What is Body Dysmorphic Disorder?
Body Dysmorphic Disorder (BDD) is an obsessive-compulsive disorder. It features preoccupation with one or more perceived defects or flaws in one’s physical appearance. These flaws tend to be self-perceived, and in reality may appear insignificant or even non-existent to others. Commonly perceived flaws involve the skin (e.g. acne), hair (e.g. balding), nose (e.g. size or symmetry). However, any other body part can be the subject of BDD, such as the teeth, stomach, genitalia or legs. Their preoccupation with these perceived bodily flaws usually lead them to compulsive behaviours such as skin picking [1].
These obsessive thoughts and resulting compulsive behaviours tend to affect daily functioning. For example, an individual might be unable to go to work as he feels like others will judge his bad appearance. Having BDD also increases one’s risk of developing certain mental disorders, such as mood, anxiety and eating disorders. Individuals with BDD might even develop suicidal tendencies due to the condition [2].
BDD occurs equally in both men and women. It is typically a long-term disorder that begins during one’s teen years or early adulthood.
Symptoms of Body Dysmorphic Disorder
Cognitive Symptoms
- Preoccupation with a perceived flaw that is otherwise insignificant or nonexistent to others
- Belief that others are paying special attention to these perceived flaws
- Belief that these perceived flaws make one ugly
- Comparison of appearance with that of others’
Behavioural Symptoms
- Engagement in repetitive behaviours to “fix” one’s perceived flaw, e.g. mirror checking, excessive grooming, and skin picking
- Constant seeking of reassurance from others on one’s appearance
- Hiding perceived flaws through makeup, clothing, accessories, etc.
- Undergoing cosmetic procedures like plastic surgery [3]
Causes and Risk Factors of Body Dysmorphic Disorder
There is no established cause or set of causes for BDD; researchers suggest that the condition arises from a combination of genetic and environmental risk factors such as [4]:
- Relation to family members with BDD or other related conditions
- Experiencing of traumatic events or emotional conflict during childhood, such as neglect or abuse
- Personality traits like high neuroticism
- Low self-esteem
- Association with parents and peers who were critical of the individual’s appearance
- Other mental disorders such as social anxiety or Major Depressive Disorder
Treatment of Body Dysmorphic Disorder
Typically, mental health professionals will suggest therapeutic methods to treat mild BDD, only prescribing medication when BDD is severely affecting an individual.
Cognitive Behavioral therapy (CBT)
CBT teaches individuals with BDD to rationalise negative feelings and thoughts surrounding their appearance and reframe these negative thinking patterns. By going through this process, patients are then able to replace their maladaptive rituals with alternate positive behaviours. Patients are also taught to recognise the triggers of their behaviour to learn when to actively reframe their thoughts and behaviour.
CBT for BDD typically includes exposure and response prevention, where patients are exposed to situations that trigger their preoccupation with their appearance. These exposures increase in intensity, with the therapist guiding the patient on how to respond in a positive manner, both cognitively and behaviourally [5].
Medication
Mental health professionals believe that BDD is related to mood-determining hormones. Thus, antidepressants, particularly selective serotonin reuptake inhibitors (SSRIs), can help relieve the obsessive and compulsive symptoms of BDD. Most commonly, the SSRI fluoxetine is used to treat BDD; in extremely severe cases where both CBT and medication does not reduce symptoms, clomipramine may be prescribed [6].
It may take up to 4 months for the effects of SSRIs to become evident. In the early stages of treatment, patients might experience side effects such as anxiety, indigestion, dizziness and constipation. Doctors will also pay special attention to patients under 30 as they might develop thoughts of self-harm during early treatment with SSRIs [7]. Due to these side effects, professionals only consider SSRIs when CBT has failed as a first-choice treatment method.
FAQ
1. What’s the difference between Muscle Dysmorphia and BDD?
Mental health professionals consider Muscle Dysmorphia as a subset disorder of BDD. It occurs almost exclusively in males, involving a specific preoccupation with one’s muscularity. Sufferers of Muscle Dysmorphia are preoccupied with the thought that they are not muscular enough, leading to maladaptive behaviour like excessive exercise and the consumption of steroids.
2. Will plastic surgery resolve BDD?
It is unlikely that plastic surgery will “cure” one’s BDD – in fact, less than 10% of people with BDD who undergo plastic surgery are happy with the results [7]. This further points towards the nature of BDD as a psychological issue rather than an issue about physical flaws. It is common for BDD sufferers to face deeper root struggles with identity, standards and expectations of beauty, hurt and past trauma and more. Counselling support, rather than the correction of physical appearances, more holistically deal with these issues.
