Body dysmorphic disorder
Body Dysmorphic Disorder (BDD) is a psychiatric condition characterized by an excessive preoccupation with perceived flaws in one’s physical appearance, often leading to significant emotional distress and social impairment. Individuals with BDD may fixate on various aspects of their appearance, typically concerning the face, skin, or hair, and often engage in compulsive behaviors such as excessive grooming or mirror checking. The exact causes of BDD remain unclear, though factors such as genetics, brain chemistry, and societal pressures around beauty may contribute to its development.
This disorder can severely disrupt daily functioning, affecting interpersonal relationships and occupational performance, and it often coexists with conditions like depression and anxiety. While treatment may involve high-dose selective serotonin reuptake inhibitors (SSRIs) and cognitive behavior therapy, individuals frequently pursue cosmetic surgery in hopes of correcting their perceived defects, which often does not alleviate their distress. BDD is typically a chronic condition, necessitating ongoing treatment and support. Its recognition has evolved, with increased attention in recent years due to the potential impact of social media on body image. Understanding and addressing BDD requires a compassionate approach that acknowledges the complex emotional and psychological challenges faced by those affected.
Body dysmorphic disorder
DEFINITION: A psychiatric somatoform disorder resulting in exaggerated preoccupation with an imagined or minor defect in physical appearance that causes significant impairment of social functioning.
ALSO KNOWN AS: BDD, Dysmorphobia, imagined ugliness syndrome
ANATOMY OR SYSTEM AFFECTED: Brain, psychic-emotional system, skin
CAUSES: Unknown; genetics and brain chemistry thought to play a central role
SYMPTOMS: Excessive concern with one or more aspects of physical appearance causing emotional distress, repeated behavior or thoughts in response to preoccupation with perceived flaw, severe disruptions in social functioning, repeated attempts at corrective cosmetic surgery
DURATION: Chronic
TREATMENTS: High-dose selective serotonin reuptake inhibitors (SSRIs) such as Prozac and Zoloft, cognitive behavior psychotherapy
Causes and Symptoms
Body disorder (BDD) may be related to, though distinct from, other psychiatric disorders such as obsessive-compulsive disorder, eating disorders, and depression. No definitive cause has been identified, though proposed models suggest an interaction of societal overemphasis on physical appearance, low self-esteem, and abnormalities. There is increasing evidence of a genetic predisposition to anxiety-related disorders.
Those with body dysmorphic disorder have an overblown concern about one or more perceived body defects, commonly of the face, hair, or skin. Some patients may fixate on their muscles, penis, breasts, or buttocks. Individuals experience extreme distress as a result, which interferes with social and occupational functioning. Diagnostic criteria determined by the American Psychiatric Association include preoccupation with an imagined or minor defect in physical appearance that causes significant interruption of social functioning and is not explained by another mental disorder, such as anorexia nervosa.
Patients are often embarrassed or ashamed of the problem. They may become housebound and have difficulty maintaining interpersonal relationships. They may spend hours each day checking their appearance in mirrors and attempting to correct or hide the defect with excessive grooming rituals. Poor school and job performance are common, and approximately three-quarters of patients are unmarried.
People living with body dysmorphia will often seek help from plastic surgeons or dermatologists to correct their perceived defect. This approach is most often unsuccessful, as the change in appearance is rarely enough to satisfy the patient. This may lead to repeated attempts at corrective surgery, which continue to result in disappointment, as they address only a symptom rather than the underlying disordered thinking.
Approximately 1.7 to 2.4 percent of the general adult population is thought to live with body dysmorphic disorder, with men and women being equally affected. The typical onset is in late adolescence or early adulthood. Patients are at increased risk for major depression. A 2021 study estimated that 53 to 81 percent of patients with body dysmorphia also live with comorbid anxiety or depression, and this combination can place these patients at significant risk of suicide. Coexisting obsessive-compulsive disorder, a disorder on the anxiety spectrum, is also common. With the advent of social media in the early twenty-first century, many experts began examining the harm that its use can have on one’s body image.
Treatment and Therapy
The disorder is not uncommon, but it is frequently missed or misdiagnosed. Patients are most likely to be identified during visits to family practitioners, internists, dermatologists, or plastic surgeons where they describe physical features that they wish to change. Often they are seeking referral to a for correction of the imagined defect.
When BDD is suspected, referral to a psychiatrist for evaluation and treatment is most appropriate. Definitive treatment is unknown, but pharmacologic treatment with high-dose selective serotonin reuptake inhibitors (SSRIs) combined with nonpharmacologic cognitive behavior psychotherapy is the most effective approach currently. It is important to avoid attempted cosmetic correction, which does not treat the underlying disorder and is rarely effective.
SSRIs are thought to reduce symptoms by regulating neurotransmitters in the brain. Their use has been shown to decrease the frequency of disturbing thoughts and ritualistic behaviors related to the perceived physical flaw. This treatment is more effective when combined with cognitive behavior psychotherapy to address the patient’s low self-esteem and negative body image. Therapy that educates and includes family members, spouses, and other close individuals may improve outcome.
Body dysmorphic disorder is typically a chronic condition requiring ongoing care. Relapse following discontinuation of therapy is common. The is good with continued treatment and follow-up.
Perspective and Prospects
Italian physician Enrique Morselli coined the term dysmorphobia in 1891 to describe patients who were tortured by their fear of an imagined physical deformity that was not noticeable to others. The condition was recognized by the American Psychiatric Association in 1987, renamed body dysmorphic disorder, and classified as a distinct in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV; 1994). Among other updates, the DSM-5, published in 2013, adds the diagnostic criterion of repetitive behavior, feelings, or thoughts in response to a preoccupation with a perceived flaw.
The disorder has received significant attention and is now the subject of ongoing clinical research. Additional data is needed to pinpoint causes and evaluate new treatment approaches, particularly regarding the relationship between social media and body image and any connection it may have with the development of body dysmorphic disorder.
Bibliography
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: DSM-5. 5th ed. Arlington: Author, 2013.
American Psychiatric Association. “Highlights of Changes from DSM-IV-TR to DSM-5.” Arlington: Author, 2013.
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