Psychological Conditions

Body Dysmorphic Disorder (BDD)

People with Body Dysmorphic Disorder (BDD) often hide or are in denial about the true nature of their condition. They may desperately seek relief from cosmetic surgeons or dermatologists long before consulting with mental health professionals. They may be embarrassed to tell others about what they are experiencing for fear of being thought vain or “crazy”. BDD can be extremely serious with an elevated risk of self-destructive thoughts or behaviors. This condition is also associated with a variety of problems in social and emotional adaptation that compound the problem.

Technically, BDD is a Somatoform Disorder as per the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision (DSM IV-TR). It specifically involves an excessive preoccupation with one or more physical characteristics. Although this condition is classified as a Somatoform Disorder, it shares many similarities with Obsessive Compulsive Disorder in that individuals with both conditions experience obsessions and compulsions relating to their appearance. For example, someone with BDD may have a compulsion to repeatedly check the way his or her nose looks in a mirror. Individuals with BDD have obsessions about either an imaginary defect in their appearance or an exaggeration of a defect that to others seems inconsequential. Unique to BDD, the obsession or preoccupation regarding this imaginary or exaggerated defect predominates any other obsession. Even more than with Obsessive Compulsive Disorder, the belief in the defect is very strongly held. Individuals with BDD may believe so strongly in the defect that they can appear virtually delusional. BDD was once thought of as “imagined ugliness” but it is more about perfectionism or, in other words, believing that appearance should be flawless.

BDDers may become extraordinarily concerned about most any body part although some are more typical to have issues about than others. The shape of their head, their breasts, their genitals, skin, teeth, nose, and hair are some examples of possible problem areas. Further examples of imagined or exaggerated physical defects include that one’s body is disfigured, that one’s body has scars or marks, that their body is aging extraordinarily fast, that a body part is too large or too small, or that body parts are asymmetrical.

Individuals with BDD also engage in compulsive behaviors that are performed in an attempt to reduce the discomfort aroused by the obsessive belief in a perceived defect in their appearance. People diagnosed with BDD may repetitively seek reassurance from others about their appearance, have multiple surgeries to alter their appearance, or attend many doctor’s appointments to address their appearance. Unfortunately, these behaviors typically only serve to reduce the discomfort temporarily. In fact, BDD may become reinforced and worsened because this temporary relief creates a vicious cycle.

 

Over time, individuals with BDD encounter many difficulties due to their strong belief in a defect in their appearance and the associated compulsions done to reduce the discomfort related to the obsession. They may learn to avoid interacting with people due to negative feelings elicited by their belief in the physical defect. Not only do these individuals tend to avoid socializing, their obsessions and compulsions may consume an enormous amount of time, thus, limiting their ability to carry out even common everyday activities such as caring for their home and working. Young people with BDD often cannot function effectively in school or participate in extracurricular activities. It is no surprise that BDDers often are frustrated and anxious as well as depressed.

Treatment for BDD is focused upon reducing body-focused obsessions and compulsions, re-structuring erroneous and self-defeating thought patterns, and improving the ability to function in life despite appearance concerns. Addressing the emotional distress of these individuals is also essential. Both psychotherapy and medications may be used in the treatment of BDD. Teaching family members and friends to understand and cope with someone who has BDD is often very helpful, as is attending support groups. However, it needs to be recognized that when BDD is very severe intensive treatment may be the only realistic option.

Despite the difficulties presented by BDD there are many who can make improvements in treatment. Sometimes the most important steps are the first- willingness to accept that BDD is the problem and keeping an open mind about therapeutic interventions.