Body Dysmorphic Disorder (BDD) is often called the 'imagined ugliness' disorder. It was formerly known as Dysmorphophobia and is an anxiety disorder whereby a person is abnormally preoccupied with an imagined or slight defect in their physical appearance.
BDD obsessions may manifest themselves as excessive, disproportionate concerns about a minor flaw, or as recurrent, anxiety-provoking thoughts about an entirely imagined defect. The obsessions are most frequently focused on the head and face, but may involve any body part. When others tell them that they look fine or that the flaw they perceive is minimal, people with BDD find it hard to believe this reassurance.
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The onset of BDD usually begins in adolescence up to early twenties, a time when people are generally most sensitive about their appearance. It is not unique to, although more predominant in, women, although clinic samples tend to have suggested an equal proportion of men and women. It has been noted that BDD has features that are quite similar to those of OCD. Some studies have shown that many of those with BDD also have OCD.
Common BDD obsessions involve concerns about the face, namely the nose, the hair, the skin, the eyes, the chin, or the lips. Flaws on the face or head, such as hair thinning, acne, wrinkles, scars, vascular markings, paleness or redness of the complexion or excessive hair are perceived as major concerns. Sufferers may be concerned about a lack of symmetry, or feel that something is too big or swollen or too small, or that it is out of proportion to the rest of the body. Any part of the body may however be involved in BDD including the breasts, genitals, buttocks, abdomen, hands, feet, legs, hips, overall body size, body build or muscle bulk. These concerns lead most patients to engage in compulsive behaviours, such as mirror checking, excessive grooming, and skin picking.
The behaviour of BDD sufferers will include some or all of the following:
Checking the appearance of the specific body part in mirrors.
Camouflaging the perceived defect with clothing or makeup.
Excessive grooming, by combing, shaving, removing or cutting hair, applying
makeup.
Picking their skin to make it smooth.
Picking the skin around the perceived defect.
Comparing the appearance of the perceived defect with that of others.
Dieting and excessive exercise or weight lifting.
Avoiding social situations in which the perceived defect might be exposed.
Possibly seeking surgery or dermatological treatment despite being told
that surgery is not required.
Sufferers of BDD may also experience periods of depression, anxiety, and even suicidal thoughts because of their preoccupation with the perceived flaw.
Although some people with this disorder manage to function well despite their distress, most find that their appearance concerns cause problems for them. They may find it hard to concentrate on their job or school work, which may suffer, and relationship problems are common. People with BDD feel very self-conscious in social situations and generally have a very poor quality of life.
There is still not a single clear cause for Body Dysmorphic Disorder, but experts believe that biological, psychological and socio-cultural factors have contributed to its emergence. Neurochemical factors, such as abnormalities in the brain chemical serotonin, may make some people more likely to express the symptoms of BDD than others. However, psychological factors such as teasing about one's appearance during childhood, families' or peers' emphasis on appearance and trauma or sexual abuse might also be risk stimuli for the expression of symptoms.
What treatments are available?
Research and treatments for BDD have grown steadily over the past few years with medication and CBT leading the way (The principles of Cognitive Behaviour Therapy (CBT) are described in the Treatments section. Briefly, it is based on a structured programme of self-help so that a person learns to change the way they think and act).
Although no one treatment has been found to be effective for everyone, sometimes a combination of both CBT and medication will be required. Evidence suggests that medication and CBT complement each other well. In addition to these treatments, family education and counselling for those with BDD may also be of benefit.
CBT will teach BDD sufferers to confront their fears without camouflage and to stop all 'safety behaviours' such as excessive camouflage or avoiding showing one’s profile. This means repeatedly learning to tolerate the resulting discomfort and to test out their beliefs. Facing up to the fear becomes easier and the anxiety gradually subsides. Sufferers begin by confronting simple situations and then gradually work up to more difficult ones.
The first step towards getting better is to consult your GP. Many GPs have little or no knowledge of BDD so you may have to explain to them what it is and what your symptoms are. However, BDD often goes unrecognised and undiagnosed by GPs, often because of the patients' reluctance to divulge their symptoms due to their feelings of embarrassment and shame. It is also sometimes misdiagnosed because the symptoms mimic other psychiatric disorders such as social phobia, agoraphobia, panic disorder, Trichotillomania and depression. A good GP should refer you to an appropriate psychologist or psychiatrist who will ensure correct diagnoses.
The history of BDD
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| Sergei Pankejeff
(Wolf Man) |
BDD was not published in the Diagnostic and Statistical Manual of Mental Disorders until 1987. In 1997 it was subsequently renamed Body Dysmorphic Disorder in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV).
Before 1987, Body Dysmorphic Disorder (BDD) was referred to as Dysmorphophobia, so named by Italian psychopathologist Enrique Morselli in 1891. The name is derived from the Greek word, 'dismorfia' – 'dis' meaning abnormal or apart, and 'morpho' meaning shape.
Morselli described persons with a subjective feeling of ugliness or with a slight physical defect considered abnormal by the patient but undetectable by others. He stated that these people felt miserable, were tormented by their imagined defect, and were consumed by thoughts of this defect in any situation.
Psychologist Sigmund Freud once described a patient, whom he referred to as the 'Wolf man', as having classical symptoms of BDD. The 'Wolf man' was a wealthy Russian aristocrat, real name Sergei Pankejeff, who was preoccupied with his nose, and believed that it was so ugly that he avoided all public life and work.
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