Did you ever wish you could change part of your appearance? Maybe the size of your nose or the way your ears stick out? Most people fantasize about improving something, but some relatively normal-looking people think they are so ugly they refuse to interact with others or otherwise function normally for fear that people will laugh at their ugliness. This curious affliction is called body dysmorphic disorder (BDD). And at its center is a preoccupation with some imagined defect in appearance by someone who actually looks reasonably normal.
BDD was considered a somatoform disorder because its central feature is a psychological preoccupation with somatic (physical) issues. OCD often co-occurs with BDD and is found among family members of BDD patients.
People with BDD complain of persistent, intrusive, and horrible thoughts about their appearance, and they engage in such compulsive behaviors as repeatedly looking in mirrors to check their physical features. BDD and OCD also have approximately the same age of onset and run the same course.
Diagnostic Criteria for Body Dysmorphic Disorder (BDD).
A. Preoccupation with one or more defects or flaws in physical appearance that are not observable or appear slight to others.
B. At some point during the course of the disorder, the individual has performed repetitive behaviors (e.g., mirror checking, excessive grooming, skin picking, reassurance seeking) or mental acts (e.g., comparing his or her appearance with that of others) in response to the appearance concerns.
C. The preoccupation causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
D. The appearance preoccupation is not better explained by concerns with body fat or weight in an individual whose symptoms meet diagnostic criteria for an eating disorder.
With good or fair insight: The individual recognizes that the body dysmorphic disorder beliefs are definitely or probably not true or that they may or may not be true.
Found with poor insight: The individual thinks that the body dysmorphic disorder beliefs are probably true. With absent insight/delusional beliefs: the individual is completely convinced that the body dysmorphic disorder beliefs are true.
With muscle dysmorphia: The individual is preoccupied with the idea that his or her body build is too small or insufficiently muscular. This specifier is used even if the individual is preoccupied with other body areas, which is often the case.
Most people with BDD seek other types of health professionals, such as plastic surgeons and dermatologists. BDD is equally common in men and women.
No one knows exactly what causes BDD. However, recent research suggests that there are a number of different risk factors that could mean you are more likely to experience BDD, such as:
- Abuse or bullying
- Low self-esteem
- Fear of being alone or isolated
- Perfectionism or competing with others
- Depression, Anxiety
Treatment for BDD.
Patients with BDD believe they physically deformed in some way and go to medical doctors to attempt to correct their deficits. Dermatology (skin) treatment most often received (45.2%), followed by plastic surgery (23.2%). Looking at it another way, in one study of 268 patients seeking care from a dermatologist, 11.9% met criteria for BDD. The concerns of people with Body Dysmorphic Disorders involve mostly the face or head.
There are two, and only two, treatments for Body Dysmorphic Disorders with any evidence of effectiveness, and these treatments are the same effective in OCD.
First, drugs that block the re-uptake of serotonin, such as clomipramine (Anafranil) and fluvoxamine (Luvox), provide relief to at least some people. One controlled study of the effects of drugs on BDD demonstrated that clomipramine was significantly more effective than desipramine. A drug that does not specifically block re-uptake of serotonin, for the treatment of BDD, even BDD of the delusional type.
Second, exposure and response prevention, the type of cognitive-behavioral therapy effective with OCD, has also been successful with BDD. patients with BDD and OCD have similar rates of response to these treatments.
David H. Barlow, V. Mark Durand. Abnormal Psychology, An Integrative Approach. (7th ed).