Body Dysmorphic Disorder

1 What is Body Dysmorphic Disorder?

Body dysmorphic disorder (BDD), also referred to as a body-image disorder or dysmorphophobia involves the fear of having a deformity.

It is a chronic mental illness in which the affected person gets continually preoccupied thinking about an imagined or slight defect in the physical appearance, which others cannot see.

BDD usually develops during one's adolescence and teenage years, and it affects both the genders equally.

Individuals with BDD consider themselves to be ""ugly"", and often tries to avoid being seen by anyone.

This perception causes a significant amount of emotional distress and inability to perform daily activities.

People with BDD may start disliking any of their body parts, but most often they find flaws with their skin, hair, nose, stomach, and chest portion.

In order to get rid of this perceived flaw, they seek several cosmetic surgical corrections or perform vigorous exercises.

Treatment of BDD may include medications and cognitive behavioral therapy.

2 Symptoms

Signs and symptoms of Body Dysmorphic Disorder (BDD) can include the following:

  • Being obsessed about your physical appearance for hours together or up to an entire day
  • Frequent examination of self in the mirror, or otherwise, avoidance of mirrors altogether
  • Strong belief that you have an abnormality or defect in your appearance that makes you ugly
  • Staying housebound and avoidance of social situations
  • Seeking frequent reassurance about your appearance from others
  • Lack of focus on anything except for your imagined flaws
  • Frequent plastic surgeries with no satisfaction
  • Excessive grooming, such as hair plucking or skin picking, or performing excessive exercises in an attempt to improve the flaw
  • Growing a beard or wearing excessive makeup or clothing to camouflage your perceived flaws
  • Comparing your appearance with that of others
  • Being reluctant to appear in pictures
  • Low self-esteem
  • Extreme self-consciousness leading to absence from school or work

Feeling ashamed and embarrassed about your appearance may lead to avoidance of seeking treatment for BDD.

This disorder does not get better on its own and if left untreated, it may get worse as time passes, and provoke suicidal thoughts and behavior.

Therefore, if you have any signs or symptoms of BDD, consult your doctor, mental health provider or other health professional.

3 Causes

The exact cause of body dysmorphic disorder (BDD) remains obscure.

As with many other mental disorders, BDD may occur due to a combination of various factors such as:

  • Brain differences: Abnormalities in the structure or functioning in certain areas of the brain that perceives information regarding appearance.
  • Genes: Studies have shown that BDD is more common in people whose biological family members have the condition, indicating that there may be at least one gene associated with this disorder.
  • Environment: Your surroundings, past life experiences and culture may contribute to BDD, especially if there were negative experiences such as bullying or abuse about your body or self-image during childhood.

4 Making a Diagnosis

Making a diagnosis of body dysmorphic disorder is done by several tests.

Although you may initially discuss concerns with your family health provider, you will also be referred to a mental health provider such as a psychiatrist or psychologist for further evaluation and treatment.

Actively participate in your care as it will help you manage your condition better.

Know your needs and goals for treatment.

Also, write down a list of questions to ask your doctor, such as:

  • Why can't body dysmorphic disorder resolve on its own?
  • How is body dysmorphic disorder treated?
  • Is psychotherapy helpful?
  • Are there any medications that may help?
  • How long is the course of treatment?
  • What self-care steps can I take?

Your mental health provider may ask you a number of questions regarding your mood, behavior, thoughts, and your perception about your appearance.

These questions may include:

  • Are you seriously concerned about your appearance?
  • When did you start thinking about your appearance?
  • Is your daily life affected by your thinking?
  • How much time each day do you spend thinking about your flaws?
  • Have you had any cosmetic procedures or other treatment?
  • What have you tried on your own to feel better and control your symptoms?
  • What things make you feel worse?
  • Have friends or family commented on your mood or behavior?
  • Do you have any relatives with a mental illness?
  • What do you expect from treatment?
  • What medications, herbal remedies or supplements do you take?

If your mental health provider suspects that you may have BDD or another mental illness, a series of medical and psychological tests will be ordered to derive a diagnosis.

Types of testing

  • Physical examination: This helps rule out other problems that may be associated with your symptoms.
  • Laboratory tests: Laboratory tests may be ordered by your doctor if necessary, based on your overall health, and problems associated with your symptoms.
  • Psychological evaluation: A mental health provider discusses your symptoms, thoughts, feelings and behavior patterns. You may also talk about thoughts of self-harm if they are present.
  • Pinpointing which condition you have: Sometimes, it can be difficult to accurately diagnose BDD, as it appears similar or your symptoms overlap with other psychological conditions such as an eating disorder or obsessive-compulsive disorder. Also, you may be so embarrassed about your appearance that you may avoid seeking medical help, or do not reveal your true thoughts to your doctor. It may take some time and effort to derive an accurate diagnosis so as to determine an appropriate treatment method.

Diagnostic criteria for BDD

To be diagnosed with BDD, you must meet the symptom criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM).

This manual, published by the American Psychiatric Association, is used by mental health providers to diagnose mental illnesses and by insurance companies to reimburse treatment expenses.

Symptom criteria required for a diagnosis of BDD include:

  • Extreme preoccupation with an imaginary defect or a minor flaw in your appearance
  • Significant emotional distress or problems in your social life, at work, school or other areas of functioning

5 Treatment

Treatment of Body Dysmorphic Disorder (BDD) can be difficult, particularly if you do not participate actively in your care.

Often, treatment for BDD involves a combination of cognitive behavioral therapy and medications.
  

Cognitive behavioral therapy
     

Cognitive behavioral therapy focuses on:

  • Making you aware of your condition, feelings, thoughts, moods, and behavior
  • Using the insights and knowledge gained through psychotherapy to avoid automatic negative thoughts and to think of yourself in a more realistic and positive way
  • Learning healthy ways of controlling urges such as mirror checking or skin picking
  • Inculcating healthy behaviors such as socializing with others

You can talk to your therapist to find out which type of therapy is best for you, your goals for therapy, and other issues, such as the number of sessions required, and the length of treatment.

Medications
     

Although there are no medications specifically approved by the Food and Drug Administration (FDA) to treat BDD, psychiatric medications used in treating depression can be effective.

  • Selective serotonin reuptake inhibitors (SSRIs): As BDD is believed to be a result of problems related to the brain chemical serotonin, SSRIs are generally prescribed. SSRIs appear to be more effective than other antidepressant medications, and may help control your obsessions and repetitive behaviors. Your doctor may gradually increase your dose so that you can tolerate the medication and possible side effects.
  • Other medications: Sometimes, you may benefit from taking medications in addition to your primary antidepressant. For instance, your doctor may prescribe an antipsychotic medication along with an SSRI if you have delusions associated with BDD.
  • Hospitalization: In cases where the symptoms of BDD are very severe, psychiatric hospitalization may be required. Psychiatric hospitalization is recommended only when you are unable to care for yourself properly or when you are in a danger of causing harm to yourself.

6 Prevention

There is no known way to prevent body dysmorphic disorder (BDD).

It is better if BDD is identified at an early stage, and treatment should be initiated as soon as the symptoms appear.

Long-term maintenance therapy helps in preventing recurrence of symptoms of BDD.

In addition, encouraging patients to have a healthy and realistic attitude regarding their body image may prevent development and worsen BDD.

7 Lifestyle and Coping

Lifestyle modifications are necessary in order to cope with body dysmorphic disorder.

In most cases, BDD symptoms do not resolve without professional help.

However, you can take some measures for yourself that build on your treatment plan, such as:

  • Strictly adhere to your treatment plan: Do not miss your therapy sessions, even if you do not feel like attending.
  • Take your medications as directed: Even if you start feeling well, do not skip your medications. If you stop the medicine, symptoms will come back. You may also experience withdrawal-like symptoms after discontinuing a medication suddenly.
  • Awareness about your condition: Education about BDD can empower you and motivate you to adhere to your treatment plan.
  • Learn about your warning signs: Learn what might trigger your symptoms. Make a plan so that you are aware of managing the situation if symptoms return. Contact your doctor or therapist if you note any changes in symptoms or how you feel.
  • Be active: Physical activities and exercise can help manage various symptoms such as depression, stress and anxiety. Physical activity may counteract the effects of some psychiatric medications that cause weight gain. Consider walking, jogging, swimming, gardening or taking up another form of physical activity that you are interested in.
  • Avoid drugs and alcohol: Alcohol and illegal drugs worsen mental illness symptoms or negatively interact with your medications.
  • Get routine medical care: Do not avoid checkups or skip visits to your family doctor, specially if you are not feeling well. You may have a new health problem that needs to be treated, or you may be experiencing side effects of medication.

An understanding and supporting environment helps to reduce the severity of your symptoms and to cope up with the disorder better.

Discuss with your therapist ways to improve your coping skills and ways to focus on identifying, monitoring, and changing the negative thoughts about your appearance.

Specific coping tips for BDD

  • Consider writing in a journal: This can help express your pain, anger, fear and other associated emotions.
  • Avoid being isolated: Try and participate in normal activities and get together with your family or friends regularly.
  • Take better care of yourself: Eat a healthy, balanced diet, stay physically active and get sufficient hours of sleep.
  • Read reputed self-help books: Consider discussing them with your doctor or therapist.
  • Consider joining a support group: Support groups can help you connect with other people facing similar challenges.
  • Focus on your goals: Recovery is an ongoing process. Stay motivated by concentrating on your recovery goals.
  • Relaxation and effective stress management: Try stress-reduction techniques such as meditation, Yoga or tai chi.
  • Avoid making important decisions when you are in despair or distress: You may not be able to think properly and may regret your inappropriate decisions later.

8 Risks and Complications

Certain risk factors are involved in the development of body dysmorphic disorder (BDD), which include:

  • Family history: Having a biological relative with a diagnosis of BDD
  • Negative experiences during childhood such as bullying and teasing
  • Personality traits, including low self-esteem
  • Societal pressure or expectations of beauty
  • Having another psychiatric disorder, such as anxiety or depression

BDD usually starts during adolescence, and it affects both males and females.

Complications that BDD may cause or be associated with include:

While it may seem that a procedure to correct your perceived flaw is a good option, skin procedures, cosmetic surgery, dentistry or other approaches usually do not relieve the stress of BDD.

You may not get the results you expected, or you may simply begin obsessing about another aspect of your appearance and seek out more procedures.

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