Body Dysmorphic Disorder

Definition

Definition of Body Dysmorphic Disorder
Body dysmorphic disorder (BDD, also body dysmorphia, dysmorphic syndrome; originally dysmorphophobia) is a type of mental illness, a somatoform disorder, wherein the affected person is concerned with body image, manifested as excessive concern about and preoccupation with a perceived defect of their physical features. The person complains of a defect in either one feature or several features of their body; or vaguely complains about their general appearance, which causes psychological distress that causes clinically significant distress or impairs occupational or social functioning. Often BDD co-occurs with emotional depression and anxiety, social withdrawal or social isolation.

Symptoms

Symptoms of Body Dysmorphic Disorder
There are many common symptoms and behaviors associated with BDD. Often these symptoms and behaviors are determined by the nature of the BDD sufferer's perceived defect; for example, use of cosmetics is most common in those with a perceived skin defect. Due to this perception dependency many BDD sufferers will only display a few common symptoms and behaviors.

Common symptoms of BDD include:

1. Obsessive thoughts about (a) perceived appearance defect(s).
2. Obsessive and compulsive behaviors related to (a) perceived appearance defect(s) (see section below).
3. Major depressive disorder symptoms.
4. Delusional thoughts and beliefs related to (a) perceived appearance defect(s).
5. Social and family withdrawal, social phobia, loneliness and self-imposed social isolation.
6. Suicidal ideation.
7. Anxiety; possible panic attacks.
8. Chronic low self-esteem.
9. Feeling self-conscious in social environments; thinking that others notice and mock their perceived defect(s).
10. Strong feelings of shame.
11. Avoidant personality: avoiding leaving the home, or only leaving the home at certain times, for example, at night.
12. Dependent personality: dependence on others, such as a partner, friend or family.
13. Inability to work or an inability to focus at work due to preoccupation with appearance.
14. Problems initiating and maintaining relationships (both intimate relationships and friendships).
15. Alcohol and/or drug abuse (often an attempt to self-medicate).
16. Repetitive behavior (such as constantly (and heavily) applying make-up; regularly checking appearance in mirrors; see section below for more associated behavior).
17. Seeing slightly varying image of self upon each instance of observing a mirror or reflective surface.
18. Perfectionism (undergoing cosmetic surgery and behaviors such as excessive moisturizing and exercising with the aim to achieve an ideal body type and reduce anxiety).

Causes

Causes of Body Dysmorphic Disorder
The causes of Body Dysmorphic Disorder are different for each person, usually a combination of biological, psychological, and environmental factors. Furthermore, mental and physical abuse, and emotional neglect, are life-experiences that can contribute to a person developing BDD. The onset of the symptoms of a mentally unhealthy preoccupation with body image occurs either in adolescence or in early adulthood, whence begins self-criticism of the personal appearance, from which develop atypical aesthetic-standards derived from the internal perceptual discrepancy between the person's ‘actual self’ and the ‘ideal self’. The symptoms of body dysmorphia include psychological depression, social phobia, and obsessive compulsive disorder. The affected individual may become hostile towards family members for no reason.

Diagnosis

Diagnosis of Body Dysmorphic Disorder
According to the DSM IV to be diagnosed with BDD a person must fulfill the following criteria:

• "Preoccupation with an imagined or slight defect in appearance. If a slight physical anomaly is present, the person's concern is markedly excessive."
• "The preoccupation causes clinically significant distress or impairment in social, occupational, or other important areas of functioning."
• "The preoccupation is not better accounted for by another mental disorder (e.g., dissatisfaction with body shape and size in Anorexia Nervosa)."

Treatment

Treatment of Body Dysmorphic Disorder
Studies have found that cognitive behavior therapy (CBT) has proven effective. In a study of 54 BDD patients who were randomly assigned to cognitive behavior therapy or no treatment, BDD symptoms decreased significantly in those patients undergoing CBT. BDD was eliminated in 82% of cases at post treatment and 77% at follow-up.

Due to believed low levels of serotonin in the brain, another commonly used treatment is SSRI drugs (selective serotonin reuptake inhibitors). 74 subjects were enrolled in a placebo-controlled study group to evaluate the efficiency of fluoxetine (Prozac); patients were enrolled in a 12-weeks, double-blind, randomized study. At the end of treatment, 53% of patients responded to the fluoxetine.

A combined approach of cognitive behavior therapy (CBT) and anti-depressants is more effective than either alone. The dose of a given anti-depressant is usually more effective when it exceeds the maximum recommended doses that are given for obsessive compulsive disorder (OCD) or a major depressive episode.

Prognosis

Prognosis of Body Dysmorphic Disorder
Many individuals with BDD have repeatedly sought treatment from dermatologists or cosmetic surgeons with little satisfaction before finally accepting psychiatric or psychological help. Plastic surgery on these patients can lead to manifest psychosis, suicidal tendencies or never-ending requests for more surgery. Treatment can improve the outcome of the illness for most people. However, some may function reasonably well for a time and then relapse, while others may remain chronically ill. Outcome without therapy has not been researched but it is thought the symptoms persist unless treated.

Prevention

Prevention of Body Dysmorphic Disorder
There's no sure way to prevent body dysmorphic disorder. Because body dysmorphic disorder often starts in adolescence, identifying children at risk of the condition and starting treatment early may be of some benefit. In addition, taking steps to control stress, to increase your resilience and to boost low self-esteem may help. And long-term maintenance treatment also may help prevent a relapse of body dysmorphic disorder symptoms.