Body Dysmorphic Disorder
What is BDD
Although many of us report being unhappy with one or more aspects of our physical appearance, a much more serious and debilitating form of dissatisfaction is body dysmorphic disorder.
Body dysmorphic disorder, or BDD, is diagnosed when a person is excessively preoccupied or focused on a perceived defect or problem with their appearance. This preoccupation can be directed at any part of the face or body.
BDD is different to being merely dissatisfied with your appearance, because it becomes an obsession. Thoughts about the defect intrude on your mind constantly, and it causes great suffering.
Many of us have looked in the mirror and thought "I wish my nose was a bit smaller" or "gee I am getting a bit fat." For those who don't have BDD, such thoughts come and go. However for those with BDD the thoughts don't pass, they get stuck and cause great distress.
People with BDD believe the physical defect is real and significant, even though in reality the defect is not there, or is very minimal. Family and friends may say "I can't see it" or "it's not that bad." People suffering from BDD don't see their concerns as excessive. They typically view their concerns as justified. This is not because they are 'crazy', it's just the nature of the disorder. People may even consider cosmetic or dermatological treatment to 'fix' the apparent defect, instead of seeking psychological help.
People with BDD spend a lot of time trying to hide their 'defects'. For example, wearing certain clothing to cover or disguise it, touching or picking at the perceived defect, changing the way they walk or sit and paying particular attention to grooming.
Researchers have found that the face is the most common body part that people with BDD worry about. The concern may be a particular part of the face such as the nose, lips or ears, or facial skin appearance. They might believe that their nose is disproportionately large, or that their ears are on an odd angle, or that their skin is excessively pockmarked. Other parts of the body that may be focused on are size and shape of breasts, shape of legs, arms, buttocks and genitals.
Many men with BDD suffer from what is called muscle dysmorphia. As the name suggests, these men worry that they are not muscular enough. They may perceive themselves as being 'puny.' This concern can lead to extreme exercise regimes, avoiding going places, wearing clothes to hide their body, and in some cases the use of extreme diets and anabolic steroids.
BDD and extreme dysmorphic concern can have a devastating effect on people's lives. It can result in social anxiety, social avoidance, clinical depression, suicidal thoughts and attempts, and financial difficulty (due to numerous cosmetic procedures). It is hugely disruptive to people's lives, and very tough for the person's family and loved ones to cope with.
Who has it and how common is it?
Both men and women can suffer from BDD. Research indicates that about 1-2 percent of the general population have BDD. BDD is found in up to 7 percent of people seeking cosmetic surgery.
Treatment of BDD - What works?
Research on BDD and how to treat it is in its infancy. However, two methods for treating BDD have been identified by evidence based research. Medication is often used to help relieve depression and obsessive thoughts. Cognitive behavioural treatment (CBT) has also been demonstrated to be helpful for BDD and body image dissatisfaction in general.
Cognitive Behavioural treatment aims to:
bring your body image perception into balance
help you develop a healthier response to your body image
help you develop a more balanced ideal body image based on peer pressure and cultural influences
help you develop a healthy response to the difference between your ideal body image and your actual body image
help you find new ways of defining yourself and discover other aspects of self image and self esteem
help reduce obsessive thinking and checking behaviours associated with maintaining BDD.
What doesn't work?
There is no evidence that herbs, supplements, hypnosis or special diets can significantly reduce the obsessive thoughts and repetitive behaviours of BDD and dysmorphic concern.
Many people with BDD seek surgical or dermatological intervention for their perceived defect. People with BDD may spend a lot of time and money on such cosmetic procedures, but ultimately they are no better off as a result of surgery. Because the problem is not the defect itself, but the person's perception of the defect, surgery to change appearance usually has no effect on how the person feels.