD.
What are the symptoms of Body Dysmorphic Disorder?
Sufferers are typically preoccupied by slight or imagined flaws on their face or head such as acne, wrinkles, scars, vascular markings, paleness or redness of their complexion, swelling, facial proportions, baldness or excessive facial hair. Other preoccupations include the shape, size, or some other aspect of the nose, hair, eyes, mouths, lips, teeth, jaw, chin, cheeks, or head. However, any part of the body may be the main focus of concern.
People with BDD often spend several hours a day preoccupied with their 'defect', and in this regard BDD is like an obsession. Sufferers often avoid a wide range of public or social situations because of shame about their appearance, and may go to great lengths to change their posture, or to camouflage themselves. Others compulsively check themselves in the mirror or other reflective surfaces, or may avoid looking at themselves in order to avoid doing a ritual. A great deal of time may be spent on grooming, Sufferers often seek frequent reassurance about the severity or visibility of their 'defect'. If assurance is accepted, doubts will creep back before too long. Self-surgery is a common characteristic of the disorder, while many people with BDD tend to consult cosmetic surgeons or dermatologists rather than to seek psychiatric help.
A recent phenomenon is muscle dysmorphia, the compulsion to increase the size of muscle mass. Even though muscle mass may be of average or above average size, it is thought to be chronically under-developed. Excessive, compulsive exercise thus may be regarded as a symptom of BDD, masking body image dissatisfaction and feelings of inadequacy.
What causes Body Dysmorphic Disorder?
The precise causes of BDD are unknown, but symptoms often first appear in adolescence which is a time of increased sensitivity about appearance. Its onset can either be gradual or abrupt, possibly triggered by a traumatic event. Environmental factors have been identified as possible triggers: for example, schoolyard taunting, an over-emphasis on appearance within the family, or sexual abuse. Environmental stresses may work hand in hand with a genetic predisposition, or identified psychiatric histories within the family. Media reinforcement of an unrealistic 'perfect' body image may also have a role to play in the development of BDD.
How is Body Dysmorphic Disorder Treated?
Treatment can improve the outcome of the disorder for many BDD sufferers. They may best respond to either Cognitive Behavioural Therapy (CBT); antidepressant medication - selective serotonin reuptake inhibitors (SSRI's); supportive psychotherapy; or a combination of these.
CBT would be concerned with cognitive distortions of body image, the recognition of irrational thinking and how to alter such patterns of thought through exposure and restraint strategies. Such strategies would include the non-avoidance of anxiety provoking situations, and the refusal to, for example, mirror-check, skin-pick, pull hair, excessively groom, over-exercise, or to seek reassurance. Such strategies help to enhance self-esteem while consolidating a healthier attitude to personal appearance. Supportive psychotherapy may be required to investigate the emotional underpinnings of the disorder.