Body dysmorphic disorder (BDD) is an anxiety disorder that causes a person to experience excessive worries and anxiety about one or several aspects of their physical appearance. BDD affects approximately one in every 50 people. While a person of any age or gender can have BDD, it is most common in teenage and young adult women.
People with BDD:
- become preoccupied with minimal or nonexistent flaws in their appearance
- the most common areas of fixation include skin, hair, nose, chin and teeth
- muscle dysmorphia is a subtype of BDD in which people (usually men) believe that they are too small and thin, thinking about becoming more muscular.
- believe these areas their body are deformed, asymmetrical, disproportional and ugly
- spend several hours a day thinking about the area or areas of concern
- experience clinically significant distress/impairment due to preoccupation with appearance
BDD and OCD
Many people struggle with body image dissatisfaction or low self-esteem at some point in their lives. But for those with BDD, these worries extend beyond what is considered “normal” and their reaction to these perceived flaws can become overwhelming.
BDD is closely related to obsessive-compulsive disorder (OCD) in this way. Both disorders cause a person to have intrusive, negative thoughts that are hard to control. These thoughts cause a significant amount of anxiety, often leading compulsive behaviors and rituals to deal with the unbearable distress.
Common intrusive thoughts related to BDD include:
- spending several hours a day thinking about the area/areas of concern
- thoughts of being ugly, deformed
- worrying that other people take special notice of the perceived defect (e.g., laugh or stare at it)
Compulsions are defined as repetitive behaviors that an individual feels driven to perform. They are used to combat or reduce the anxiety and distress accompanied by obsessions. As with OCD, engaging in compulsions may briefly decrease anxiety but only serve to reinforce the anxieties in the long-term.
Common compulsive behaviors related to BDD include:
- seeking out cosmetic surgery/dental procedures
- checking appearance in mirrors
- seeking reassurance about appearance
- overexercising, often in a way that targets the area of concern
- body checking with fingers
- picking at skin
- checking body weight on scale
- comparing one’s appearance/features with other people
- avoidance of people, places, or things due to the unbearable anxiety the flaw causes (including mirrors or reflective surfaces)
As with many mental health disorders, causes of BDD can be attributed to both nature (genetic) and nurture (environmental).
Biological factors may be present but the manifestation of BDD may never occur, or occur later in life for some. So what gives? The answer likely lies with an environmental influence. Much of our behavior is so automatic that we are unaware of the learning that takes place over the years.
- Environmental factors include bullying/teasing, childhood neglect/abuse, lack of praises and displays of affection from parents, societal pressure
- Psychological factors include personality traits such as perfectionism, over-importance of appearance, low self-esteem and rejection sensitivity
Treatment for BDD typically consists of medication (SSRIs) in combination with specific therapeutic approaches, such as cognitive behavioral therapy (CBT); acceptance and commitment therapy (ACT)
The use of medication for the treatment of BDD is commonly used to reduce the sensitivity to anxiety and allow a sense of letting go, rather than clinging on to obsessions.
Currently, Selective Serotonin Reuptake Inhibitors (SSRI’s) are commonly used for treatment of BDD. Some of the most commonly administered SSRI’s include citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac), sertraline (Zoloft), fluvoxamine (Luvox), paroxetine (Paxil), and clomipramine (Anafranil).
Cognitive-Behavioral Therapy (CBT)
CBT is an evidence-based treatment strategy, is also integral in treating those with BDD. This strategy works to identify commonly used thinking errors that serve to reinforce cycles of obsessions and compulsions.
Exposure and Response Prevention (ERP), otherwise known as exposure therapy, is an evidence-based method of treatment within CBT. ERP exposes a person to a stimulus (i.e. person, place or thing) that produces anxiety or discomfort. Throughout the exposure process, the individual is encouraged to actively resist engaging in their typical response to that trigger. This allows people to learn that their feelings of discomfort and doubts naturally subside on their own without them doing anything about it.
Acceptance and Commitment Therapy (ACT)
ACT is an additional treatment modality that can be incorporated into BDD presentation. The intolerance of uncertainty is very common for people struggling with BDD, and acceptance can be an integral part of treatment by learning how to tolerate feelings and thoughts that may have once seemed unmanageable. Excessive value is often placed on thoughts that people with BDD have, as if these compulsions signify some depravity of the person. Instead of trying to fight off compulsions with rituals, ACT helps guide the person towards acceptance of thoughts and feelings as part of the experience of life. ACT works to help teach the individual that these compulsions can come and go rather than being stuck.
Seeking Mental Health Support
If you feel that you or a loved one may be experiencing some of the signs and symptoms associated with BDD, it may be time to speak with a professional. Scheduling an appointment with Chicago Counseling Center may be the first step among many for the battle against BDD. Meet our team to learn more!