What is body dysmorphic disorder?

4 min read

Body dysmorphic disorder (BDD), is a body image disorder thought to affect 1.7-2.5% of the population.

It is common for most people, at times, to worry about the way we look. We often feel a bit anxious about self-perceived “imperfections” and wish we had a smaller waist or a clearer skin.

We're not always one hundred percent happy with the way we look, but we accept these physical “flaws” and get on with our daily lives.

If, however, you are an individual suffering from body dysmorphic disorder (often referred to as body dysmorphia or muscle dysmorphia), you would be thinking about these perceived physical flaws for hours each day.

For people with BBD the negative thoughts would feel uncontrollable, causing extreme emotional distress and interfering with many aspects of daily life, including having a negative impact on work or school.

It is not uncommon if you do suffer from BDD to avoid social situations altogether and even if friends or family tell you that you look great, you refuse to believe them.

Who suffers from body dysmorphia?

The most common time for you to develop BDD is in the adolescent years. Unlike eating disorders, where typically more women than men are affected, in BDD men and women are affected equally.

Although it is not yet clear what causes BDD, research has suggested that you may have a genetic predisposition to BDD which, combined with traumas such as peer bullying, may increase your risk of BDD.

There is also an increased risk if you are a perfectionist or a societal pressure to look a certain way, for example, fitness professionals or athletes.

Characteristics of body dysmorphic disorder

BDD is a type of body-image disorder; your body image is how you see yourself when you look in the mirror and encompasses how you feel about your body.

Characteristics of body dysmorphia include:

  • Your height
  • Your weight
  • Your body shape
  • What you believe about your appearance
  • How you physically feel in your own body

If you are persistently preoccupied with intrusive thoughts about a defect or flaw in your appearance that impacts your relationships and everyday functioning, this may suggest that your body image is not positive and puts you at high risk of BDD.

Is BDD an eating disorder?

BDD does has similarities with eating disorders and obsessive-compulsive disorder (OCD); however, it presents itself slightly differently.

If you have an eating disorder you are fixated on your overall body shape and weight; whereas if you have BDD you are preoccupied with a specific body part; commonly skin, nose, hair, chest and stomach.

With OCD, you may suffer from recurrent distorted thoughts that you feel you cannot control. The anxiety that you develop from these recurrent fears usually causes you to develop routines or rituals, which are referred to as compulsions.

A person with BDD, may develop an obsession with the perceived imperfection which may lead to ritualistic behaviours such as exercising obsessively or putting on your make-up a certain way.

Girl with BDD leans her head against mirror, hiding her 'perceived flaws'

What are the signs and symptoms of BDD?

The symptoms of BDD vary from person to person, but you will find yourself obsessively thinking about your perceived flaw and spending a lot of time and effort trying to remove or hide the flaw.

Common perceived flaws include acne, moles, too little hair on head, size of breasts, shape of stomach, non symmetry of face, size and shape of genitalia, size and shape of muscles – known as muscular dysmorphia.

The main symptoms to consider if you feel you or someone you know may be suffering from BDD include;

  • Avoidance of mirrors or having your photo taken
  • Repetitive checking of perceived imperfection in the mirror
  • Repetitive touching, or measuring perceived flaw
  • Obsessive exercising
  • Wearing excessive makeup
  • Undergoing multiple surgical procedures to try and remove imperfections
  • Repetitive grooming activities
  • Covering perceived flaw with certain clothing
  • Frequent thoughts about appearance – hours per day
  • Repetitive need for other’s reassurance on physical appearance
  • Repetitive skin picking
  • Avoidance of social situations
  • Emotional problems such as feelings of depression, anxiety and low self-esteem

Diagnosis

The awareness of BDD, even in the medical profession, is unfortunately poor and therefore diagnosis is difficult. This is especially true as, if you have BDD, you are likely to hide your obsessions from friends and family too.

It may also be misdiagnosed as social phobia or depression; however, a major red flag is if you have repeated plastic surgeries.

If a medical professional feels you may be suffering from BDD after taking a health history and physical exam, they would refer you to a mental health professional who would assess your symptoms and behaviours.

Treatment

At present, there are two main treatments if you have been diagnosed with BDD:

  • Cognitive Behavioural Therapy (CBT)

The first common treatment is a talking therapy called cognitive behavioural therapy or CBT. If you have been referred to CBT you will be working with a therapist who will help teach you how to recognise irrational thoughts and change negative thinking patterns and replace them with more rational and positive ones.

Once you have developed a positive relationship with your therapist and are progressing, you are likely to be introduced to exposure and response prevention.

This involves you confronting situations that cause irrational fear, for example, going out in public wearing minimal makeup, or missing an exercise session. This will allow you to see that nothing negative will occur if you do not carry out your compulsions.

Response prevention will help you to resist the urge to cover up your perceived flaw or decrease time spent checking your appearance.

  • Selective Serotonin Reuptake Inhibitor (SSRI)

You may be offered an antidepressant medication called a Selective Serotonin Reuptake Inhibitor (SSRI). SSRI’s can help relieve your compulsive thoughts. It is thought that if you do suffer BDD there may be problems with serotonin uptake in your brain which is why this medication is effective.

In conclusion

In order to optimise your recovery, it is vital that you turn up to all your therapy sessions, even if you don’t feel like it. And if you have been prescribed medication, make sure you take it.

It is also important that you educate yourself about BDD, a good place to look for further information is the MIND website. There you will find useful contacts to help you take the first important steps to your recovery.


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