The Distortion in the Mirror

I frequently hear from women diagnosed with PCOS who are not over weight. The pervasive myth that PCOS means you are fat consternates all of us. Being “fat” is a dreaded condemnation. Many people can look in the mirror and see- if their self-concept is healthy- that they are objectively not over fat, and yet we frequently seek external validation from family and friends. When someone suffers a pronounced version of this distress it is called Body Dysmorphic Disorder or BDD. The following is borrowed from the Anxiety and Depression Association of America:

Most of us have something we don’t like about our appearance — a crooked nose, an uneven smile, or eyes that are too large or too small. And though we may fret about our imperfections, they don’t interfere with our daily lives.

But people who have body dysmorphic disorder (BDD) think about their real or perceived flaws for hours each day.

They can’t control their negative thoughts and don’t believe people who tell them that they look fine. Their thoughts may cause severe emotional distress and interfere with their daily functioning. They may miss work or school, avoid social situations and isolate themselves, even from family and friends, because they fear others will notice their flaws.

They may even undergo unnecessary plastic surgeries to correct perceived imperfections, never finding satisfaction with the results.

Characteristics of BDD

BDD is a body-image disorder characterized by persistent and intrusive preoccupations with an imagined or slight defect in one’s appearance.

People with BDD can dislike any part of their body, although they often find fault with their hair, skin, nose, chest, or stomach. In reality, a perceived defect may be only a slight imperfection or nonexistent. But for someone with BDD, the flaw is significant and prominent, often causing severe emotional distress and difficulties in daily functioning.

BDD most often develops in adolescents and teens, and research shows that it affects men and women almost equally. About one percent of the U.S. population has BDD.

The causes of BDD are unclear, but certain biological and environmental factors may contribute to its development, including genetic predisposition, neurobiological factors such as malfunctioning of serotonin in the brain, personality traits, and life experiences.

Symptoms

People with BDD suffer from obsessions about their appearance that can last for hours or up to an entire day. Hard to resist or control, these obsessions make it difficult for people with BDD to focus on anything but their imperfections. This can lead to low self-esteem, avoidance of social situations, and problems at work or school.

People with severe BDD may avoid leaving their homes altogether and may even have thoughts of suicide or make a suicide attempt.

BDD sufferers may perform some type of compulsive or repetitive behavior to try to hide or improve their flaws although these behaviors usually give only temporary relief. Examples are listed below:

• camouflaging (with body position, clothing, makeup, hair, hats, etc.)
• comparing body part to others’ appearance
• seeking surgery
• checking in a mirror
• avoiding mirrors
• skin picking
• excessive grooming
• excessive exercise
• changing clothes excessively

BDD and Other Mental Health Disorders

People with BDD commonly also suffer from the anxiety disorders obsessive-compulsive disorder [1] (OCD) or social anxiety disorder [2], as well as depression [3] and eating disorders [4].

BDD can also be misdiagnosed as one of these disorders because they share similar symptoms. The intrusive thoughts and repetitive behaviors exhibited in BDD are similar to the obsessions and compulsions of OCD. And avoiding social situations is similar to the behavior of some people with social anxiety disorder.

Diagnosis and Treatment

To get an accurate diagnosis and appropriate treatment, people must mention specifically their concerns with their appearance when they talk to a doctor or mental health professional. A trained clinician should diagnose BDD.

However, you can take a self-test that can help suggest if BDD is present, [5] but it will not offer a definitive diagnosis.

If your child is preoccupied with appearance so that it interferes with concentration in school or if behaviors listed above appear, talk to a mental health professional.

Effective treatments are available to help BDD sufferers live full, productive lives.

• Cognitive-behavioral therapy [6] (CBT) teaches patients to recognize irrational thoughts and change negative thinking patterns. Patients learn to identify unhealthy ways of thinking and behaving and replace them with positive ones. Find out about ACT with CBT. [7]
• Antidepressant medications [8], including selective serotonin reuptake inhibitors (SSRIs), can help relieve the obsessive and compulsive symptoms of BDD.

Treatment is tailored to each patient so it is important to talk with a doctor to determine the best individual approach. Many doctors recommend using a combination of treatments for best results.

Find out more

• Feeling Good About the Way You Look: A Program for Overcoming Body Dysmorphic Disorder, [9] by Sabine Wilhelm, PhD (Guilford Press, 2006)
• The Broken Mirror: Understanding and Treating Body Dysmorphic Disorder, by Katharine Phillips, MD [10] (Oxford University Press, 2005)
• Understanding Body Dysmorphic Disorder, by Katharine Phillips, MD [11] (Oxford University Press, 2009)
• Body Image Program, Rhode Island Hospital [5]
• Massachusetts General Hospital BDD Clinic [12]
• Podcast: Body Dysmorphic Disorder (BDD) [13]

Source URL: http://www.adaa.org/understanding-anxiety/related-illnesses/other-related-conditions/body-dysmorphic-disorder-bdd