Body dysmorphic disorder

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at March 10, 2016
StartDiseasesBody dysmorphic disorder

Body dysmorphic disorder, or BDD, is classified as a mental disorder. While not yet fully understood, researchers are gaining ground in defining BDD as separate and apart from related disorders, including eating disorders and obsessive-compulsive disorder. BDD is often referred to by its nickname, imagined ugliness disorder or an earlier medical term, dysmorphophobia.

Contents

Definition & Facts

The current definition of body dysmorphic disorder includes both a physical and mental component. It is thought that body dysmorphic disorder is present in an estimated two percent of people, and usually starts in the late teens; however, it can take up to a decade or longer before symptoms are pronounced enough to diagnose. The disease can affect a person for much of their adult life and is considered chronic by researchers.

Symptoms & Complaints

The most prevalent complaint by patients with BDD is that there is something wrong with or abnormal about one or more body parts. The patient may spend 60 minutes or longer daily worrying about or checking the part and may consult many specialists to try to create a solution to the flaw. Here is a list of the areas most commonly considered "flawed" by BDD sufferers:

Because of concern about the flaw(s), the patient may make significant effort to try to alter or hide the area(s) of concern. Sometimes the person will withdraw socially because of a fixation on the perceived flaw. Here is an overview of the most common symptoms reported by BDD sufferers:

  • Feeling overwhelmingly concerned about the flaw(s).
  • Constantly checking and re-checking the flaw(s).
  • Feeling unable to focus in daily life due to worry about the flaw(s).
  • Continually touching or examining the flaw(s).
  • Having relationship or work problems due to a focus on the flaw(s).

Causes

It is not currently known precisely what leads to a development of body dysmorphic disorder. Currently theories include a possible genetic factor as well as a link through family history. There are also possible environmental factors, including a history of physical or sexual abuse, insecure attachment as a child, bullying by peers, poor self-esteem or other social causes may trigger BDD. Western culture, with its image-perfection obsession, may also be a reason why some people develop body dysmorphic disorder.

Diagnosis & Tests

The hardest part about diagnosing body dysmorphic disorder is simply getting the sufferer to open up about their fears and concerns. Sometimes it can take years before the sufferer consults a mental health professional about their fears.

One path that offers an easier route to diagnosis is when a patient contacts one or multiple plastic surgeons asking for surgery to fix the flaw(s). After taking the usual health history, the surgeon is often the one to make a referral to a mental health professional.

Either a psychiatrist or a psychologist can diagnose BDD using diagnostic tests that look at symptoms and their impact on feelings, emotions and daily life functioning. There are no particular special mental health tests in use to diagnose BDD at this time.

Treatment & Therapy

There are a number of different treatment approaches that have shown some success with treating sufferers who have body dysmorphic disorder. The most common approach combines multiple treatments together to improve the health of the whole person. One common treatment route combines these different therapies together:

  • Psychotherapy. In this therapy, the sufferer is encouraged to open up about their feelings and to begin to identify recurring thought and emotion patterns around the flaw(s). The goal is to adjust the patient's thinking and feeling towards a more normal perception.
  • Psychiatry. There are some medicines that can help sufferers with BDD. The type of medication will depend on the patient's medical and personal history. In general, antidepressants (SSRIs) and antipsychotic medications are the most commonly prescribed drugs.
  • Group support. Attending support groups with fellow sufferers can help to break down barriers of shame and stigma and encourage active participation in therapy.
  • Family support. Therapy sessions with loved ones can also be an essential aid, both in helping the family better understand what their loved one is going through and in providing care to the whole family unit.

Prevention & Prophylaxis

At this time, researchers are still seeking to better understand how body dysmorphic disorder begins, who is at greatest risk and the best approach to diagnosing and treating the disorder. There is no recognized route to preventing BDD at this time, but there is a focus on increasing awareness of symptoms for earlier diagnosis and treatment. As with all health issues, earlier diagnosis can lead to better treatment outcomes as well as less risk of future complications from an undiagnosed disorder.

As such, at this time the best known way to prevent body dysmorphic disorder is to help young people develop close, supportive relationships that are open and honest, where fears can be shared and discussed. Because the disorder so often strikes during the late teens, peer and parental relationships are particularly significant in building up self-esteem and positive body image and possibly preventing a later case of BDD from ever occurring.