Body Dysmorphic Disorder (BDD) is a preoccupation with ones appearance having a perceived defect that others do not notice or do not believe to have great importance. These symptoms also must cause significant impact or handicap to life to meet the criteria for diagnosis.
What may also cause distress to those suffering with BDD is that when they seek validation and reassurance that others see what they do, this is not confirmed. The degree of insight that patients have into this being a psychological issue rather than an appearance one is varied. Even so, it is important to remember all severities of BDD are treatable.
Do most people have a concern about their appearance?
It is true that if you ask any individual if they have a concern about a part of their appearance, that they will name something. But the diagnosis of BDD is different, there is a significant amount of distress attached to the way they feel about their appearance. Alongside distress is the handicap in at least one area of the individuals life.
An example of this is that someone with BDD may only enter social situations whilst trying to hide/camouflage a perceived defect, this may include wearing certain clothing/hats or brushing hair a particular way. Other common unhelpful coping behaviours include using makeup or changing their posture. There is a significant amount of time thinking about how others may negatively judge them. Another common aspect of BDD is asking themselves unanswerable questions such as “why was I born with this nose”, “if only my stomach was flatter”
How common is BDD and what are the most common preoccupations?
There is a lot of misconception regarding BDD, many may worry they are seen as vain, or may draw attention to an area they do not want to be shown. It is generally recognised that BDD is a hidden disorder due to very high levels of shame. Surveys have shown that BDD to be about 2% of the population but could be higher. BDD is equally common in men and women.
Majority of those suffering with BDD are concerned with multiple defects on their face, nose, hair, skin, eyes, chin, lips and overall body shape and/or build. Perfectionism is common in BDD and a concern with symmetry or that a part Is too big or small, or out of proportion is also frequently reported . Any part or parts may be involved, including genitalia or breasts. There may also be a general feeling of ‘ugliness’ rather than an actual specific area of concern.
When does BDD begin?
BDD usually develops in adolescence a time when people are generally most sensitive about their appearance. However, many sufferers leave it for years before seeking help. When they do seek help through mental health professionals, they often present with other symptoms such as depression, social anxiety or obsessive-compulsive disorder (OCD) and do not reveal their real concerns. Patients may have suffered trauma in childhood including being treated differently bullied. Individuals may also have received praise for how they look, making the individuals identity built solely on their appearance.
What causes BDD?
The generally accepted explanations are Biological and Psychological. The Biological explanation accepts an emphasis on genetic predisposition to BDD, certain stressors, such as abuse or bullying encourage a development of the disorder.
The Psychological explanation emphasises a person’s low self-esteem in relation to body image. They may judge themselves solely on this and not see themselves having an identity outside of their appearance. This individuals may fear that they are worthless or will be teased or rejected due to appearance. There may be evidence of a ‘ghost from the past’ where they have been humiliated and shamed. In relation to perfectionism shame occurs that their appearance is not an impossible ideal.
What is the recommended treatment?
NICE guidelines on BDD recommend Cognitive Behavioural Therapy (CBT) is the recommended treatment for BDD. This form of therapy is based on a structured programme which focuses on challenging the way individuals think and act. Skills taught include mirror retraining, attention training and compassionate focused therapy (CFT) techniques. Value driven goals are created, and fears are confronted using Exposure Response Prevention (ERP).
Evidence based treatment with a Cognitive Behavioural Therapist in London online or in-person home visits.
If you feel that you, a friend or relative would like help for Body Dysmorphic disorder, then please get in touch via email: firstname.lastname@example.org
Websites and additional information
The BDD Foundation is a charity for people with BDD and their carers.
The National Institute of Clinical Excellence of treatment guidelines on BDD can be downloaded here.