Body Dysmorphic Disorder (BDD)

Most of us have something we don't like about our appearance - a crooked nose, an uneven smile, or eyes that are too large or too small. And though we may fret about our imperfections when we look in a mirror or see our reflection in a window, our discomfort doesn't interfere with our daily lives.

But some people are preoccupied with their appearance and they think about their real or perceived flaws for hours each day. They can't control their negative thoughts and don't believe people who try to reassure them that they look fine. Their thoughts may cause severe emotional distress and interfere with their daily functioning. They may miss work or school, avoid social situations and isolate themselves, even from family and friends, because they fear others will notice their flaws. They may even undergo unnecessary plastic surgeries to correct perceived imperfections, never finding satisfaction with the results.

These people have body dysmorphic disorder (BDD). Read on to learn more about BDD and how it can be treated.

What is BDD?

BDD is a body-image disorder. It consists of persistent and intrusive preoccupations with an imagined or slight defect in one's appearance. People with BDD can dislike any part of their body, although they often find fault with their hair, skin, nose, chest, or stomach. In reality, a perceived defect may be only a slight imperfection or nonexistent. But in the eyes of someone with BDD, the flaw is significant and prominent, often causing severe emotional distress and difficulties in daily functioning.

Who can suffer from BDD?

BDD can affect people of any age, although it most often develops in adolescents and teens. Preliminary research shows that BDD affects men and women almost equally. About one percent of the population has BDD.

What are the symptoms?

People with BDD think they look ugly, abnormal, deformed, or even monstrous. They suffer from preoccupations with their appearance - called obsessions - that can last for hours or even an entire day. These preoccupations are difficult to resist and hard to control. It may become tough for people with BDD to focus on anything but their imperfections. This can lead to low self-esteem, avoidance of social situations, and problems at work or school. People with severe BDD may avoid leaving their homes altogether and may even have thoughts of suicide or make a suicide attempt.

BDD sufferers may perform some type of compulsive or repetitive behavior to try to hide or improve their flaws. These behaviors usually give BDD sufferers only temporary relief. Examples are listed below:

• camouflaging (with body position, clothing, makeup, hair, hats, etc.)
  
• comparing body part to others' appearance
  
• seeking surgery
  
• checking in a mirror
  
• avoiding mirrors
• skin picking
  
• excessive grooming
  
• excessive exercise
  
• changing clothes excessively

What causes the disorder?

The causes of BDD are unclear, and much more research is needed to determine its causes. However, certain biological and environmental factors may contribute to the development of BDD, including genetic predisposition, neurobiological factors such as malfunctioning of serotonin in the brain, personality traits, and life experiences.

Does BDD occur with other mental health disorders?

People with BDD may also have one or more other mental health disorders. It commonly co-occurs with depression, eating disorders such as anorexia nervosa or bulimia, and anxiety disorders such as obsessive-compulsive disorder (OCD) or social anxiety disorder (SAD).

BDD can also be misdiagnosed as one of these disorders because they share similar symptoms. The intrusive thoughts and repetitive behaviors exhibited by BDD sufferers are similar to the obsessions and compulsions of OCD. And avoiding social situations is similar to the behavior of some SAD patients.

Even with strong similarities between BDD and other mental health disorders, which often overlap, BDD is a separate disorder. To get an accurate diagnosis and the appropriate treatment, people must mention specifically their concerns with their appearance when they talk to their doctors or other mental health professionals.

How can I determine if I have BDD?

A trained clinician should diagnose BDD. However, you can ask yourself questions that can help to suggest if BDD is present. Please keep in mind that these will not offer a definitive diagnosis.

Adults: To take a self-test developed by Katharine A. Phillips, MD, Director of Butler Hospital Body Image Program, click here.

Adolescents: To take a self-test developed by Butler Hospital, click here.

How can I help my child?

When reassuring your child that he or she looks fine doesn't help, it may be a good time to learn more about BDD. Talk to a mental health professional if your child or teen is preoccupied with appearance to the extent that it interferes with concentration in school or if behaviors listed above appear.

What treatments are available?

BDD is a real, serious, and treatable mental disorder. The good news is that effective psychological and medication treatments are available to help BDD sufferers live full, productive lives.

Cognitive-behavioral therapy (CBT) teaches patients to recognize irrational thoughts and change negative thinking patterns. Patients learn to identify unhealthy ways of thinking and behaving and replace them with positive ones.

Antidepressant medications, including selective serotonin reuptake inhibitors (SSRIs), can help relieve the obsessive and compulsive symptoms of BDD.

Treatment is tailored to each patient so it is important to talk with a doctor to determine the best individual approach. Many doctors recommend using a combination of treatments for best results. For more information about psychological treatment and medication, click here.

Where can I find more information about BDD?

The Broken Mirror: Understanding and Treating Body Dysmorphic Disorder
Written by Katharine Phillips, MD, professor of psychiatry, Butler Hospital and Brown Medical School, this book is considered the most comprehensive publishing on BDD and its treatment. Available from the ADAA Online Bookstore: http://www.adaa.org/bookstore/Sub/b&n2.asp?category=SH3

Feeling Good About the Way You Look: A Program for Overcoming Body Image Problems
Written by Dr. Sabine Wilhelm, this book offers self-assessment tools to help readers understand their problems and decide whether they should be evaluated for BDD. Step-by-step guidelines teach readers to overcome discouraging thoughts, curtail obsessive appearance rituals, and see themselves realistically. Available from the ADAA Online Bookstore:
http://www.adaa.org/bookstore/Sub/b&n2.asp?category=SH3

Body Image Program, Butler Hospital
One of the few specialized programs in the United States dedicated to understanding and treating BDD.
http://www.butler.org/body.cfm?id=123

Neysa Jane BDD Fund, Inc.
A not-for-profit corporation created in memory of Neysa Jane Powley, who suffered from BDD.
http://www.accuratereflections.com/NeysaJaneBDDfund.html

BDD Central
A website dedicated to informing the public about BDD.
http://www.bddcentral.com/

NYU Child Study Center
Organization dedicated to advancing the field of child mental health.
http://www.aboutourkids.org/aboutour/articles/about_bdd.html

National Women's Health Information Center
From the U.S. Department of Health & Human Services, this website offers information on a variety of health concerns for women.
http://www.4woman.gov/BodyImage/bdd.cfm

Mayo Clinic
Owned by Mayo Foundation for Medical Education and Research, this site's mission is to empower people to manage their health by offering useful and up-to-date medical information.
http://www.mayoclinic.com/health/body-dysmorphic-disorder/DS00559

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