July 28, 2013

Facing the Mirror: Body Dysmorphic Disorder. ~ Erin Walton

Photo: Cea

To be human is to be imperfect.

Therefore, most people can relate to the humbling experience of wishing they were somehow different. Expressing momentary desire for a different hair color, smaller nose or thinner body frame is normal.

For individuals suffering from body dysmorphic disorder, also known as BDD, these desires morph into obsessions, preoccupying their minds and causing them to worry incessantly about their physical appearance.

Common Symptoms of BDD

BDD affects one percent of the US population and wreaks havoc on the self-esteem of those individuals. Affecting both genders equally, BDD often begins during adolescence. Classified as a body-image disorder, BDD hinders an individual from perceiving his/her body accurately. Thus, an individual with BDD will either magnify an insignificant physical imperfection or create an imperfection where, in reality, there is none.

Typically BDD individuals obsess about the following body parts:

  • Skin, including acne and wrinkles
  • Nose
  • Hair
  • Muscle size
  • Breasts
  • Stomach

Through a deluded lens, the slight physical imperfections cause the BDD individual profound distress. Initially, the individual may spend hours fixating on a specific body part; often ruminating in shame. Individuals with BDD will then obsess on the myriad of methods they can employ to hide this shameful part of themselves.

Nearly 15 percent of individuals who seek cosmetic surgery suffer from BDD. Following surgery, BDD individuals report greater dissatisfaction with the procedure and heightened feelings of anxiety, anger and distress than other individuals. Due to the intensified fixation on the physical body, a simple dissatisfaction with cosmetic surgery or rude comment may prompt the BDD individual to consider destructive behaviors, including suicide. Because of the incessant and intrusive nature of these thoughts, BDD individuals will likely find themselves unable to break free, despite their desire to stop obsessing. Without intervention, the obsessions lead to heightened anxiety, often affecting all aspects of the individual’s life.

With the focus solely on the perceived physical imperfection, the BDD individual’s quality of life naturally diminishes. Thus, it is not unlikely for BDD to result in poor school or work performance, increased isolation and low self-esteem. Without intervention, individuals with BDD may become so entrenched in their shame that they refuse to leave their house; resulting in social isolation.

As people with BDD become more enmeshed in the deceit of their disease, they will compulsively seek behaviors to hide or correct their shameful body part.

The following are typical behaviors associated with BDD:

  • Seeking constant reassurance from family and friends regarding their physical appearance
  • Compulsive and excessive exercise habits
  • Spending large amounts of money on cosmetic surgery
  • Spending excessive time, energy and money on grooming habits and/or materials
  • Frequent comparing of oneself to the appearance of others
  • Either compulsive use of mirrors or complete refusal to look into a mirror

The Risk Factors for Body Dysmorphic Disorder

While engaging in these repetitive behaviors grant individuals with BDD temporary relief, they do not cure the illness. BDD is a complex disorder. It is difficult to identify a single root cause. Similar to most mental illnesses, BDD is influenced by a variety of factors—from individual temperaments to culture. Studies reveal that living within a family structure or society where physical appearance is highly valued reiterates the importance of external perfection, and therefore, encourages already vulnerable individuals with low self-esteem to seek the endless pursuit of perfection through BDD.

Similar studies suggest that individuals who experienced trauma during their upbringings are more likely to suffer from low self-esteem and body dysmorphic disorder. The biological evidence suggests both a genetic and biochemical component in BDD.

Perhaps the most intriguing evidence is from a study conducted by Harvard Medical School. This particular study reported a higher prevalence of BDD among artists. Given that many musicians, writers and artists are deeply sensitive and intuitive, this finding is not surprising. While most research paints a negative portrait of the BDD personality, this study suggests that individuals with BDD are inherently sensitive and creative—flawed only by their own thoughts.

BDD and Other Mental Illnesses

According to The American Psychological Association, body dysmorphic disorder is a somatoform disorder—a disorder in which psychological issues manifest as physical symptoms. While an individual may desire to stop the irrational thoughts or fixations, the obsessive worries feel overwhelming. The irrationality, coupled with the excessive compulsive behaviors, create a sense of powerlessness. This sense of vulnerability is reminiscent of a multitude of other anxiety disorders, including social anxiety disorder, obsessive-compulsive disorder and eating disorders. As a result, BDD is often difficult to diagnose.

The irrational fears of individuals with BDD are similar to the paralyzing fears found in those with OCD. In their effort to “fix” themselves, individuals with both OCD and BDD compulsively engage in what they believe to be cleansing behaviors. With similar anxiety, anorexics, bulimics and compulsive over-eaters work diligently to rid themselves of anxiety, depression and grief through food and exercise. While the specific diagnosis may differ, BDD, OCD and eating disorders all stem from low self-esteem.

 Requirements for Successful Treatment

Because people with BDD often suffer from other anxiety disorders, treatment is difficult. At the heart of the disorder is the deep-seated belief that the individual is inherently flawed. Although the individual fixates on the physical body, successful treatment must nurture the whole person. Recovery requires individuals to explore, with honesty and compassion, the root issues which triggered their deluded belief system. Psychologists share that the most difficult aspect in treating BDD is making the initial diagnosis and convincing individuals that there is nothing wrong with them. Once these pieces are in place, healing can begin.

Successful treatment for BDD should include the following components:

  • Cognitive Therapy
  • Medication (SSRIs such as Prozac)
  • Education on Body Dysmoric Disorder (for the individual, family and loved ones)
  • Alternative Therapies (yoga, meditation, art therapy, acupuncture, and nutritional therapy)

Making the decision to recover from body dysmorphic disorder requires trust in a journey that can often feel lonely. With the support of a compassionate community, innovative therapies and determination, we believe healing is possible.

Believe in your strength and take the leap of faith. We are only a phone call away.


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Assistant Ed: Dana Gornall/Ed: Brianna Bemel

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Erin Walton