You DON’t See What I see!!

Body dysmorphic disorder (BDD) is a serious mental disorder in which the person is preoccupied with some type of flaw that they perceive themselves to have. This flaw can either be minor or imaginary and often involves the skin, hair or nose. Individuals who suffer from body dysmorphic disorder may turn to cosmetic surgery in order to fix their “flaw”. But, even when surgeries are successful they are unhappy with the results.

Unfortunately, cosmetic surgery can actually make body dysmorphic disorder worse because the individual will become even more preoccupied trying to fix the new “defects”. In some cases the patients become so angry with the surgeon that they are violent or turn to the law for recourse.

This disorder is listed in the DSM-IV under is somatisation disorders but actually has more similarities with obsessive-compulsive disorder. In order to be diagnosed with body dysmorphic disorder the individual must have a preoccupation that causes significant impairments in their life and they must think about their defects for at least one hour per day.

Individuals with body dysmorphic disorder will limit their friendships and limit their ability to communicate with individuals in public. Because they obsessively ruminate over their appearance it can also make it difficult to concentrate on their schoolwork or their job.

Teens who suffer from this disorder frequently glance at reflective surfaces, not just mirrors, in order to check out their appearance. They may avoid mirrors altogether or repeatedly measure or touch the perceived defect on their bodies. There may be skin picking or excessive grooming. They often go through elaborate grooming rituals an attempt to camouflage their appearance without hats, their hands or even make up. Teenagers who suffer from BDD may drop out of school, suffer from major depression and may even commit suicide.

Some who have body dysmorphic disorder can also suffer from obsessive-compulsive disorder, social phobias or delusional disorders. Some estimates place the number of individuals who suffer from body dysmorphic disorder at one in every 50 people. There is often a gradual onset but it can happen abruptly. Most often individuals are perfectionists and may also suffer from low self-esteem.

Body parts which are most frequently obsessed over in body dysmorphic disorder are breast size, hair, skin, moles or freckles, muscle size and even genitalia. This feature can change over time and the disorder can become so pervasive that the individual becomes delusional, imagining that something is there that really isn’t.

Shame and embarrassment about their appearance usually keeps an individual from seeking treatment. Often times it is friends and family members who convince the individual that something is wrong and they must seek the help and treatment of their physician or mental health provider. Body dysmorphic disorder does not get better on its own and, when left untreated, will get worse possibly leading to suicidal thoughts and behaviour.

Researchers have been unable to pinpoint exact causes and, like other mental diseases, it is believed to result from a combination of things, including biochemical changes in neurotransmitters, genetics and life experiences. Children and young adults who have biological relatives with body dysmorphic disorder, who have experienced physical or sexual abuse, have low self-esteem societal pressure or expectations of beauty are at higher risk of developing body dysmorphic disorder.

To be diagnosed individuals must meet criteria spelled out in the DSM-IV (Diagnostic and Statistical Manual of Mental Disorders) published by the American psychiatric Association. These criteria include extreme preoccupation with an imagined defect or minor flaw that causes significant distress or impairment at school, work, social or other areas of functioning.

Treatment can be difficult, especially when the individual is unwilling or inactive in their care. However, when treatment is effective for the underlying causes it can be very successful. Psychiatrists and psychologists work together on psychotherapy and medications so that individuals can learn about their condition and identify feelings, thoughts and behaviours to stop automatic negative thoughts and see themselves in a more realistic way.

There is no single medication specifically approved to treat body dysmorphic disorders but those used for depression can also be helpful, especially selective serotonin re-uptake inhibitors and tricyclic antidepressants. These medications help control obsession and repetitive behaviour.

In most cases body dysmorphic disorder will not get better when treated at home. There are some things that individuals can do at home to help increase the chances that their treatment protocols will be successful. Do not skip any therapy sessions and stick with your treatment plan. Take all medications as directed and learn as much as possible about the condition itself. Discuss the warning signs with your physician so that you can identify when things are changing. Be sure to include physical activity in your daily regimen and avoid using drugs and alcohol which can worsen mental illness symptoms or interact with the medications you are taking.


World Psychiatry: Body Dysmorphic Disorder

Kids Health: Body Dysmorphic Disorder