Body dysmorphic disorder (BDD) is characterized as an obsession with an imaginary defect in physical appearance or an extreme concern with a slight physical blemish, which other individuals may not even recognize. Body dysmorphic disorder is much different than body image disturbance. Body image disturbance deals with body size or body type whereas individuals with body dysmorphic fixate on a body part repeatedly to the point where it interferes with their social, emotional, educational, and occupational welfare. People with BDD may think something like, “I have a horse face” which can lead to obsessive thoughts, negative mindsets and low self-esteem.
This mental illness is classified as an “obsessive-compulsive spectrum disorder”, as obsessions over body image are involved, and compulsions to act on thoughts are repeatedly done to reduce anxiety. Some of the most common preoccupations with body dysmorphic disorder include anomalies on the skin, such as acne, scarring, or spotting, nose size or shape, and hair, such as baldness or excessiveness. Preoccupations can be focused on any body part, and physical anomalies are usually imagined defects in appearance. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) the individual must have be preoccupied with a nonexistent or of slight flaw in their physical appearance where they think about this flaw for at least one hour a day and perform repetitive compulsive behaviors directly associated with their preoccupation for their flaw.
Signs and Symptoms
Individuals with BDD have misconceived beliefs regarding their body and the most
common body parts for both men and women to have false misconceptions about are
skin, hair and nose. Others include eyes, teeth, chin, legs, lips and height. Individuals
with body dysmorphic disorder often portray the following behaviors:
- Ritualistic behaviors to confirm their physical “defect”. This can include constant
checking in the mirror, touching that specific area of the body or actively avoiding
the “defects” recognition by others by covering that area of the body up with
clothing, makeup or tattoos.
- The constant need for constant reassurance from others
- An enormous amount of time (1 hour or more, sometimes as much as 8 hours) daily on thoughts and behaviors relating to the “defect”
- Repeated visits to dermatologists or cosmetic surgeons for correction of this
- Skin picking
- Mirror checking
- Excessive shopping
- Excessive grooming
- Social anxiety
Body dysmorphic disorder is highly linked to suicide. According to a study exploring the suicidality in BDD, 45 to 70 percent of the patients with BDD have reported suffering from suicidal ideation, and 22 to 24 percent of patients with BDD have attempted suicide. What makes BDD particularly dangerous is that people who suffer from it develop dependencies on obsessive behaviors; they believe these behaviors will provide relief.
One such example is “mirror checking,” the ritual of checking a mirror hundreds of times a day to either catch a glimpse of looking good or, as is usually the case, reinforce feelings of negativity surrounding body image.
Treatment for body dysmorphic disorder
Although there is no cure for body dysmorphic disorder, cognitive behavioral therapy and exposure therapy are the psychotherapy methods of choice in order to alleviate symptoms and harmful behaviors. Exposure therapy involves exposing a patient to their biggest fears. For example, someone with BDD who thinks their face is hideous might try leaving the house without wearing makeup. The hope is that overtime these fears will lessen.