Body Dysmorphic Disorder (BDD)

Individuals with this disorder often believe they look ugly, unattractive, abnormal, or deformed. However, the perceived flaws are often not observable or may be minimal to others.

Some of the most common preoccupations include skin (e.g. acne, scars, lines, wrinkles, paleness), hair (i.e. “thinning” hair or “excessive” body or facial hair), or nose (i.e. size or shape). Although these preoccupations with skin, hair, and nose are most commonly displayed, any area of the body can be an object of focus, such as eyes, teeth, weight, stomach, breasts, legs, face size or shape, lips, chin, eyebrows, genitals, as well as the overall symmetry of the specified body area. The constant apprehension and negative thoughts about appearance can be intrusive, time consuming, and often difficult to resist and overwhelming to control.

Due to the perceived flaw, the individual will engage in repetitive behaviors such as mirror checking, or mental acts such as comparing themselves to others. For many, these thoughts and behaviors cause the individual to experience significant impairment in their daily functioning.

These behaviors include, but are not limited to mirror checking, excessive grooming, skin picking, reassurance seeking, or comparing themselves to others. Individuals will often engage in excessive grooming (combing, styling, shaving, plucking, or pulling hair), camouflaging (continuous application of makeup or hiding disliked areas with hats, clothing, makeup or hair), seeking reassurance for the perceived flaws, checking the disliked body areas by touching them, excessively exercising, and seeking cosmetic procedures to aid in “fixing” the problem areas. Individuals may engage in excessive tanning or repeatedly changing their clothing. Individuals with perceived skin defects most commonly will perform compulsive skin picking to improve the problem area. However, skin picking can lead to skin damage, infection, or ruptured blood vessels.

To receive a diagnosis of body dysmorphic disorder, the previously mentioned preoccupations must cause significant impairment in the individual’s social, occupational, and other areas of daily functioning, and must be differentiated from an eating disorder.

A form of body dysmorphic disorder that almost exclusively occurs in males is known as muscle dysmorphia. Suffers of this disorder believe their body appears too small or inadequately lean or muscular.  Individuals with this form of body dysmorphic disorder often have “normal” looking bodies or tend to already have muscular bodies.

Prevalence of body dysmorphic disorder

The age of onset for body dysmorphic disorder is typically late childhood or early adolescence. The average age of diagnosis is 17 years old. Body dysmorphic disorder impacts both genders equally.

Individuals suffering from this disorder are unique, so it’s critical to be open and honest about symptoms to receive an accurate diagnosis. Clinicians may use a variety of techniques to tailor treatment to the client’s specific needs. Some of the treatment methods used include: cognitive behavioral therapy (CBT) and acceptance and commitment therapy (ACT). Psychiatric medication is also utilized in conjunction with therapy methods.

Cognitive behavioral therapy (CBT) is used to identify and challenge irrational thoughts and negative thinking strategies. Through CBT, individuals will learn to replace unhelpful thinking patterns with healthier thoughts. Exposure and response prevention (ERP) is a technique used with individuals with body dysmorphic disorder to reduce compulsive and avoidance behaviors. However, some individuals may be resistant of this treatment modality, therefore clinicians may need to take a different approach.

Acceptance and commitment therapy (ACT) is an action-oriented approach that focuses on the individuals thought patterns. However, rather than changing the thought and attempting to produce an alternative thought, ACT works with the individual to tolerate situations that produce anxiety. The core concepts of ACT are mindfulness, acceptance, and value-based living.

• Mindfulness: Teaches the individual to acknowledge their thoughts by engaging in a mindfulness activity, such as taking a walk and observing the thoughts that arise. Through mindfulness, the individual will experience situations, but eventually work towards the idea that they are not defined by those situations.
• Acceptance: Addresses your willingness to experience unpleasant thoughts, followed by the idea that unpleasant thoughts are not as harmful as they seem. Practicing Acceptance will lead to increasing thought flexibility.
• Value-based living: Works towards identifying other values, beyond appearance, to aid in guiding their lives. Value-based living encourages the individual to live their life for value, rather than in a way to reduce symptoms or change their appearance.

A psychiatric evaluation also may be beneficial to determine if psychiatric medication is warranted. The treatment of body dysmorphic disorder is tailored to individual needs. Many professionals recommend a combination of treatment methods for best results.

Newsletter:
Read Anxiety Institute’s newsletter about body dysmorphic disorder.

Foundation;
http://bddfoundation.org/resources/

Body Dysmorphic Disorder (BDD) Popular Literature;
http://guides.library.illinois.edu/c.php?g=526620&p=3600781

Diagnostic and Statistical Manual of Mental Disorders (5th ed.)
American Psychiatric Association. (2013).
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