Almost everyone experiences discontent about some part of his or her body at least occasionally. Such dissatisfaction may even be considered normative during certain periods of development, such as adolescence or post-pregnancy. However, Body Dysmorphic Disorder (BDD) represents an exponential magnification of this issue. BDD is a chronic psychological condition characterized by worries and strongly held beliefs about a specific physical flaw, or set of flaws, that appear over-exaggerated, trivial, or actually non-existent to objective observers.
To understand what it’s like to have BDD, recall for a moment that sense of worry or dread you might have felt about fitting in to your favorite pair of pants after a long holiday season or a relaxing food-filled vacation. Now repeatedly multiply that discomfort, so that it lasts not just for a brief moment, but returns persistently throughout that day, the next day, and so on.
Then imagine that you have not really gained any weight at all, your pants fit perfectly fine, and yet you persistently find yourself worrying that are somehow much heavier. Perhaps you try on your favorite pants again… and again… but the reassurance you get that they still fit only lasts for a brief moment.
People With BDD
Most commonly, BDD begins in the teenage or early adult years. Males and females manifest BDD about equally. The body aspects that are most likely to distress those with BDD are their hair, skin condition, or noses. People with BDD will often pick or tweeze to try to look better which often results in actual damage.
Research about BDD has led to steady improvements in both diagnosis and understandings about helpful treatments, but its exact cause remains elusive. One important issue is whether those with BDD literally see their own appearance in a distorted way or it’s more that they think about their appearance, or the importance of appearance, in atypical ways – or some combination of both.
Since people affected by BDD are often attractive objectively, it is not surprising that they may be misperceived as being vain and frequently are not properly diagnosed in a timely manner, or ever, in part because their plight is easy to minimize or mock. In fact, feelings of shame and embarrassment relating to worries about being thought to be vain or superficial frequently create barriers to those with BDD being open about the problems they are experiencing, or seeking help even if they want it.
This is the difference: vanity is associated with conceit and arrogance about one’s looks while those with BDD worry that due to their “flaws,” they simply don’t measure up in the appearance department – and in a flight of illogic, as persons. Vain people, if anything, drastically overemphasize their beauty; individuals with BDD, if anything, overemphasize their perceived appearance-related defects.
However, it is also true that if questioned thoroughly, most of those with BDD do not actually rate their overall appearance as truly deficient but hold strong beliefs that, for them, anything less than extreme attractiveness is unacceptable. Interestingly, typically they are not too concerned about the appearance or flaws of others- to the contrary, they may be quite accepting.
It would be disingenuous to say physical attractiveness is irrelevant; however, those with BDD exaggerate this “germ of truth” to the extent that preoccupations with correcting their perceived “flaws” comes to dominate their lives to the point of EVERTHING revolving around this one aspect of life. In fact, while they are engaged in pursuing this goal, often nothing else really matters to them. Consequently, they often experience impairments in their relationships and education as well as their ability to perform in the workplace and carry out the basics of everyday existence.
Moreover, they engage in self-defeating behaviors such as excessive exercising, and seeking external “solutions” like spending inordinately on beauty products or seeking unwarranted cosmetic surgery. However, they are rarely, if ever, satisfied by the results for very long and ultimately develop poor self-image, appearance-related perfectionism, and obsessive-compulsive behaviors (e.g. repeatedly examining – or avoiding examining – their reflection, trying to disguise the body part(s) they are worried about with exaggerated make-up, hats, baggy clothes, bottomless-pit reassurance seeking, or, in some of the most severe cases, masks).
BDD is often accompanied by other psychological problems or diagnoses. Since those with BDD often also seek solutions through modifying their weight via unhealthy dietary or exercise practices, there is considerable overlap between this condition and eating disorders. Mood and identity instability are often prevalent in this population as well. Over time, BDD-related levels of anxiety, frustration, self-disparagement, and depression may escalate in a vicious cycle. If a person with BDD comes to believe that there is no hope for them to see what they want to see in the mirror, they may become particularly high risk for suicidal behaviors.
Typically, providing feedback to those with BDD that they appear to be suffering more from psychological issues than physical ones does not really help – nor does getting angry with them, guilt tripping, or “using logic.” In this respect, BDD is functionally very similar to a delusion. In other words, attempting to talk someone with BDD out of his or her worries is typically fruitless. Sadly, this is often also the case with attempts to get them the psychological interventions that they truly need.
Similarly, although those with BDD often compulsively seek reassurance about how they look from their friends or family members, complimenting the person with BDD, or telling them they have nothing to worry about often makes them feel invalidated and may result in these good intentions somehow backfiring into accusations of “just not getting it.” This is just one reason why, to the consternation and confusion of others in their lives, people with BDD often will increasingly become isolative and guarded as their concerns escalate.
Unfortunately, many with BDD struggle with body-related obsessions for years without realizing that effective treatments are available. Research shows that Cognitive Behavioral Therapy (CBT) may be effective. This type of treatment often involves gradual exposures to “real life” fears. For instance, a person that irrationally obsesses about balding might be asked to venture outside without the hat they always must wear – at first with the support of a therapist – to both determine how many people actually notice the perceived “flaw” and learn to tolerate the discomfort this experience produces.
CBT also focuses on increasing readiness for change, helping people to find value in other parts of life than how they look at a given moment as well as developing more realistic and adaptive ways of thinking. An emerging body of research evidence suggests that medication in conjunction with CBT may be the most effective approach for many individuals with BDD at this time. There is no specific medication for BDD per se. Rather, medication is targeted at specific symptoms, often with the goal of decreasing anxiety, depression, or severe cognitive distortions that present obstacles to making progress in therapy.
Most individuals with BDD may need to remain in treatment, or once improved, receiving periodic “check-ups” over considerable lengths of time due to the often chronic and relapse-prone nature of the condition. Unfortunately, in the absence of intervention, BDD can be progressive.
Although BDD remains one of the most challenging and disheartening psychological disorders, with the proper diagnosis, appropriate and consistent treatment, understanding, support, and care from significant others, and commitment to making positive changes for the long run, there is hope. Finally, taking the time to learn more about BDD and its treatment is highly recommended for friends and family, especially when the affected individual is highly resistant to getting help.
Contact Neurobehavioral Institute for more information regarding treatment options for Body Dysmorphic Disorder (BDD).