Body dysmorphic disorder, also known as body dysmorphia or dysmorphic syndrome, is a mental
illness that involves belief that one's own appearance is unusually defective, while one's
thoughts about it are pervasive and intrusive, although the perceived flaw might be nonexistent.
If the perceived flaw is actual, it is minor or its significance is severely exaggerated.
Relatively common, found in about 1% to 2% of the general population, BDD is about equally
prevalent in women and men. BDD can occur in adults or in children, yet usually begins
during adolescence. Severe, the distress of BDD worsens quality
of life by impairing social, occupational, and academic functioning, and yields social
isolation. A person experiencing BDD is usually fearful of being thought vain or superficial,
and thereby conceals the preoccupation. BDD is an obsessive-compulsive related disorder.
Often occurring along with major depressive disorder, social anxiety disorder, and substance
abuse, BDD usually involves suicidal ideation and often involves suicide attempts. BDD is
common among psychiatric patients, whose BDD often remains unrecognized. Causal factors
seem to be genetic, developmental, personality, and social. Accepted treatments of BDD are
mainly SSRI antidepressant drugs and cognitive-behavioral therapy.
History The disorder was first documented in 1891
by Enrique Morselli, who dubbed the condition dysmorphophobia. BDD was recognized by the
American Psychiatric Association as a disorder in 1987 with the revision to the third edition
of the Diagnostic and Statistical Manual of Mental Disorders. The name has since been
changed from dysmorphophobia to body dysmorphic disorder, as the original implies a phobia
of people, not a reluctance to interact socially because of poor body image.
The fourth edition of the DSM defines BDD as a somatoform disorder marked by a preoccupation
with an imagined or trivial defect in appearance, but a preoccupation causing clinically significant
distress or impairment in social, occupational, or other functioning. The individual's symptoms
must not be better accounted for by another disorder, such as anorexia nervosa, an obsession
with becoming thinner. In the manual's new edition, DSM-5, published in 2013, BDD is
grouped in a new category, obsessive-compulsive spectrum. The DSM-5 also includes operational
criteria, such as repetitive behaviors or mental acts, and notes the subtype muscle
dysmorphia, which involves belief that one's body is too small or not muscular enough.
Disorder People experiencing BDD wish to change or
improve some aspect of their physical appearance—usually hair, nose, skin, or, particularly in men,
body size or musculature—and may seek cosmetic surgery or dermatological treatment for it,
although the outcome usually does not stem the BDD symptoms. Although the individual
may look normal or even attractive, the individual feels ugly, hideous, or unusually defective,
and conducts interventions to fix or habits to conceal the perceived flaw. Skin picking
might be a habit and might paradoxically worsen the individual's appearance. BDD might involve
delusions of reference, whereby one believes, for instance, that passersby are pointing
at the flaw. BDD is under-diagnosed, as BDD received diagnostic
criteria in the fourth edition of the DSM, while clinician knowledge of BDD, especially
among general practitioners, is still not widespread. Afraid of being thought vain,
the individual experiencing BDD usually conceals the preoccupation itself, and continues efforts
to fix or hide the perceived deformity or defect. Often misdiagnosed, BDD is often thought
to be merely major depressive disorder or social phobia. Individuals with BDD seek treatment
from dermatologic treatment or cosmetic surgery, but usually gain find little satisfaction,
and might eventually receive psychiatric or psychological help. In extreme cases, patients
insist that they would rather suffer than be convinced that the deformity is nonexistent.
Research Neuroimaging suggest weaker connection between
the amygdala and the orbitofrontal cortex. In a cognitive-behavioral model, BDD arises
through interaction of personality factors, such as introversion and self-consciousness,
with early childhood experiences and social learning. As a group, BDD cases report high
incidence of emotional abuse during childhood. BDD might also reflect social effects of the
biomedical paradigm, which depicts bodies as either normal or abnormal, thus either
accept acceptable or unacceptable as aesthetic objects, amid the biomedical quest for "better"
and more youthful bodies Treatment
Cognitive behavior therapy is thought to be an effective treatment for BDD. A meta-analysis
found CBT more effective than medication after 16 weeks of treatment. CBT may improve connections
between the orbitofrontal cortex and the amygdala. See also
References
Further reading Fang A, Hofmann SG. "Relationship between
social anxiety disorder and body dysmorphic disorder". Clin Psychol Rev 30: 1040–8.
doi:10.1016/j.cpr.2010.08.001. PMC 2952668. PMID 20817336.
External links Looks that Kill, TV documentary by former
BDD sufferer, John Furse