Body Dysmorphic Disorder

Body Dysmorphic Disorder (BDD) is the term used to describe a condition where a person imagines and fully believes that an aspect of his or her body is disfigured or defective when, in fact, it is not. The disorder interferes with the person’s daily functioning. Body Dysmorphic Disorder affects men and women equally. BDD is also sometimes seen in children.

A person with Body Dysmorphic Disorder is not distressed about the imagined “defect” for vanity reasons. Instead the person believes that the defect equates to not being good enough or to being ugly or hideous. The person will hold on to distressing, unfounded beliefs about his or her appearance no matter how attractive the person actually is. A person with Body Dysmorphic Disorder is usually concerned with perceived defects involving the hair, skin and nose.

How does the disorder develop?

As with most mental health disorders, Body Dysmorphic Disorder develops for a number of different reasons. It usually begins in adolescence. Researchers are not entirely sure of the cause(s) of BDD but it is known that BDD is influenced by environment, by other existing mental health conditions and by certain personality traits.

Environmental Influences

• Extreme criticism, teasing, bullying or verbal abuse during childhood
• Physical or sexual abuse
• Trauma or neglect
• Unrealistic images and influences of mass media
• Upbringing involving extreme focus on outward appearance
• Upbringing involving very little or no focus on outward appearance

Mental Health Influences

• Anxiety Disorders
• Avoidant Personality Disorder
• Borderline Personality Disorder
• Dependent Personality Disorder
• Drug or alcohol abuse
• Eating Disorders
• Major Depression
• Obsessive Compulsive Disorder

Personality Influences

• Avoidant, introverted, shy
• Chronic low self esteem
• Chronic negative thinking
• Neurotic
• Non-assertive
• Overly sensitive
• Perfectionist
• Schizoid personality

Consequences

Body Dysmorphic Disorder brings with it many obsessive-compulsive thoughts and behaviors that sometimes serve to protect the person from being seen, embarrassed or ridiculed by others. Those thoughts and behaviors include:

• Anxieties and phobias such as social anxiety, social phobia, agoraphobia and panic attacks
• Attempts to hide the defect (make up, clothing, hats, etc)
• Compulsion to look in or avoids mirrors and other reflective surfaces
• Compulsion to touch the defect
• Difficulty with relationships, romantic and otherwise
• Distracting others to avoid attention to defect
• Excessive grooming
• Extreme self-consciousness
• Hostility towards opposite sex
• Inability to look at self in photos
• Obsession with finding information related to the defect
• Obsession with looking like a specific famous person
• Poor work history or work performance because of obsession with appearance
• Self harm
• Social and family withdrawal and isolation including hostility towards family members
• Staying at home or leaving only at certain times
• Strong feelings of shame
• Suicidal thoughts
• Unnecessary attempts to modify outside appearance (over-exercising, cosmetic surgery)
• Unnecessary dependence on others or excessive need for reassurance

A person with BDD will often undergo plastic surgery to fix the imagined defect. The person is never satisfied with the results and might continue to request more and more surgeries. Occasionally a person with BDD will try to fix the defect and perform cosmetic procedures on her his or her own body. In some cases, plastic surgery can lead to psychosis in a person who has Body Dysmorphic Disorder.

Suicidal thoughts are common among people with BDD and suicide in this population is significantly higher than that of the general population.

Treatment for Body Dysmorphic Disorder

Quality of life for a person suffering with Body Dysmorphic Disorder is severely decreased if professional treatment is not received. Women are more apt to pursue treatment for BDD than men are. A combination of Cognitive Behavioral Therapy and anti-depressant medication has shown some success in treating the disorder.