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This post is by guest blogger Anna Fialkowska

Body dysmorphia disorder (BDD) is a mental health disorder characterised by an obsession with an imagined defect in one’s appearance or markedly excessive concern with a slight physical anomaly. Individuals with BDD may focus on any part of their body and many will perceive defects across multiple parts of the body. The most common parts include skin (73%), hair (56%), nose (37%), eyes (20%), stomach (22%) or face size (12%) (Phillips, 2005). According to the diagnostic criteria, impacted individuals need to be preoccupied by their flaw for at least an hour a day and their preoccupation must cause significant distress and impairment in social functioning for a BDD diagnosis to be made.

How common is BDD?

BDD is not an uncommon disorder. It is believed that it effects around 0.7 to 2.4% of the general population, and up to 8% of individuals with depression (Rief et al., 2006; Buhlamann et al., 2010). The prevalence of BDD is highly similar across both genders but the areas of preoccupation tend to differ between males and females. Specifically, men are more likely to be preoccupied with their body build, genitals or balding, whereas females tend to be obsessed with their skin, stomach, breasts or legs (Phillips, Menard, & Fay, 2006). The onset of the disorder is usually in adolescence, when the focus on one’s appearance becomes much more apparent.

What are some of the main symptoms of BDD?

A high number of individuals with BDD display excessive checking behaviours, such as checking their appearance in the mirror, excessive grooming or hiding of body parts under clothing. Nevertheless, the aforementioned methods are often ineffective, and, for instance, excessive mirror gazing can lead to heightened levels of distress (Veale & Riley, 2001). The compulsions can also include mental acts, such as comparing their appearance to others. Social avoidance and isolation are also very common, which is caused by a fear of being negatively judged by others due to a perceived defect. Social withdrawal and high levels of unemployment, alongside other experienced difficulties, lead to a significantly lower average quality of life observed among BDD sufferers in comparison to the general population (IsHak et al., 2012). According to the data, the employment rate among people with BDD is only 50% (Neziroglu et al., 2004), hindered further by another common symptom of reassurance seeking.

Is BDD related to any other mental health conditions?

Comorbidities among individuals with BDD are not uncommon. Specifically, it is estimated that about 50% of people with BDD also suffer from depression and a substantial amount suffer from anxiety disorders (Coles et al., 2006).  Furthermore, according to a study by Phillips and Menard (2006), between 28-80% of impacted individuals had a history of suicidal ideations and suicidal attempt respectively. Individuals with BDD also often seek dermatological support and decide to undergo medical procedures to alter their defect which, unfortunately, rarely bring positive results and the preoccupation remains intact. It is estimated that between 8 and 20% of individuals seeking cosmetic medical treatments meet the criteria for BDD (Crerand et al., 2004; Phillips, 2005), which can lead to an assumption that the prevalence of the disorder is much higher than currently estimated.

There is no doubt that BDD resembles in many aspects symptoms of Obsessive Compulsive Disorder (OCD), including obsessive thoughts and compulsions to engage in repetitive behaviours (Eisen et al., 2003). Additionally, there are some overlaps in the onset and treatment of both conditions (Phillips, 2005). Specifically, the same neurotransmitter (serotonin) and brain structures are associated with the onset of both conditions (Rauch et al., 2003). The most effective treatment for OCD is also used to treat BDD. Beyond the resemblance to OCD, BDD also has some similarities with eating disorders, especially anorexia nervosa. The main overlapping features include a distorted body image and a preoccupation and dissatisfaction with one’s appearance (Allen & Hollander, 2004). Nevertheless, we cannot forget that individuals with BDD, even though they may appear “normal”, are highly distressed by some aspect of their appearance. On the other hand, anorexia sufferers, although often looking undernourished, often feel satisfied with their lost kilogram (Phillips, 2005).

What treatment is available for BDD?

As mentioned above, treatment for BDD resembles many aspects of the support offered to individuals suffering from OCD. There is some evidence showing the effectiveness of anti-depressants from the SSRI group. However, according to some studies, the improvement was minimal or not observed at all (Phillips, 2004; Phillips, Pagano, & Menard, 2006) as it may be possible that a higher dose in comparison to OCD treatment is needed, which can lead to an underestimation of their actual potential efficacy (Hadley et al., 2006).  Additionally, effectiveness of psychological treatment seems to be significantly increased when pharmacological support is implemented. Talking therapy, especially cognitive behavioural therapy, allow for a focus on exposure and response prevention (Williams et al., 2006) and this approach has shown positive results. For instance, individuals are encouraged and supported to recognise and alter their distorted perception of themselves by exposing themselves to anxiety-triggering situations and by the prevention of checking behaviours. Furthermore, the long-term effectiveness of such treatment provides promising prognosis to individuals suffering from BDD (Sarwer et al., 2004), suggesting that BDD sufferers can relearn how to think about their bodies.

 

About Anna Fialkowska

Anna Fialkowska is a Trainee Health Psychologist, is completing her doctoral training at the University of the West of England and currently works as a Heath Improvement Practitioner. She has worked within the field of mental health dysfunction and cognitive rehabilitation over the last six years. Her main areas of research include the development of behaviour change interventions, the impact of stress on individuals’ physical health and the effect of chronic conditions on psychological well-being.

References:

Buhlmann U, Glaesmer H, Mewes R, Fama JM, Wilhelm S, Brähler E, Rief W. Updates on the prevalence of body dysmorphic disorder: a population-based survey. Psychiatry Res. 2010 Jun 30;178(1):171-5. doi: 10.1016/j.psychres.2009.05.002. Epub 2010 May 8. PMID: 20452057.

Coles ME, Phillips KA, Menard W, Pagano ME, Fay C, Weisberg RB, Stout RL. Body dysmorphic disorder and social phobia: cross-sectional and prospective data. Depress Anxiety. 2006;23(1):26-33. doi: 10.1002/da.20132. PMID: 16278832; PMCID: PMC1397710.

Sarwer DB, Crerand CE. Body image and cosmetic medical treatments. Body Image. 2004 Jan;1(1):99-111. doi: 10.1016/S1740-1445(03)00003-2. PMID: 18089144.

IsHak WW, Bolton MA, Bensoussan JC, Dous GV, Nguyen TT, Powell-Hicks AL, Gardner JE, Ponton KM. Quality of life in body dysmorphic disorder. CNS Spectr. 2012 Dec;17(4):167-75. doi: 10.1017/S1092852912000624. Epub 2012 Sep 3. PMID: 22939280.

Phillips KA. Body dysmorphic disorder: recognizing and treating imagined ugliness. World Psychiatry. 2004 Feb;3(1):12-7. PMID: 16633443; PMCID: PMC1414653.

Phillips KA, Didie ER, Menard W, Pagano ME, Fay C, Weisberg RB. Clinical features of body dysmorphic disorder in adolescents and adults. Psychiatry Res. 2006 Mar 30;141(3):305-14. doi: 10.1016/j.psychres.2005.09.014. Epub 2006 Feb 23. PMID: 16499973; PMCID: PMC1592052.

Phillips KA, Menard W, Pagano ME, Fay C, Stout RL. Delusional versus nondelusional body dysmorphic disorder: clinical features and course of illness. J Psychiatr Res. 2006 Mar;40(2):95-104. doi: 10.1016/j.jpsychires.2005.08.005. Epub 2005 Oct 17. PMID: 16229856; PMCID: PMC2809249.

Rief W, Buhlmann U, Wilhelm S, Borkenhagen A, Brähler E. The prevalence of body dysmorphic disorder: a population-based survey. Psychol Med. 2006 Jun;36(6):877-85. doi: 10.1017/S0033291706007264. Epub 2006 Mar 6. PMID: 16515733.

Sarwer DB, Cohn NI, Gibbons LM, Magee L, Crerand CE, Raper SE, Rosato EF, Williams NN, Wadden TA. Psychiatric diagnoses and psychiatric treatment among bariatric surgery candidates. Obes Surg. 2004 Oct;14(9):1148-56. doi: 10.1381/0960892042386922. PMID: 15527626.

Veale, D., & Riley, S. (2001). Mirror, mirror on the wall, who is the ugliest of them all? The psychopathology of mirror gazing in body dysmorphic disorder. Behaviour Research and Therapy, 39(12), 1381–1393

Body Dysmorphic Disorder (BDD)

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