What is Body Dysmorphic Disorder? BDD is a psychological disorder in which a person becomes obsessed with flaws they see in their appearance. It is categorized by excessive concern with imagined or exaggerated problems in ones appearance. Cases of Body Dysmorphic Disorder can vary from mild to very severe. Back to top
What are the symptoms? Common symptoms and signs of BDD may include:
Excessively checking appearance in mirrors or other reflective surfaces
Constantly comparing appearance to other people
Picking at or otherwise attempting to fix the imagined flaw, such as through excessive grooming
Measuring, touching or checking the supposed defect
Changing clothes frequently
Refusing to be photographed and destroying existing photographs
Constantly asking loved ones for reassurance
Camouflaging, masking or disguising the perceived flaw with heavy make-up, bulky clothing, hats or posture
What body areas do sufferers obsess about? Most sufferers are preoccupied with some aspect of their face and body. Most focus on several areas of their appearance. The most common complaints concern the face, namely the nose, hair, skin, eyes, or perhaps the chin or lips. Typical concerns are perceived or slight flaws on the face or head, such as hair thinning, acne, wrinkles, scars, vascular markings, paleness or redness of the complexion or excessive hair. Sufferers may be concerned about a lack of symmetry. Any part of the body may also be involved in BDD including the breasts, genitals, buttocks, tummy, hands, feet, legs, hips, and sufferers may worry about body size, body build or muscle bulk. Although the complaint is sometimes specific, "My nose is too big and crooked" it may also be very vague or just refer to ugliness. Back to top
What causes Body Dysmorphic Disorder? The causes of BDD fall into two major categories, neurobiological and psychosocial. NEUROBIOLOGICAL CAUSES. Research indicates that patients diagnosed with BDD have serotonin levels that are lower than normal. Serotonin is a neurotransmitter- a chemical produced by the brain that helps to transmit nerve impulses across the junctions between nerve cells. Low serotonin levels are associated with depression and other mood disorders.
PSYCHOSOCIAL CAUSES. Another important factor in the development of BDD is the influence of the mass media in developed countries, particularly the role of advertising in spreading unrealistic images of physically 'perfect' men and women. Impressionable children and adolescents absorb the message that anything short of physical perfection is unacceptable. They may then develop distorted perceptions of their own faces and bodies. A young person's family of origin also has a powerful influence on his or her vulnerability to BDD. Children whose parents are obsessed with appearance, dieting, or who are highly critical of their children and tease them, are at greater risk of developing BDD. Back to top
How is BDD treated? There are very few controlled outcome studies on the treatment of BDD. Encouraging results have been found with medication (serotonin reuptake inhibitors, i.e. clomipramine) and cognitive-behavioral treatment strategies (i.e. exposure and response prevention). The latter techniques focus on breaking compulsive patterns such as checking in the mirror and asking others for reassurance. In addition, social avoidance is countered by helping patients learn to deal with social situations that promote appearance anxiety. Back to top
How is BDD diagnosed? In diagnosing BDD, the doctor will begin his or her evaluation with a complete medical history and physical examination. If the doctor suspects BDD, he or she might refer the person to a psychiatrist or psychologist, health care professionals who are specially trained to diagnose and treat mental illnesses. The psychiatrist or psychologist makes a diagnosis based on his or her assessment of the person's attitude, behavior, and symptoms. BDD is often misdiagnosed or undiagnosed because of patients reluctance to reveal their problem due to a number of causes.
They worry that they will be viewed as superficial or vain for being so concerned with their appearance.
They are so ashamed of the flaws they believe they have that they are reluctant to discuss them with a therapist.
They believe their problems can be addressed only through physical treatments and may not realize the disorder's psychological roots.
They often have another psychiatric disorder that they're more willing to discuss during therapy; this other disorder then becomes the primary diagnosis. Back to top
Are BDD sufferers vain? It is easy to trivialize BDD and confuse it with vanity. Actually it is not vanity at all. Some people with BDD do not want to look beautiful and do not necessarily want to be noticed for their appearance. In fact the opposite is true, they just want to look normal yet think they don't. Some sufferers may have unrealistic ideals of beauty they feel they have to live up to and are distressed at how far off their ideal they feel they are. Back to top
What is the prognosis for sufferers? Researchers do not know enough about the lifetime course of Body Dysmorphic Disorder to offer a detailed prognosis. It appears however that the disorder has a fairly continuous course with few symptom-free intervals, although the intensity of symptoms may wax and wane over time. Back to top
What about prevention? Given the incredibly powerful influence of the mass media in today's western societies, the best preventive strategy involves challenging the views that people have about beauty, and also understand how beauty in the media is manipulated and unrealistic. Parents, teachers, primary health care professionals, and other adults who work with young people can point out that uniqueness, is what makes people 'beautiful.' Children need to be taught to love and respect their bodies and in addition, parents can pay attention to any warning signs in their child's dress or behavior. It is important that the disorder is recognized in the early stages to avoid many years of suffering, and give perhaps a better chance of recovery. Back to top
What do I do if I expect I have BDD? Seeking mental health treatment can be a big decision. But acknowledging your need for treatment is the first step. If you have never consulted a mental health provider before, you may not know where to begin. You may not realize just how many types of mental health providers are available until you start looking for one. Should you see a family practice doctor? A psychiatrist? Psychologist? Social worker? Does it matter? Finding a mental health provider takes some legwork. It can seem like more time and energy than you can muster, especially if you are very depressed. Consider enlisting help from your primary care doctor, family or friends. Contact a local or national mental health organization or medical society. Use a referral service from a national professional association for doctors or therapists. Don't be afraid to ask questions about their treatment approach and philosophy, to make sure it suits your style and needs. Finding the right match is crucial to establishing rapport and making sure you are getting the best treatment. Although the process of choosing a mental health provider and the treatment itself can be hard work or downright painful, it can also be rewarding. You may resolve long-standing conflicts, overcome personal challenges and ultimately enjoy your life more. Back to top
Is BDD similar to OCD? Although BDD is not exactly the same as OCD, there are similarities. A person with BDD may feel they have to repeat certain acts such as checking/avoiding mirrors and 'fixing' their appearance using make-up etc. The daily life of people with BDD may be negatively impacted by the need to conceal their perceived defect/s. Back to top
BDDHELP, As mentioned in the book, Overcoming Body Image Problems including Body Dysmorphic Disorder, by Rob Willson, David Veale, and Alex Clarke. 
