Body Dysmorphic Disorder (BDD) or Dysmorphophobia: People obsessed with their defects

 

Body Dysmorphic Disorder (BDD) – People obsessed with a part of their body that they are not comfortable with and want to modify it. For example: “are my breast too small?” “Are my lips full enough?” “I’m losing my hair!” Discover this comprehensive handbook on dysmorphophobias or body dysmorphic disorder: what it is, its causes, symptoms, consequences, treatments, and advice.

Body Dysmorphic Disorder

Body Dysmorphic Disorder

Almost everyone has felt unsatisfied with some aspect of their physical appearance. Nonetheless, we learn to coexist with those areas of our body that we don’t like and don’t pose a problem. However, people with body dysmorphic disorder have recurring thoughts about that part of the body, generating very high levels of stress and preventing them from leading a normal life. Many of them end up going to cosmetic clinics and undergo surgery, however, they are rarely satisfied with the results.

What is Body Dysmorphic Disorder?- Definition

Dysmorphophobia, also called Body Dysmorphic Disorder (BDD), body dysmorphia, or body image distortion is a disorder that is an excessive concern with an imagined defect in their physical appearance or a minor defect, which other people don’t even notice.

What is Body Dysmorphic Disorder? People obsessed with their physical defects. People who suffer from dysmorphophobias live with a constant and insistent obsession: they see in their body clear defects, imperfections, disproportions, or deformities.

People who have a body dysmorphic disorder feel that the perception of their body and their “physical defect” is an unquestionable and objective truth. Even if their environment differs or defends the opposite, these people always believe that the assessments others make of their “defects” are not objective and that others try to minimize the defect to comfort or deceive them.

For example, you may be convinced that a subtle scar is a major flaw and everyone is looking at it. People with this disorder tend to see it very negatively, even though others flatter them.

Usually, people with body dysmorphic disorder perform repetitive behaviors, such as checking the appearance in the mirror, combing excessively, pinching their skin, searching for validation in others as well as comparing themselves to others.

About 1 in 100 people suffer from this disorder, affecting men and women alike. Dysmorphophobia usually appears in adolescence or youth. As we have seen previously, this disorder can be called with different terms. Although it has traditionally been called the dysmorphophobia disorder, the current clinical term used is Body Dysmorphic Disorder (BDD).

The main concerns of people suffering from Body Dysmorphic Disorder or dysmorphophobia are usually the following:

  • Skin Imperfections: such as wrinkles, scars, acne, birthmarks.
  • Hair: which may include capillary hair, body hair, or the absence of hair.
  • Facial features: The nose is often a source of concerns, but may involve the size and shape of any feature.
  • Body Weight: Many become obsessed with their weight or muscle tone.
  • Asymmetry: Some people worry about certain asymmetries, such as one hand bigger than the other, one ear larger than the other, and so on.

Other areas of concern may include the size of the penis, muscles, breasts, thighs, buttocks and even the presence of certain body odors.

Body dysmorphic disorder is associated with high levels of stress and anxiety symptoms, depressed mood, social anxiety, neuroticism (emotional instability), introversion, and low self-esteem.

Muscle Body Dysmorphic Disorder

One type of dysmorphophobia is muscular body dysmorphia, which usually affects mainly men, but also some women. It consists of the concern that the body is too small or not enough toned or muscular. Although in fact, these people have a normal or even very muscular body. They may also be concerned about other areas of their body such as their skin or hair. Most, but not all engage in excessive dieting, exercising and/or weight lifting which can damage the body. Some use anabolic steroids that can be hazardous to health.

Body Dysmorphic Disorder- Muscles

Body Dysmorphic Disorder- Muscles

Delusional Dysmorphophobia or Delusional Body Dysmorphic Disorder

Some people with dysmorphophobia may or may not be aware that their obsession is unfounded. Consciousness is generally poor. They may also have delusional beliefs, that is, beliefs that have no evidence of being true. They believe in them very strongly, regardless of whether you try to convince them otherwise.

Body dysmorphic disorder by proximity is a form of this disorder that involves concerns about perceived defects in the appearance of another person.

How to differentiate body dysmorphic disorder from other disorders?

Dysmorphophobia shares some characteristics with eating disorders and obsessive-compulsive disorder. With eating disorders, they share a high concern for body image. However, in eating disorders, the concern is not being in shape or gaining weight throughout the whole body, whereas in body dysmorphic disorder they worry about concrete parts.

People with obsessive-compulsive disorder (OCD) have recurring and stressful thoughts, fears or images (obsessions) that they can’t control, and they resort to compulsions to calm their anxiety (repetitive behaviors, rituals). A person with body dysmorphic disorder may also have rituals, such as constantly looking in the mirror. However, unlike OCD, the obsessions of body dysmorphic disorder focus on body and physical appearance, and compulsions are only intended to improve the appearance of such perceived defects.

It can also be confused with social phobia since in both disorders all kinds of social events are avoided. However, in body dysmorphic disorder the reason is the anxiety that causes other people to see the defect. In social anxiety, it is more to avoid feeling judged and evaluated in general.

Body Dysmorphic Disorder -Symptoms

Some of the warning signs that may indicate that a person suffers from body dysmorphic disorder are:

  • Repeated, time-consuming behaviors, such as looking in the mirror, pinching the skin, trying to hide or covering the perceived defects. 
  • Seeking others to assure you that the defect is not visible or very obvious.
  • Measure or repeatedly touch that “defective” area.
  • Experiencing problems at work, in class, in social relationships, due to the inability to stop focusing attention on the perceived defect.
  • Being too aware of that defect and avoid going out in public, or feel anxious around other people.
  • Visit doctors repeatedly, such as plastic surgeons or dermatologists to find ways to improve their appearance.

Body Dysmorphic Disorder – Causes

Like in many other disorders, the exact cause is not known, and a single cause for dysmorphophobia is unlikely. Many factors come into play.

Body dysmorphic disorder usually occurs at the same time with other psychological disorders, such as anxiety or major depression. Therefore, suffering from other disorders, such as depression and anxiety, makes you more vulnerable to dysmorphophobia.

Other factors that may influence the onset of this disorder are:

  • Experiencing traumatic events or emotional conflicts during childhood, especially neglect and abuse.
  • Low self-esteem
  • Having parents or other reference figures who were critical of physical appearance
  • Society pressure towards beauty and appearance standards. 

Body Dysmorphic Disorder – Treatment

The treatment for body dysmorphic disorder is mostly individual psychotherapy. The goal would be to modify the belief about your body and reduce compulsive behaviors.

Group therapy and family therapy are also very helpful. It is important for the family to learn about the disorder, to recognize signs and symptoms as well as to improve the family climate and communication patterns that are likely to be affected.

Pharmacological treatment is a help option, although not always necessary. Antidepressants and antipsychotics are used. The prognosis of these people, provided they receive treatment, is very positive, especially if there is a strong support system.

Body Dysmorphic Disorder – Consequences and Complications

People with body dysmorphic disorder can be socially isolated, because of the fear of being exposed in public. It also has an impact on work and school life.

These people are at greater risk of depression, and therefore suicide risk.

It is also a disorder that puts health at serious risk, due to the constant surgical interventions, diets and other strains people put on their bodies. 

What should I do if I think I have Body Dysmorphic Disorder?

Many people with body dysmorphic disorder are reluctant to seek help because they feel ashamed, however, there is nothing to be ashamed of. Psychological disorders tend to happen as a coping mechanism and are very common so no one is to blame.

Seeking help is essential since the disorder will never get better if it is not treated. Instead, complications may appear as well as other associated disorders. This will make recovery more difficult and increase relapses.

Do you have doubts if you have body dysmorphic disorder? Here are some questions that can help you:

  • Are you very concerned about your appearance and would you like to think less about it?
  • Is it difficult for you to do your job or be with friends?
  • What specific concerns do you have about your physique?
  • On a typical day, how many hours do you have in mind your appearance?
  • What effects does it have on your life?

Hope this article was helpful and please leave a comment or questions below.

This article is originally in Spanish written by Andrea García Cerdán.

Alejandra is a clinical and health psychologist. She is a child specialist with a diploma in evaluation and intervention in autism. She has worked in different schools with young children and private practice for over 6 years. She is interested in early childhood intervention, emotional intelligence, and attachment styles. As a brain and human behavior enthusiast, she is more than happy to answer your questions and share her experience.