We live in a world covered in filters. Filters of the perfect high cheek bones and the flawless complexion. We also live in a world where “body dysmorphic disorder (BDD) affects 1.7% to 2.4% of the general population- about 1 in 50 people [1].”

What is BDD?

Body dysmorphic disorder (BDD), also known as dysmorphophobia, is a body-image disorder characterized by persistent and intrusive preoccupations with an imagined or slight defect in one’s appearance [1]. With BDD, people think hours about their perceived or real flaws. Their thoughts often lead to severe emotional distress and interfere with daily life. People may stop socializing and become housebound, and even commit suicide. Because of which, BDD is associated with poor quality of life [2].

There are no known causes of BDD. Research shows that is usually begins in the adolescence or teenage years and both genders are equally affected. There are a few factors that may contribute to BDD: abnormal levels of brain chemicals, family history of BDD or a similar mental disorder, personality type and certain life experiences [3].

BDD is sometimes considered a “female disorder” because it is a body-image disorder that involves appearance but BDD appears, as common or nearly as common in males as in females [5].

Signs and Symptoms of BDD

BDD sufferers may perform some type of compulsive or repetitive behavior to try to hide or improve their flaws although these behaviors usually give only temporary relief.

Examples are listed below [1]:

  • camouflaging (with body position, clothing, makeup, hair, hats, etc.)
  • comparing body part to others’ appearance
  • seeking surgery
  • checking in a mirror
  • avoiding mirrors
  • skin picking
  • excessive grooming
  • excessive exercise
  • changing clothes excessively

BDD and Mental Health 

Currently there is a lack of research on BDD when compared with other psychiatric disorders [4]. This could be due to the reluctance of BDD patients to seek mental health support due to shame and embarrassment about symptoms, poor insight and a desire for non-mental health treatment such as cosmetic surgery. However, even though those going through BDD do seek mental health services, they are unlikely to spontaneously disclose their appearance concerns due to embarrassment.

So therefore, lack of spontaneous symptom disclosure combined with limited awareness of BDD among clinicians may result in misdiagnosis, with BDD symptoms being misclassified into other disorders that are common comorbidities, such as depression and social anxiety disorder (see table 1 [4] for more information on differential diagnosis). Furthermore, among adolescents in particular, there may be difficulty differentiating mild BDD symptoms from normative appearance concerns [4].

BDD is associated with substantial impairment in psychosocial functioning and markedly poor quality of life [6]. In a sample of 200 individuals with BDD (n=200), 36% did not work for at least one week in the past month because of psychopathology, and 11% had permanently dropped out of school because of BDD symptoms [6].

BDD and Suicidality

 Suicidality appears very common in patients with BDD. Studies have found that 78% of BDD patients have experienced suicidal ideation, 45% to 71% have had suicidal ideation attributed primarily to BDD, and 24% to 28% have attempted suicide [5]. The rates of suicidality in the United States population are very high and especially higher than for many other mental disorders.

Those with BDD have different levels of functioning but overall have poor levels. Some have functional impairment, but others manage to function fairly well while others are completely disabled [5]. One study found that 36% of 176 individuals with BDD were currently unemployed due to psychopathology, and 32% were unable to be in school or do schoolwork because of psychopathology (BDD was the primary diagnosis for most subjects) [5]. In the same study, 27% of subjects had been completely housebound for at least a week because of BDD.

Treatment

 A majority of individuals with BDD seek (71% to 76%) and receive (64% to 66%) cosmetic treatment (e.g., surgical, dermatologic, or dental) for their perceived appearance flaws [6]. Research shows that such treatment appears to only rarely improve overall BDD symptoms. In a study of 200 individuals with BDD, subjects retrospectively reported that only 3.6% of all treatments resulted in overall improvement in BDD [6]. 

Other effective treatments are available to help BDD sufferers live full, productive lives [1].

  • Cognitive-behavioral therapy (CBT) teaches patients to recognize irrational thoughts and change negative thinking patterns. Patients learn to identify unhealthy ways of thinking and behaving and replace them with positive ones.
  • Antidepressant medications, including selective serotonin reuptake inhibitors (SSRIs), can help relieve the obsessive and compulsive symptoms of BDD.

Treatment is tailored to each patient, so it is important to talk with your doctor to determine the best individual approach. Many doctors recommend using a combination of treatments for best results. This article is meant as an educational and informative piece. It is not meant to serve as a diagnosis. You should talk to your doctor or mental health professional if you have specific concerns regarding yourself specifically children and teens.

 Despite BDD’s prevalence and severity, this disorder remains underdiagnosed in clinical settings. Given the markedly poor functioning and quality of life, and high rates of suicidality, among these patients, it is important that BDD is recognized and accurately diagnosed [6].

~ Jasneelam Kaur, MPH

 

 

Resources:

[1] https://adaa.org/understanding-anxiety/related-illnesses/other-related-conditions/body-dysmorphic-disorder-bdd

[2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1414653/

[3] https://www.hopkinsmedicine.org/health/conditions-and-diseases/body-dysmorphic-disorder

[4] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5566091/

[5] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1712667/

[6] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3181960/