Body dysmorphic disorder (BDD) is an anxiety (psychiatric) disorder where an individual imagines or has a slight defect(s) in their appearance. BDD is commonly seen between the ages of 15 and 30 years, predominantly in women compared to men. Most of these individuals seek help from dermatologists, cosmetologists, and plastic surgeons to get their defects treated. Although it is a common and severe mental disorder, it often goes unrecognised due to its sparse understanding by the general physicians. Therefore, a very few people are referred to the psychiatrists for evaluation and management. Further, BDD is a cause for suicide and hence, it is important to recognise this disorder and treat them early.
Causes and risk factors
According to researchers, there are no definite causes of BDD. Few theories propose hereditary factors, certain chemical imbalances and drug ecstasy as the causes of BDD.
The risk factors that may trigger BDD include:
• Bullying/Abuse: This often occurs during teenage. Any abuses or bullying may have an adverse impact so that the individuals become conscious and obsessed about their appearance. In the long run, this may lead to BDD.
• Low self-esteem/ Attachment: Those with low self-esteem or those who are extremely attached to their physical appearance constantly try to improve their appearance. This obsession may lead to BDD.
• Perfectionist attitude: People who need to focus on the physique for their job purposes like modelling, gymnastics, body building, military recruitment, etc. are at the risk of developing BDD.
• Negative thoughts: Sometimes, few people worry that they do not fit in the group of friends or get into romantic relationships due to their appearance. This negative thought pattern may lead to BDD.
• Comparison: Constant comparison of one’s physique with others or siblings are likely to increase the chances of developing BDD. Certain times, parents may knowingly or unknowingly compare their children with others which may create negative thoughts and lead to BDD.
• Co-morbidities: It is seen that BDD is linked to depression, social phobia, OCD and delusional disorder.
Symptoms and signs
Constant worries about one’s appearance may increase their anxiety and make them obsessed with attempts to appear better. This obsession may lead to OCD (Obsessive compulsive disorder).
The most common features of BDD are:
• Obsessive thoughts: Generally, the BDD individuals are worried about different parts of their body such as:
Face – nose, eyes, hair, chin, skin or lips
Some parts of the body in particular – breasts or genitals
Body shape – unbalanced or lacking symmetry, features are out of proportion and
Body size – too fat or too skinny
• Compulsive behaviours: This includes repeated self-viewing in the mirror or avoiding it. Frequent viewing and feeling of the body parts that are usually disliked by them. Correcting one’s hairstyle often, using heavy make-up or dressing heavily while going out, comparing oneself with models in the magazines or people around them. Squeezing the blemishes on the skin often, repeatedly grooming (e.g., shaving), seeking repeated reassurance about their appearance. Seeking cosmetic surgery or medical treatment to alter their area of concern in spite of professionals’ opinion that the treatment is unnecessary.
• Avoiding public gatherings: Many BDD patients are housebound due to their imagination of being scrutinised about their appearance in the public. As a result, one may avoid going out even at the cost of their job or studies.
Individuals affected with BDD focus on their body defects to the extent that they may ignore important domains of their life such as work, family, health and well-being. As the main focus is on the body image, some people may remain unemployed and unmarried. In the long run, these individuals are likely to contemplate/commit suicide due to frustration and depression.
It is difficult to diagnose BDD since,
• A person with BDD may not approach the psychiatrist.
• Many doctors are unaware of this disorder.
• BDD may co-exist with other psychiatric conditions so that the chances of misdiagnosis are more.
Treatment includes psychiatric opinion and care and self-management. Parents and family also play a significant role in the management of these patients.
- Psychiatric opinion and care:
Almost every individual is born with some or the other defects and nobody is perfect. A majority of them ignore it while only a few become very conscious. So, before you choose any cosmetic treatment/surgeries, first have an insight whether you need it. If your answer is ‘Yes’ or your deformity is obvious, get a psychiatrist’s opinion to prevent unwanted surgeries.
Since body dysmorphic disorder goes undiagnosed due to a sparse understanding amongst doctors, it is suggested that a psychiatrist’s opinion should be sought before undergoing any form of cosmetic treatment.
Once diagnosed, BDD will be evaluated thoroughly for other co-existing psychiatric illnesses. It will be managed along with co-existing medical and other psychiatric illnesses. BDD is managed initially by psychotherapy (cognitive behaviour therapy) and anti-depressants (SSRIs -serotonin reuptake inhibitors).
Self-help materials based on CBT principles are known to be effective in BDD.
•Role of parents and family:
Support from parents and family members can help the people suffering from BDD by accepting their concerns positively and being empathetic to them. Parents and family members should avoid judging and comparing them with others.
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- Understanding body dysmorphic disorder. National Association for Mental Health. www.mind.org. Accessed on June 6,2016.
- D Veale. Body dysmorphic disorder. Postgraduate Medical Journal. 2004; 80:67–71.
- Body dysmorphic disorder (BDD). Victoria State Government, Australia. https:// www.betterhealth.vic.gov.au /health/conditions and treatments/body-dysmorphic-disorder-bdd. Accessed on June 6,2016.