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What is body dysmorphic disorder?

Body dysmorphic disorder (BDD) is a condition that involves an extreme preoccupation with one or more features that are not noticeable or abnormal to others.  People with BDD usually feel that they are ugly, that they are “not right” and are very self-conscious.  They usually have compulsive behaviours such as mirror-checking that are difficult to resist.  They may resort to needless cosmetic and dermatological procedures, which they are often either dissatisfied with or that have little impact on their preoccupation and distress.

People with BDD also tend to be very secretive and reluctant to seek help because they are afraid that others will think them vain or narcissistic.  Of course, they are not vain at all, as their goal is to fit in rather than to stand out and they usually hate their appearance.

The older term for BDD, “dysmorphophobia” is sometimes still used.  The media sometimes refer to BDD as “Imagined Ugliness Syndrome.”  This isn’t particularly helpful, as the ugliness is very real to the individual concerned.  A few people with BDD acknowledge that they may be blowing things out of proportion.  At the other extreme, others are firmly convinced of the reality of their supposed abnormality.  Whatever the person’s degree of insight into their condition, someone with BDD usually knows that others believe their appearance to be “normal” and will have been told so many times.

How much does BDD interfere in people’s lives?

The degree of disability caused by BDD varies from slight to very severe.  Many people with BDD are either single or divorced, which suggests that they find it difficult to form relationships.  It can make regular employment and family life impossible.  Those who are in regular employment or who have family responsibilities would almost certainly find life more productive and satisfying if they did not have the symptoms of BDD.  Their partners may also become involved and suffer greatly.

How common is BDD?

About 1-1.5% of the world’s population may have BDD, and it may be more frequent in some cultures where appearance is more valued.  The exact figure is not known.  It is recognized to be a hidden disorder, as many people with BDD are too ashamed to reveal their problem.

Does it affect both sexes?

Both sexes are equally affected by BDD.  People with BDD are most commonly concerned with their skin, followed by concerns about their nose, hair, eyes, chin, lips, or overall body build.  People with BDD may complain of a lack of symmetry, or feel that something is too big or too small, or that it is out of proportion to the rest of the body.  Any part of the body may be involved in BDD, including the breasts or genitals.  Although women are more likely to have hair concerns (e.g., that hair is the wrong colour, or it lacks body, or thee is excessive body hair), men are significantly more concerned with hair thinning or baldness.

The sex differences also occur with body size and shape.  Women ae more likely to be preoccupied by their breasts, hips, weight, and legs, usually believing that they are too large or fat.  In contrast, men tend to be preoccupied with body build, which has also been described as muscle dysmorphia.  

Another significant sex difference is that men are more likely to report hair thinning and preoccupation with their genitals (usually a concern that their penis is too small), or be concerned about breast development, which they see as too feminine.  Woman may also feel that their genitalia or labia are too large and seek cosmetic surgery to reduce their size.

Muscle dysmorphia is a variation of BDD in which a man is usually worried about being too small or too skinny or not muscular enough.  Despite such concerns, many such men are unusually muscular and large.  Many of them spend hours lifting weights and pay great attention to nutrition.  Others may abuse steroids.  

When does BDD start?

BDD usually begins in adolescence, a time when people are generally most sensitive about their appearance.  However, many people wait for years before seeking help.  They may repeatedly consult dermatologists or cosmetic surgeons but often get little satisfaction from these treatments.  When they do initially seek help from mental health professionals, they often ask about other symptoms such as depression, social anxiety, or obsessive compulsive disorder (OCD) and do not reveal their real concerns.  However, people with BDD are often  also depressed with high rate of attempting suicide.

What treatments are available for BDD?

The National Institute of Health and Clinical Excellence (NICE) has provided guidelines for treatment based on research.  The guidelines places emphasis on client’s choice and on their experience of previous treatment.  These options depend on availability of therapists and local resources.  Sometimes you may have to try two or three different approaches before you find one that is effective for you.  The core message is that there is evidence that BDD is treatable and you can get back to a normal life.  

(visit www.nice.org.uk/guidance/CG31).

At WOSPS we apply the specialist CBT for BDD which may or may not be applied alongside medication.  Why not telephone, email or text for an appointment for a comprehensive assessment now and let us help.

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