Body dysmorphic disorder

Body dysmorphic disorder (BDD) is a mental disorder, which involves a disturbed body image. Body dysmorphic disorder is generally diagnosed of those who are extremely critical of their physique or self image, despite the fact there may be no noticeable disfigurement or defect; individuals secluding themselves from social interaction, often avoiding seeing themselves through a mirror or reflection.

Most people wish they could change or improve their physical apearance, but some people, otherwise considered normal, believe that they are so unspeakably hideous that they are unable to interact with others or function normally for fear of ridicule and humiliation at their ugliness.

BDD focuses on an individual's preoccupation with an imagined physical defect in their appearance although this person looks reasonably normal. This disorder has been referred to as "imagined ugliness" (Barlow, 2006).

It is estimated that BDD affects 1 in 50 people, mostly teenagers and young adults. Low self-esteem is a trademark of those with BDD due to their perceived physical flaws (Phillips, 1991).

Diagnostic criteria (DSM-IV-TR)

Body dysmorphic disorder is a somatoform disorder featuring a disruptive preoccupation with some imagined defect in appearance ("imagined ugliness").

The DSM-IV-TR, the latest version of the diagnostic manual of the American Psychiatric Association, lists three (3) necessary criteria for a diagnosis of body dysmorphic disorder:

Preoccupation with an imagined defect in appearance. If a slight physical anomaly is present, the person's concern is markedly excessive.
The preoccupation causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
The preoccupation is not better accounted for by another mental disorder (e.g., dissatisfaction with body shape and size in anorexia nervosa).

Explanation

There are various locations of imagined defects in people with body dysmorphic disorder. Skin and hair are usually the top two locations of imagined defects (Phillips, 1991). As well as avoiding mirrors to an almost phobic extent, individuals with BDD can also become fixated on mirrors; frequently checking if their presumed defect has changed.

This disorder can cause considerable disruption in an individual's life. Many people become homebound due to their fear of people laughing at their "ugliness". Individuals with BDD also believe that everything going on in the world is somehow related or referring to them and their imagined defect.

These affected individuals are often unable to realize that their ideas about their imagined defect are irrational. This disorder was previously known as dysmorphobia (fear of ugliness, thought to represent a psychotic delusional state)(Barlow, 2006).

Suicide, attempts and ideation, are unfortunately usually consequences of this disorder. Studies have suggested that around 80% of BDD patients experience the thought at some point that life is not worth living, and that 25% of sufferers will go on to attempt suicide (Phillips, 2005). Most individuals with BDD are not mental health patients, but rather, become patients of dermatologists and plastic surgeons. According to published reports, slightly more females than males have BDD in the United States. Age of onset ranges anywhere from eary adolescence through the 20s. Individuals are also usually reluctant to seek treatment due to the fact that they want to "fix" their "deformity" and will take extreme measures to do so, regardless of the consequences. Often BDD patients will turn to cosmetic surgery and will even attempt to alter their appearance by themselves which often results in tragedy.

Individuals with body dysmorphic disorder react to what they think and truly believe is a grotesque physical feature. Obviously society and culture play a major role in the concepts of beauty and body image.

Treatment

There is little known on the cause or treatment of body dysmorphic disorder. There is no meaningful information on biological or psychological predisposing factors or vulnerabilities.

There are only two medical treatments that seem effective for BDD: clomipramine (Anafranil) and/or fluvoxamine (Luvox); and fluoxetine (Prozac). Drugs such as clomipramine and fluvoxamine block the reuptake of seratonin. Common antidepressants such as Paxil and Zoloft are also used to treat this disorder (Phillips, 1991).

Cognitive-behavioral therapy using exposure and response prevention methods have been the most effective and successful with BDD.

BDD and other disorders

Note that, according to the DSM criteria, a BDD diagnosis cannot be made if another disorder accounts for the preoccupation with a perceived defect. For instance, people who worry excessively about their weight are not considered to have BDD if this preoccupation is accounted for by an eating disorder. Body dysmorphic disorder is also considered to be different from gender identity disorder and transsexualism, even though the desire to modify one's body is also reflected in people who are judged to have these disorders. Some paraphilias also involve a wish to modify one's body. For example, people with apotemnophilia are convinced that a part of their body needs to be amputated.

In the medical community, some make links between BDD and obsessive-compulsive disorder because there are some similarities between these disorders. For instance, obsessive thoughts and compulsive behaviors are common symptoms of both disorders.

There are a lot of similarities between BDD and OCD. People with BDD often complain of persistent, intrusive, obsessive thoughts about their appearance anad therefore engage in repeated, compulsive behaviors. BDD and OCD also share approximately the same age of onset. Drugs that have the strongest effect in BDD also have a strong effect in OCD. Furthermore, the type of cognitive-behavioral therapy effective with OCD (exposure and response prevention ) has been successful with BDD; and both have shown similar rates of response to these treatments.

BDD can lead to or take on other psychiatric problems as well. Depression, OCD, eating disorders, anxiety issues, agoraphobia, and trichotillomania (hair pulling) are all problems that commonly follow or may trigger Body dysmorphic disorder.

Forms of body dysmorphia

Muscle dysmorphia
Seeing oneself as too fat, often resulting in anorexia, bulimia, or exercise bulimia
Obsessing about the perceived ugliness of a facial feature or body part

Common locations of imagined defects

hair
nose
skin
teeth
ears
genitalia
forehead
eyes
head/face
overall body build
legs/knees
cheeks
arms/wrists
shoulders
lips
chin
stomach/waist
breasts/pectoral
buttocks
neck

Or other fantasy-based effects, including:

tail/s
wings
claws

References

Barlow, David H.; Durand, V. Mark. Essentials of Abnormal Psychology. Thomson Learning, Inc., 2006.
Phillips, KA. Body dysmorphic disorder: the distress of imagined ugliness. American Psychiatric Association 148: 1138-1149, 1991.

External links