Body Dysmorphic Disorder: Signs, Symptoms, & Treatment

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Body dysmorphic disorder (BDD) is a mental health diagnosis that refers to an unhealthy and excessive preoccupation with one's physical appearance. Where someone with distorted body image would tend to focus on overall physical shape or size, those with body dysmorphic disorder place extreme focus on a particular body part or feature of their body. Thoughts of their specific flaw surface frequently and can become overwhelming, often consuming their thoughts and presenting an obstacle to their general well-being and daily functioning.

Although excessive focus and attention can be on a variety of body parts, traits or characteristics, some of the more common include:

  • Hair
  • Nose or other facial features
  • Chest
  • Genitalia
  • Muscularity or size of a body part
  • Symmetry (hair, facial features, body parts)

Many of us have areas of our body that we would like to improve, but our thoughts about this aren't necessarily persistent and intrusive, which is a key piece to the distinction between general body image concerns and the clinical diagnosis of BDD. Another important factor is that, with BDD, you're often preoccupied with a flaw or trait that is barely noticeable, even nonexistent. Features that others might see as a slight imperfection or inconvenience (or not see at all) become consuming and unbearable, to the point of threatening your quality of life.

Who Tends to Experience Body Dysmorphic Disorder?

BDD is suggested to impact about one in 50 people within the general population, which would equate to roughly 5 to 7.5 million people in the United States alone.

BDD seems to affect men and women equally, with an estimated 2.5 percent of women and 2.2 percent of men identified as having this disorder. Although BDD can show up for people at any age, many start to show signs and behaviors of the disorder around the age of 12 or 13 years old. No single cause of BDD has been identified.

This disorder is considered to be influenced by a variety of factors, such as social and interpersonal interactions, genetic predisposition, or a triggering event.

Signs of Body Dysmorphic Disorder

If you are dealing with BDD, you may often be consumed with intrusive and persistent thoughts related to a feature on your body, such as a mark, trait, or a perceived physical defect. The thoughts can show up at any time without warning and, no matter how hard you try, you likely have difficulty in stopping or changing your thoughts about the physical concern. Because of the persistence of these thoughts, it's possible you feel a significant disruption in your quality of life. The amount of distress experienced can be so intense that it becomes difficult to engage in social interactions, fulfill responsibilities such as school or work and, in extreme cases, even find it difficult to leave home.

People with BDD will often engage in repetitive behaviors in an attempt to address these physical concerns. Even though you can spend anywhere from three to eight hours or more per day on these behaviors, any relief is often short-lived. If you think a loved one may be dealing with BDD, some of the behaviors they may be demonstrating include:

  • Skin picking
  • Excessive use of makeup
  • Clothing to hide certain body parts or features
  • Repeatedly checking appearance in mirrors
  • Excessive grooming
  • Changing body positions frequently
  • Wearing accessories such as hats, scarves, and gloves
  • Seeking cosmetic surgery or other procedures
  • Over emphasizing other body parts or physical traits
  • Seeking excessive reassurance from others about that trait or body part

Other Mental Health Disorders That May Occur With Body Dysmorphic Disorder

Overlap has been shown to exist between BDD and other mental health disorders, particularly anxiety disorders such as generalized anxiety, OCD, and social phobia.

In fact, BDD is currently categorized among the Obsessive Compulsive Disorders. Research has shown that over 60 percent of patients with BDD have a lifetime anxiety disorder and 38 percent had identified social phobia. The preoccupation with a perceived physical flaw can leave people feeling isolated and apprehensive of any social interaction, leading to feelings of hopelessness and depression.

Although unhealthy body image is often associated with eating disorders, it is important to point out that body dysmorphia is not necessarily related to weight or weight loss. For many with BDD, the focus is on a body part such as the nose, hair, or scars—things that eating disordered behaviors would not change or influence. When the obsessive focus for someone is related specifically to the size of a body part, such as the thighs or midsection, eating disordered behavior may take place in an effort to address that perceived flaw. It is estimated that about 12 percent of those with BDD also meet the criteria for eating disorders such as anorexia and bulimia.

Clinical Symptoms of Body Dysmorphic Disorder

To avoid appearing vain or not being taken seriously by their healthcare provider, people with BDD may suffer for a period of time before coming forward and seeking help. Even then, they often disclose their concerns to a healthcare professional such as a dermatologist, reconstructive surgeon, or dentist, rather than a psychiatrist or other mental health practitioner. People with BDD often fear judgment from others even though their level of distress is so high that it severely impacts their quality of life and relationships.

In order to be clinically diagnosed with BDD, the following criteria must be met:

  1. Preoccupation with appearance. Not only must the person be preoccupied with appearance, it is important to note that the focus of their attention is on a slight imperfection, something barely observable or noticed by others or nonexistent. In order to be considered "preoccupied" with the perceived flaw, the person would be engaging in the obsessive thoughts about their flaws for hours a day.
  2. The person must engage in a repetitive behavior in an effort to "fix" the perceived flaw. The repetitive behaviors are demonstrated in an attempt to conceal, fix, or respond to the focus of the obsessive thought. For example, someone may repeatedly look in the mirror, pick at their skin, change their clothes, reapply makeup, excessively ask others for reassurance, etc.
  3. The obsessive thoughts and repetitive behaviors must be clinically significant. In other words, the distress that the person experiences must be to the point that their quality of life is significantly impaired. The person's social life, occupation (school or work) and other important areas of their life must be impacted drastically as a result of these thoughts and behaviors.

Body dysmorphic disorder can be easily misdiagnosed as another mental health disorder, so it is important for a properly trained clinician to do a thorough diagnostic assessment to avoid misdiagnosing BDD as one of the following:

What Treatment Is Available for Body Dysmorphic Disorder?

If you or a loved one are dealing with BDD, you may feel reluctant to start therapy or counseling. It's very common—even in those without BDD—to believe that psychological treatment is not an adequate solution to your concerns. In fact, it is likely that you will have already sought out help in other ways, such as with makeup, hair and clothing consultants, plastic surgeons, aestheticians, dermatologists, and dentists (depending on the body feature in question). Those with BDD want their physical "problem" addressed. They want the perceived flaw to be fixed, transformed, or removed. It may feel daunting, but psychological treatment can be very beneficial, addressing any thoughts and feelings around these physical concerns.

One approach that has shown to be effective in the treatment of BDD is cognitive behavioral therapy (CBT). CBT is a first line treatment for BDD. It involves changing the maladaptive thoughts and beliefs present in the disorder. It can also involve exposure techniques that aim to decrease the repetitive behaviors and thoughts around the bodily preoccupations. Additionally, the use of medications, specifically selective serotonin reuptake inhibitors (SSRIs), have been shown to be an effective in decreasing some of the symptoms of BDD. These medications are often used most effectively in combination with Cognitive Behavioral Therapy (Porter, 2017). It is important that those with Body Dysmorphic Disorder allow themselves adequate time for psychotherapy to be effective.

Goals of Treatment

Physical safety is key in the treatment of BDD. By the time an individual has started counseling or therapy, it is likely that they have already shown some physically unhealthy coping behaviors such as excessive skin picking or hair pulling, for example. These behaviors can leave you and your loved ones feeling no hope that the situation can change. It is important that this behavior is seen as not only harmful to one's well-being, but also ineffective in accomplishing the goal of "fixing" a perceived flaw.

A Word From Verywell

Social comparison is a big challenge for many of us, and even more so if you're dealing with BDD. Because of insecurities around physical characteristics and a tendency to judge ourselves so harshly, being around others can be challenging and intimidating. For example, you may be critical about the shape of your nose and find yourself comparing your nose to those of others in the room, criticizing and judging yourself even more. CBT can help interrupt and challenge those unhelpful thought patterns.

If you or a loved one are dealing with Body dysmorphic disorder, acceptance of self will be paramount to any treatment. After spending so much time focused on personal flaws, the idea of self-acceptance can feel foreign and sometimes even impossible but, with the help of treatment, it can be possible to challenge debilitating thoughts and unhealthy behaviors, improve your self-talk, and come to a place of greater acceptance and self-compassion.

Sources:

Hartman, A., Greenberg, J. & Wilhelm, S. (2007). A therapist’s guide for the treatment of body dysmorphic disorder. Retrieved October 11, 2017 from https://bdd.iocdf.org/professionals/therapists-guide-to-bdd-tx/

Koran, L.M., Abujaoude, E., Large, M.D. & Serpe, R. T. (2008). The prevalence of body dysmorphic disorder in the United States population. CNS Spectrum. April; 13(4): 316-22.

Muffadel A, Osman O, Almugaddam, F, Jafferany, M. Body dysmorphic disorder: A brief review and presentation in different clinical settings. Primary Care Companion to CNS disorders. 2013; 15(4):1464

Phillips, K. (2017). Diagnosis and clinical assessment of BDD. Retrieved October 11, 2017 from https://bdd.iocdf.org/professionals/diagnosis/

Porter, D. (2017). Body dysmorphic disorder DSM-V 300.7. Retrieved October 11, 2017 from https://www.theravive.com/therapedia/body-dysmorphic-disorder-dsm--5-300.7-(f45.22)

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