What is Body Dysmorphic Disorder?

Body Dysmorphic Disorder (BDD) is a preoccupation with one or more perceived flaws in one’s physical appearance that are not observable or appear minor to others. People with BDD remain distressed due to imagined physical defects, such as a blemish, the size or shape of a body part, or some other personal feature. People may spend many hours each day in mirror checking, excessive grooming or comparing appearance with others. This causes impairment in daily life functioning, individual may avoid social situations and become withdrawn from others because of feeling embarrassed, ashamed and anxious. The individual with BDD is also likely to develop depression.

The core symptoms of this disorder

This disorder usually remains undetected for a longer period. Most of the time the people have no insight into the illness. The severity of symptoms varies from patient to patient. For easy understanding, the core symptoms of this disorder are explained in the box below

Common Focused body areas in BDD

The cultural norms and values may influence the focused body areas in this disorder. The features may change over time. However, researches revealed that the following are usually focused among men and women:

Six Physical Harms of BDD

People with BDD might face some physical harmful consequences due to their behaviors aimed at overcoming the perceived defects. These might include:

The patient frequently uses clothing to cover up signs of harm, such as wearing long sleeves or turtleneck shorts and full-length pants.

How much common is this disorder?

BDD affects 1.7% to 2.4% of the general population which means about 1 in 50 people in the US. It appears relatively common among patients seeking dermatologic treatment.

In Pakistan, a higher proportion of people are seen as more conscious about beauty. This results in using various skin-care products (e.g., whitening creams and cosmetics). According to a survey on the prevalence of BDD in Pakistani medical students (2008), about 78.8% of students reported dissatisfaction with some aspects of their appearance and 5.8% met the diagnosis criteria of BDD. The male to female ratio was 1.7. It’s possible that BDD is even more common than this. Because people with this disorder are often reluctant to reveal their BDD symptoms to others.

Factors Responsible for BDD

  • Psychosocial factors: Most of the bodily concerns typically start in the early teenage years which may in result negative life experiences: such as childhood teasing, parental neglect, abuse or bullying at school. Environment and culture play a significant role, especially if they involve societal pressure or expectations of beauty and negative social evaluations about body or self-image. Having perfectionist personality traits can also lead to BDD.
  • Biological factors: Physical vulnerability and genetic factors may involve in BDD, a study notes that 8% of people with BDD have a blood relative who has had this condition or obsessive-compulsive disorder at some time.
  • Neurological factors: Low level of the neurotransmitter serotonin can also influence BDD but it is not known that what role serotonin plays, however it is seen in treatment that serotonin gives some relief to the symptoms.

Treatments Options

The treatment for body dysmorphic disorder is carried out on the basis of both drug treatment and psychotherapeutic intervention:

1. Psychological Intervention

The psychotherapeutic treatment majorly involves Cognitive Behavioral Therapy (CBT) that helps the people to understand the thoughts and feelings that influence behaviors. The main goals of therapy are summarized as follows:

  • To decrease the level of distress associated with appearance concerns and compulsive behaviors by the use of psycho-education.
  • The cognitive focus of therapy is directed at challenging the negative thoughts and errors in thinking in the light of concrete evidence that the individual is having concerning his or her flawed body image and then replacing them with acceptable and real positive thoughts.
  • The behavioral focus is aimed at engaging the client in daily routine and pleasurable activities. Behavioral experiments are also a part of it in which the individual is asked to drop his or her safety behaviors that he or she used to overcome flaws and then the consequences.

2. Few Coping Statements

The following coping statements are helpful in overcoming the repeated thoughts that kept on intruding the mind concerning the body image:

  • it’s ok that I just had that thought/images, and it does mean anything. 
  • I don’t have to pay attention to it. 
  • I am ready to move on now. 
  • I have no such defect in my appearance. 
  • I don’t deserve to suffer like this. I deserve to feel comfortable, etc 

Treatment with medicine

Selective serotonin reuptake inhibitors (SSRIs) are usually prescribed by the psychiatrists, considered the first-line medication treatment for BDD. SSRIs are a type of antidepressant that works by increasing levels of serotonin within the brain. They’re considered relatively safe and cause fewer side effects than other kinds of medications. Sometimes the intensity of beliefs about body images is so severe that we need anti-psychotic drugs

Stories of People with BDD

Nicole’s story: He was 20 years old boy and he was diagnosed with BDD at the age of 19. When he was only 9 years old he thought about cutting off his nose because it was too big. He tired of the snide remarks from friends and even strangers about how big it was. He couldn’t bear to look in a mirror or have his picture taken.

On school picture days he would come home bawling because he knew that his nose would be posted everywhere. He wore a windbreaker with long sleeves so he could use the sleeve to cover up his face. He used to make fun of himself before anyone else could get to him first. He suffered from anorexia for years, as well as addiction to painkillers. He was diagnosed with BDD, along with the panic disorder. He was put on an anti-depressant that has saved him. While telling his story he said “I know no matters how many times people might tell someone with BDD that you are beautiful, you still won’t believe it. I’m still not ready to be photographed, but hopefully, with time and my therapy I will make that giant step!”

Shirley Manson: (born 1966) is a Scottish singer, musician and songwriter, lives and works in Los Angeles. In a magazine interview, she wrote her history of BDD: “I always turned up five hours late because I’d be fussing about my hair and make-up. I would change into a million different outfits and make them change the lighting a million times, I would spend two hours crying in the toilet – and whatever the result, I always thought I looked disgusting. I would look in the mirror every morning and be upset. I would get dressed and look in the mirror again, and be upset. It could be anything; I could be a too fat, too thin, too flat chest. My hands were not long enough, my neck was too long . My tummy stuck out, my bum was too big. It was driving me crazy and I was wasting energy – precious energy – that I should have been putting into my music or my family or friends”.

Franz Kafka (1883–1924) the author of Metamorphosis, his psychological autopsy reveals that he may have had BDD. He hated his appearance and wrote in his diary: “I didn’t want any new clothes at all; because if I had to look ugly anyway, I wanted to at least be comfortable. I let the awful clothes affect even my posture, walked around with my back bowed, my shoulders drooping, my hands and arms all over the place. I was afraid of mirrors because they showed an inescapable ugliness”

Michael Jackson (1958–2009) an American singer and dancer. Dubbed the “King of Pop”, he is regarded as one of the most significant cultural figures of the 20th century and one of the greatest entertainers. He possibly had BDD and many other psychological problems. He spent 30 years trying to achieve his idea of perfection. He is known for his tragic history of cosmetic surgeries, Jackson’s autopsy reported that he underwent up to 100 operations. He changed his appearance radically over the decades but he always strongly denied having numerous cosmetic procedures. He had an abusive childhood and developed an addiction to painkiller drugs and sedatives which eventually led him to death.

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