Body Dysmorphic Disorder
What is Body Dysmorphic Disorder?
- Obsession with some perceived flaw or flaws in one's appearance (Butcher, Mineka & Hooley, 2004)
Introduction to Body Dysmorphic Disorder
Body dysmorphic disorder is said to be the most unusual among the subcategories of somatoform disorders - hypochondriasis, somatization disorder, pain disorder, and conversion disorder - listed in the revised edition of the fourth version of the Diagnostic Statistical Manual (DSM-IV-TR). It involves a relatively strong delusional preoccupation with certain parts of the body that are deemed to be imperfect, ugly, defective, or abnormal; although such perceived flaws are exaggerated or exceedingly distorted. Sometimes, the supposed “physical problem” is not even there, and only the person with body dysmorphic disorder can see it. A normal person would see a client afflicted with this disorder as overly concerned with his/her physical appearance and is excessively dissatisfied with his/her body. Such an obsession is distressing, unhealthy, and can impair one’s social and occupational functioning.
Preoccupations in body dysmorphic disorder typically center on one body part, especially the skin (for many, the texture, color, or blemishes of the skin), hair (balding, and even the shape of the eyebrows), nose, eyes, mouth, chin/jaw, legs/knees, breasts/chests/nipples, stomach/waist/abdomen, face (size and shape, and if blood vessels are noticeable), body build, and the genitals. Perfectionistic tendencies, according to famous cognitive psychologist Alfred Adler, is possibly the culprit behind the development of “preoccupations” in both body dysmorphic disorder and obsessive-compulsive disorder.
People with body dysmorphic disorder, at times, are not too concerned over their appearance; but for the most part, they are “hopeful” that the perceived flaw will change. This hope encourages them to take active measures to hide and correct the problem. People with body dysmorphic disorder are characteristically neurotic, introverted and impulsive, and are prone to being paranoid when surrounding people “seem” to be looking at their flaws. Consequently, they try to avoid social gatherings, and isolate themselves. When alone, they scrutinize the flaw in as much as 3 hours every day, perhaps even using a special tool to examine the defect extensively; yet sometimes, they avoid mirrors altogether. In some cases, people with body dysmorphic disorder report covering hotel mirrors and deliberately crossing the street just to avoid glass windows. As much as 75 percent of people with this disorder undergo surgical, dermatological, and dental procedures; and more than half of women bodybuilders have this disorder as well. In the movie “First Wives Club,” Goldie Hawn plays the role of a young woman who underwent cosmetic surgery to make her lips fuller, but she remained unhappy. Indeed, as with the reassurances people with body dysmorphic disorder often seek from close friends and family members, these corrective measures provide only momentary relief.
Body dysmorphic disorder has high comorbidity (or typically occurs) with other Axis I disorders, such as major depressive disorder, social phobia, obsessive-compulsive disorder, and substance abuse or dependence; eating disorders; anxiety disorder; trichotillomania; psychotic disorders; and, some personality disorders. It is not surprising that some researchers are suggesting that body dysmorphic disorder may be part of a spectrum of disorders with some of these comorbid disorders; for example, as one of the “obsessive-compulsive spectrum disorders,” or, together with eating disorders, as a variant of a so-called “body image disorder.” Around 70 to 80 percent of people with body dysmorphic disorder are diagnosed with major depressive disorder (severe depression), and some even attempt and commit suicide. Reported rates of comorbidity with social phobia and obsessive-compulsive disorder are also substantial, but not as significant as with depression. Although there is a strong distinction between obsessive-compulsive disorder and body dysmorphic disorder - the former is concerned with imaginary future problems and the latter with physical appearance and social acceptability -, studies show that the striking similarities between the two disorders are also reflected in their symptoms, causes, involved biological factors, and treatments. Besides the presence of both obsessions and ritualistic-like behaviors, neurochemical (pertaining to the brain) activities associated with obsessive-compulsive disorder have been shown to operate similarly in people with body dysmorphic disorder. Pharmacological and behavioral treatments used in obsessive-compulsive disorder are also effective in treating body dysmorphic disorder. Yet in another way, body dysmorphic disorder is also similar with eating disorders, precisely because both are concerned with a distorted body image that is believed to be critical in romantic relationships. Lastly, it was also found out that more than half of those people with body dysmorphic disorder have at least one related personality disorder.
Body dysmorphic disorder is relatively not a new disorder. Symptoms are largely implicated in many historical and literary accounts. It is also not rare. In fact, around 2 percent of the general population have this disorder. Body dysmorphic disorder is present in up to 5 percent of people who seek cosmetic surgery, 8 percent of people with depression, and 12 percent of outpatients undergoing psychotherapy. It is equally represented across genders, and is more common among middle-age women and young adult men. The lifetime prevalence rate (or the chance of one normal person getting this disorder) is from 5 to 15 percent, depending upon the setting. The range of onset (when symptoms typically start to show) is from early adolescence, when pubertal changes peak and many are becoming concerned over their physical appearance, to the 20s, and at age 15 on average. Symptoms may come out suddenly or gradually, and the course of the disorder is fairly stable, lasting even up to old age. Interestingly, most individuals with this disorder are known to be aesthetically inclined; and it is not yet known whether the disorder influences their preference for art, or if their artistic endeavors force them to be critical of their appearance. The above estimates and statistics for body dysmorphic disorder, however, are modest, as some people with body dysmorphic disorder are known to be secretive, keeping the perceived defect by themselves so as not to attract unwanted attention. Until recently, when body dysmorphic disorder is increasingly being discussed in daily talk shows as the so-called “imaginary defect disorder,” people with this condition started to seek psychological help instead of previously sought-after medical treatments.
Body dysmorphic disorder may be treated using antidepressant medications and cognitive-behavioral therapy. Fluvoxamine, an antidepressant in the selective serotonin reuptake inhibitor (SSRI) category, is at least moderately effective in treating about two-thirds of patients with this disorder. Cognitive-behavioral therapy for body dysmorphic disorder, on the other hand, is shown to be effective in 50 to 80 percent of patients even on follow-up. This form of therapy consists of thought stopping (in which patients are asked to recognize and change distorted perceptions), relaxation techniques (for bouts of paranoia), exposure therapy (in which patients are asked to talk about each other’s defects, or to highlight the flaw instead of concealing it), and response prevention (in which patients are trained to control compulsions).
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- Halgin, R. P. (2008). Abnormal psychology: Clinical perspectives on psychological disorders. Boston: McGraw-Hill.
- Ksir, C. (2008). Drugs, society, and human behavior. Boston: McGraw-Hill.
- Oltmanns, T. F. & Others. (1995). Abnormal psychology. NJ: Prentice Hall.
- Sue, D. (2003). Understanding abnormal behavior. Boston: Houghton Mifflin.
Frequently Asked Questions
- What are the main features of this disorder?
- What is the source of obsession in this case?
- Is there any available case study of a person with BDD?
- How are eating disorders related to it?
- Does it have any relationship with obsessive-compulsive disorder? What are their similarities and differences?
- How common/prevalent is it? Which gender tend to have it more? In what age does it often come up?
- What is the treatment for it? Did it prove to be effective?