What is body dysmorpiic disorder (BDD) ?
BDD is a condition where the sufferer is preoccupied with an imagined defect, or a slight imperfection, in their appearance. Although many people are concerned about some aspect of their appearance, body dysmorphic disorder sufferers concern about their appearance is considered excessive and their appearance worries significantly negatively impact upon their ability to work, socialize or carry out activities of daily living. BDD sufferers often seek treatment from dermatologists and cosmetic and plastic surgeons in an effort to reduce their perceived ugliness. Many people do not get appropriate treatment (be it cognitive behavioural therapy and/or medication) as they are too embarassed and ashamed to tell their doctor they are so worried about some aspect of their appearance. Some people with BDD will have cosmetic surgery and, even if the surgery would be considered successful by the average person, they may not be happy with the outcome and even go onto have further procedures on the same area.
What causes body dysmorphic disorder?
As yet it is not fully understood what causes the condition and researchers have developed neuroanatomical, neurochemical, genetic and cognitive behavioural models to explain BDD. Research indicates that a number of factors may be involved in the etiology of BDD and that they may occur in combination.
Genetics appears to play a role in the development of body dysmorphic disorder, with family members of BDD sufferers having a prevalence rate of that is 4-8 times that of the general population.
Another cause of body dysmorphic disorder is thought to be a chemical imbalance in the brain, involving the neurotransmitter seratonin.
There have also been several cognitive behavioural models developed which comceptualise body dysmorphic disorder as being the result of maladaptive thoughts and beliefs that overemphasize the importance of perceived beauty.Sufferers place too much importance on being physically attractive and therefore evaluate themselves unfavorably which results in feeling of anxiety, shame, sadness and low self esteem. Body dysmorphic disorder sufferers engage in maladaptive behaviours such as: excessive gazing in mirrors, comparing their perceived body defect/s to those body parts of other people, camouflaging their body part and avoiding social situations.
When does body dysmorphic disorder start?
The condition generally starts in adolescence or early adulthood. The average age of onset is approximately 16 years of age.
Who gets body dysmorphic disorder?
Men and women appear to affected by BDD with near equal frequency.However women tend to be worried about the appearance of their legs and breasts whereas men are more likely to worry about the size of their muscles.
believing that they re not muscular enough.
What percentage of the population has body dysmorphic disorder?
The condition affects approximately 1-2% of the population.
What are some of the disorders body dysmorphic disorder could be misdiagnosed as?
- Anorexia Nervosa
- Obsessive Compulsive Disorder
- Conversion Disorder
- Delusional Disorder
- Major Depression
- Social Anxiety
- Medical condition (e.g. brain tumour)
What other diagnoses may body dysmorphic sufferers have?
- Obsessive Compulsive Disorder
- Major Depression
- Social Anxiety
N.B. This list is not exhaustive.
Body dysmorphic disorder sufferers may be concerned about the appearance of their:
- buttocks etc.
Please note this is not an exhaustive list of BDD complaints.
BDD sufferers may be focused on one or more body parts simultaneously.
How does body dysmorphic disorder affect sufferers lives, what are the symptoms?
The condition may be mild and therefore the person can still function reasonably well despite feeling stressed about their appearance. However, people with severe BDD may be housebound and unable to work or socialise and even end up committing suicide.
BDD sufferers may spend an excessive amount of time checking their appearance in mirrors, shops windows etc.
They may also spend time comparing their body parts to those of other people by, for example, looking at magazines.
BDD sufferers may spend an excessive amount of time grooming themselves. E.g combing their hair, plucking hairs, applying makeup etc.
BDD sufferers may ask others for reassurance about their appearance, e.g. “ Does my bottom look big in these jeans?”, but any relief gained from such reassurance is only temporary.
Some BDD sufferers are so distressed about their appearance that they may not venture out of the house, except at night, for fear of being seen. Body dysmorphic disorder sufferers may be unable to work and may avoid job interviews because of their appearance. They may lack friends and avoid dating. For example, a balding man may avoid dating because he fears a date would try to run her hands through his hair. He may avoid an invitation to go swimming because it would highlight his hair loss.
BDD sufferers may spend a lot of time trying to camouflage their imagined ugliness, e.g. a slight build may be disguised with layers of clothes, an imperfect complexion may be camouflaged with foundation and concealer, thinning hair may be masked by wigs, hats, hair products etc. Some sufferers who are concerned about their complexion would never let themselves be seen without makeup (e.g. going to bed with their makeup on), whilst those concerned with hair loss may never been seen in public without a hat.
BDD sufferers may resort to cosmetic surgery in an attempt to remedy their perceived defect, e.g. botox for wrinkles, liposuction for fat thighs and buttocks. However, post surgery they may be dissatisfied with the results and undergo repeated procedures on the same area. Following surgery BDD sufferers may find that then become preoccupied with the appearance of another body part.
Body dysmorphic disorder sufferers may end up hospitalised and they have high rates of suicidal thoughts and suicide attempts.
Body Dysmorphic Disorder Treatment
The condition may be treated with SSRI anti-depressant medication and/or cognitive behavioural therapy. CBT can be done individually or in groups.
Cognitive behavioural therapy entails the sufferer identifying and challenging their unhelpful, false thoughts and beliefs about their appearance and developing more realistic self talk. BDD sufferers are also encouraged to expose their body part/s in social situations where they have previously hidden their body part. E.g. a woman who does not like her complexion may have always worn makeup 24 hours a day whether or not she was at home or out in public. In therapy she would be encouraged to develop a exposure hierarchy, where she gradually started wearing less make up at home around her family and eventually she would progress to not wearing makeup outside in the prescence of strangers. A bald man who always wore a hat whether indoors or outdoors would gradually start taking his hat off in social situations. If body dysmorphic disorder sufferers are compulsively checking their appearance in mirrors, engaging in excessive grooming and comparing their perceived defects with others to the extent that hours of time are being wasted per day and the person is not able to get on with their activities of daily living, treatment may also involve response prevention.
Drug Treatment for Body Dysmorphic Disorder
SSRI antidepressant medication is commonly used to treat the condition. Some of the SRRI’s used include:
- Escitalopram (Lexapro)
- Fluoxetine (Prozac)
- Fluvoxamine (Luvox)
Other drugs such as: neuroleptics, lithium, trazodone, tricyclic antidepressants (excluding clomipramine), benzodiazepines and anticonvulsants have been used to treat BDD but have been found either not to be efficacious or as beneficial.
Famous people with body dysmorphic disorder or suspected to have had the condition.
Shirley Manson, lead singer of Garbage divulged in “Glamour” magazine that she had issues with her appearance since childhood.
Actor, Uma Thurman has also been interviewed and admitted to having issues with her appearance.
Michael Jackson may have had body dysmorphic disorder as he had multiple cosmetic procedures on his nose, chin facial structure and skin tone.
Marilyn Monroe is also thought to have possibly had bdd as she reportedly spent hours looking at her face in the mirror trying to make herself look better.
Andy Warhol’s diaries indicate that he was worried about baldness, and ageing and that as an adolescent he was very concerned about acne.
Melbourne Psychologist Catherine Madigan provides treatment for body dysmorphic disorder.
If you are having body image issues and want to love they way you are, call (03) 98193671 and book an appointment with a trained clinical psychologist.
Please note, it is important to consult a qualified mental health practitioner such as e.g. a psychologist or psychiatrist to confirm any diagnosis you think you might have. You must not rely on the information on this site as a substitute for professional medical advice, diagnosis or treatment. No assurance can be given that the information on this site will always include the most recent developments or research with respect to a particular topic.
Diagnostic and Statistical Manual of Mental Disorders (DSM-IV)
Psychiatric Mannifestations of Body Dysmorphic Disorder, Author: Iqbal Ahmed 2010