Body Dysmorphic Disorder (BDD)

What is body dysmorphic disorder?

Body dysmorphic disorder (also known as BDD, dysmorphophobia, body dysmorphia), is a chronic mental health condition where the affected person is overly concerned about their appearance, particularly about imaginary or minor flaws. Symptoms of body dysmorphic disorder are usually associated with anxiety, depression, and social isolation thereby hampering daily activities of the person. Several factors are responsible for BDD but it can be effectively treated with medication like selective serotonin reuptake inhibitors and psychotherapy.

How common is BDD?

Body dysmorphic disorder is not as uncommon as is often thought. It affects about 1% to 2% of the general population. Contrary to popular belief, women are not more frequently afflicted with this psychiatric disorder. In fact it affects men and women equally. Whereas body dysmorphic disorder in men is more often about muscle size, women are more concerned about body fat. It tends to start around 16 to 17 years of age and may be accompanied by other mental health conditions like anxiety, especially in females.

Signs and Symptoms

The symptoms of body dysmorphic disorder (BDD) range from :

  • Excessive concern about imaginary or minimal defect in the appearance.
  • Repeated examination of appearance in front of a mirror.
  • Always think that others are noticing the imaginary defect in their appearance with comments or criticism.
  • No amount of reassurances from others can change the belief.
  • Repeated unsatisfactory attempts to restore the defect in appearance with heavy make-up, cosmetic surgery or clothes.
  • Refusal to make public appearance.
  • Social isolation.
  • Obsessions can involve any part of the body but most commonly the imaginary defects affect the :
    – Skin complexion
    – Nose
    – Hair
    – Face
    – Breast
    – Genitalia
    – Muscle size

Apart from the above mentioned symptoms, some BDD patients also suffer from :

  • Anxiety
  • Eating disorders
  • Low self-esteem
  • Drug abuse
  • Delusional ideas and suicidal tendencies
  • Depression

What causes BDD?

Body dysmorphic disorder usually starts in teenagers and may persist through to the adult years. While concern about one’s physical appearance and social acceptance due to physical characteristics is not uncommon in the teen years, in body dysmorphic disorder the person has an unhealthy preoccupation with physical features that do not exist. Despite starting in the teen years, it often takes BDD patients years to seek treatment for the condition.

There are several causes interplay of which may lead to BDD.

Psychosocial

  • Criticism regarding appearance: almost 60% of BDD patients report this problem.
  • Style of parenting: over stressing on or complete lack of interest towards the appearance of the teenage children by parents may act as a contributing factor.
  • Other associated problems: childhood abuse, trauma, eating disorder (anorexia nervosa), hypochondria (false belief that one is severely ill without any medical basis), social withdrawal (introvert). Studies show that 76% BDD patients suffer from depression.

Environmental

  • Media: pressure about necessity of “perfect” appearance highlighted by the electronic and print media may sometimes trigger BDD.
  • Certain types of personality: certain type of personality disorders are associated with BDD (avoidant personality disorder, social phobia, social anxiety).

Neurological

  • Chemical or structural underdevelopment may lead to BDD.
  • It has been suggested that BDD patients may suffer from abnormal visual processing (although not yet conclusively proven).

Who is at risk of BDD?

  • History of family members suffering from BDD.
  • Social pressure regarding appearance.
  • Low confidence.
  • Associated psychological disorder like anxiety or depression.
  • Traumatic events during childhood.

Treatment for Body Dysmorphic Disorder

There are two standard treatment approaches for BDD.

  • Cognitive therapy: Patients are informed about their condition, symptoms and behaviors that ultimately help them to get rid of the negative feelings about their appearance.
  • Drugs: According to some studies, BDD patients may have low levels of serotonin (a neurotransmitter) therefore serotonin reuptake inhibitors (SSRI usually fluoxetine) are prescribed.

Usually a combined approach using both behavioral therapy and drugs exhibit better promise than an individual approach alone. In most cases, at least 12 weeks of treatment is required to note any benefit.

 

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