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:
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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.
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