Body dysmorphic disorder (BDD) is a chronic psychiatric disorder of body image. People with BDD are obsessed with perceived flaws or defects in one of more of their facial or body features.
BDD goes far beyond dissatisfaction with some aspect of one's appearance; rather, people suffering from BDD are preoccupied with a minor or nonexistent defect. No matter what they do, one or more aspects of their face or body always appears wrong to them. Thus, BDD is sometimes called dysmorphophobia—a fear of deformity. People with BDD may feel ashamed and unwilling to be seen by others. They may obsess over their appearance for hours every day, interfering with the functions of daily life. People with BDD may go to extremes to try to rectify their flaws through cosmetic procedures or excessive exercise— but always to no avail. Symptoms of BDD can overlap with symptoms of obsessive-compulsive disorder (OCD), with BDD compulsions focused on examining, hiding, and/or changing one's appearance.
People with BDD may obsess over any body or facial feature. The focus of their obsession may change over time. Common BDD obsessions include:
Potential complications of BDD include:
Because most people with BDD are unwilling to seek professional help, the incidence of the disorder is unknown; however, true BDD is believed to be relatively rare. BDD affects both males and females, usually beginning in adolescence and possibly continuing into adulthood.
The causes of BDD are not well understood. It may result from a combination of factors including abnormalities in brain structure or brain chemistry, genetic or inherited factors, and environmental triggers. There is evidence that BDD may be associated with an abnormality in visual processing in the brain. It may involve problems with the regulation of serotonin, an important neurotransmitter in the brain. Serotonin levels are also believed to be involved in OCD, other anxiety disorders, and depression.
Risk factors for BDD include:
Signs and symptoms of BDD may include:
People with BDD often seek dermatological treatments, cosmetic surgery or dentistry, or other alterations to their appearance, but these rarely alleviate the symptoms: either the results are perceived as unsatisfactory or the focus of obsession switches to another aspect of appearance.
BDD can be difficult to diagnose because it is similar to or may coexist with other disorders such as OCD or an eating disorder. Furthermore, many people with BDD are so self-conscious about their appearance that they avoid seeking help or are unwilling to openly discuss their feelings. Others do not realize that their body image is distorted.
The American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders criteria for a diagnosis of BDD includes extreme preoccupation with a minor or imaginary defect in appearance that causes significant distress or difficulties with school, work, social life, or other functioning. In addition to a psychological evaluation, diagnosis of BDD may include a physical exam and lab tests to identify any associated health problems.
BDD can be difficult to treat. The usual treatments—cognitive behavioral therapy (CBT) and/or medications such as selective serotonin reuptake inhibitors (SSRIs) to increase serotonin levels in the brain—are often of limited effectiveness. Nevertheless, CBT can help patients understand their condition and its effects; learn to restrain automatic negative thinking; develop a more positive and realistic view of themselves; learn to control urges such as picking at one's skin or constantly checking in a mirror; and improve socialization and other behaviors. Furthermore, SSRIs appear to be more effective than other antidepressants for controlling BDD obsessions and repetitive behaviors. BDD patients with delusions may be treated with an antipsychotic medication in addition to an SSRI. Some people with severe BDD who are unable to care for themselves or have suicidal thoughts or behaviors require psychiatric hospitalization.
People with BDD can help themselves by:
Although there is no known prevention or cure for BDD, treatment can be successful if patients are motivated and actively participate in their care.
See also Cognitive behavioral therapy ; Obsessive-compulsive disorder ; Serotonin.
Hartmann, Andrea S., et al. “Body Dysmorphic Disorder.” In Obsessive-Compulsive Disorder and Its Spectrum: A Life-Span Approach, edited by Eric A. Storch and Dean McKay. Washington, DC: American Psychological Association, 2014.
Neziroglu, Fugen, Sony Khemlani-Patel, and Melanie T. Santos. Overcoming Body Dysmorphic Disorder: A Cognitive Behavioral Approach to Reclaiming Your Life. Oakland, CA: New Harbinger, 2012.
Phillips, K. A. “Body Dysmorphic Disorder.” In Encyclo-pedia of Body Image and Human Appearance, edited by Thomas F. Cash. Waltham, MA: Academic Press, 2012.
Phillips, Katherine A. “Body Image and Body Dysmorphic Disorder.” In Body Image: A Handbook of Science, Practice, and Prevention. 2nd ed., edited by Thomas F. Cash and Linda Smolak. New York: Guilford, 2012.
Wilhelm, Sabine, Katharine A. Phillips, and Gail Steketee. Cognitive-Behavioral Therapy for Body Dysmorphic Disorder: A Treatment Manual. New York: Guilford, 2013.
Mayo Clinic Staff. “Body Dismorphic Disorder.” Diseases and Conditions, Mayo Clinic. May 9, 2013. http://www.mayoclinic.org/diseases-conditions/body-dysmorphicdisorder/basics/definition/con-20029953 (accessed June 22, 2015).
Nemours. “Body Dysmorphic Disorder.” TeensHealth. May 2013. http://kidshealth.org/teen/your_mind/body_image/body_image_problem.html?tracking=T_RelatedArticle (accessed June 22, 2015).
Nemours. “Guy's Guide to Body Image.” TeensHealth. January 2012. http://kidshealth.org/teen/your_body/beautiful/male_bodyimage.html# (accessed June 22, 2015).
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