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Body Dysmorphic Disorder (BDD)

Body Dysmorphic Disorder (BDD)

Many people can have a poor body image, seeing their general physical appearance in a negative light (e.g., “I hate my body”). However, Body Dysmorphic Disorder (BDD) is characterised by an intense preoccupation with a perceived flaw in one’s physical appearance. Individuals with BDD often spend significant periods of time worrying about and evaluating a particular aspect of their appearance.
 

While the preoccupation may be with any body part, and can change over time, the most common areas that people with BDD report as being problematic include:

  • Skin including acne, wrinkles

  • Cheeks, chin or jaw or complexion

  • Thinning or excessive hair on the head or body

  • Nose size or shape

  • Eyes or eyebrows

  • Lips, smile, teeth or mouth

  • Ears

  • Overall face shape

  • Legs, thighs or calves

  • Genitals

  • Breasts

  • Buttocks

  • Stomach

  • Arms

  • Neck

  • Scars

  • Height

  • Muscles / build

Individuals with BDD are often concerned that the body part is too big or too small, not the right shape, asymmetrical, or out of proportion to the rest of their body.
 

In BDD, usually the actual flaw a person is worrying about is so slight that others do not really notice or consider it important. In some cases, the flaw may be imperceptible to others. However, even if this is pointed out to a person with BDD, they will continue to worry about that area of their body and often believe that others are thinking negatively of them because of it.
 

Often people confuse BDD with Obsessive Compulsive Disorder (OCD). Although there are similarities (obsessive thoughts), OCD is more than just obsessive thoughts about physical appearance. Similarly eating disorders such as Anorexia and Bulimia are often confused with BDD; however BDD sufferers are concerned with more than just their weight. It is also important to recognise that BDD is not simple vanity or dissatisfaction with appearance. BDD is a distressing mental health condition, which is often associated with depressionsocial anxiety, self-harm, substance abuse, and feelings of shame, guilt and loneliness.
 

Behavioural symptoms include:

  • Going to excessive lengths to hide or cover up the area(s) of their body that they feel are disgusting.

  • Constantly checking themselves in the mirror or in any other reflective surfaces and if they are unable to check will have several repetitive thoughts about the area.

  • Feeling trapped when looking in the mirror and spending prolonged amounts of time in front of it; unable to move. Or equally, avoiding the mirror altogether.

  • Talking negatively about their area of unhappiness whilst in social situations as to seek reassurance.

  • Comparing themselves with models, celebrities, friends or even strangers.

  • Trying desperately to avoid bright lights, having their photos taken and people seeing them from certain angles.

  • Seeking surgery to correct the area of their concern, despite the professionals involved informing them that nothing needs to be ‘corrected’.


Physical anxiety symptoms include:

  • A dry mouth.

  • Hot flushes.

  • Cold or sweaty hands.

  • Heart palpitations or shortness of breath.

  • Feelings of panic, fear and apprehension.

  • Having trouble sleeping.

  • Tense muscles.

  • Having a reoccurring upset stomach.


Body Dysmorphic Disorder can affect all aspects of the sufferers’ lives and this can often mean the individual is unable to find employment or struggles to keep any job they do get. It can also affect their relationships and can limit one’s desire to leave the house or socialise.

How common is BDD?

At least 1-5 per cent of the population are affected by BDD, and it affects men and women equally. It often arises during adolescence, however most people who are diagnosed with this problem do not receive a diagnosis until 10 to 15 years after their symptoms began. It is thought that this may be due to the secrecy and shame often associated with the problem, which prevents people from seeking help.

What Treatment is Available for BDD?

Cognitive Behavioural Therapy will involve:

  • Understanding BDD and what keeps it going

  • Reducing appearance preoccupation

  • Reducing checking and reassurance seeking behaviours

  • Overcoming negative predictions and avoidance

  • Adjusting appearance assumptions