Body Dysmorphic Disorder / BDD
Body Dysmorphic Disorder (BDD) is listed in DSM-5 as an OCD Related Condition. It is characterized by an excessive preoccupation with a non-existent or trivial flaw one or more physical characteristics. It shares many similarities with Obsessive Compulsive Disorder (OCD) in that individuals with both conditions experience obsessions and compulsions; in BDD, of course, they are related to appearance. For example, someone with BDD may have a compulsion to repeatedly check the way his or her nose looks in a mirror. Even more so than in OCD, the belief in the defect is very strongly held. In fact, individuals with BDD may believe so strongly in the defect that they can appear virtually delusional. BDD was once thought of as “imagined ugliness” (dysmorphophobia), but it is more about overvaluing the importance of certain physical characteristics, and magnifying the ramifications if they are not. There is good evidence that people with BDD actually have true perceptual problems. Thus, believing the people who have it are just “vain” or “making things up” is not accurate
The focus of BDD could be 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.
(BDD by proxy is a subtype of this condition in which the person is focused on perceived flaws of other people, as opposed to themselves. Another subtype is Muscle Dysmorphic Disorder, which is sometimes referred to as bigorexia, reverse anorexia, or the Adonis Complex. Most sufferers are male, but females may be affected too. As the name implies, those with this form of BDD are drastically over-concerned with developing their musculature, and typically perceive themselves as lacking a good physique or being “too small,” no matter how highly muscled they really are. People suffering from Muscle Dysmorphic Disorder are at risk for injury from excessive exercising, as well as for abusing steroids.)
Individuals with BDD 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. They also may try to “disguise” the perceived problem, with certain clothes, hairstyles, or hats. Unfortunately, these behaviors typically only serve to reduce the discomfort temporarily. In fact, BDD is 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 often 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 and limit their ability to function in everyday activities. Young people with BDD often cannot participate effectively in school or in extracurricular activities. Depression and frustration are common in BDD. Suicidal risk in BDD is always a concern, as for some, living with the defects they becomes too much to bear at times.
Psychological treatment for BDD focuses upon reducing body-focused obsessions and compulsions, re-structuring erroneous and self-defeating thought patterns, and improving ability to function in life despite appearance concerns. Addressing the emotional distress and risk factors of these individuals is also essential. Psychotherapy and medications are often used together in the treatment of BDD. Medications are often essential in addressing the cognitive and perceptual symptoms of BDD. Teaching family members and friends to understand and cope with someone who has BDD is also 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.