Body Dysmorphic Disorder: A Mental Illness

Body dysmorphic disorder (BDD), is a mental illness in which you can't stop thinking about a flaw in your appearance, a flaw that is either minor or imagined. But to you, your appearance seems so shameful that you don't want to be seen by anyone. It's estimated that up to one in every 100 people in the UK may have BDD, although this may be an underestimate as people with the condition often hide it from others. BDD has been found to affect similar numbers of males and females.

The condition can affect all age groups, but usually starts when a person is a teenager or a young adult, when people are generally most sensitive about their appearance.

It's more common in people with a history of depression or social phobia. It often occurs alongside obsessive compulsive disorder (OCD) or generalised anxiety disorder, and may also exist alongside an eating disorder, such as anorexia or bulimia. 

Causes

The exact cause of BDD is not known. One theory suggests the disorder involves a problem with certain neurotransmitters in the brain. Neurotransmitters are chemicals that help nerve cells in the brain send messages to each other. The fact that BDD often occurs in people with other mental health disorders, such as major depression and anxiety, further supports a biological basis for the disorder.

• Brain differences. Abnormalities in brain structure or neurochemistry may play a role in causing body dysmorphic disorder.
• Genes. Some studies show that body dysmorphic disorder is more common in people whose biological family members also have the condition, indicating that there may be at least one gene associated with this disorder.
• Environment. Your environment, life experiences and culture may contribute to body dysmorphic disorder, especially if they involve negative experiences about your body or self-image.

Symptoms

Some of the warning signs that a person may have BDD include:

• Engaging in repetitive and time-consuming behaviors, such as looking in a mirror, picking at the skin, and trying to hide or cover up the perceived defect
• Constantly asking for reassurance that the defect is not visible or too obvious
• Repeatedly measuring or touching the perceived defect
• Experiencing problems at work or school, or in relationships due to the inability to stop focusing about the perceived defect
• Feeling self-conscious and not wanting to go out in public, or feeling anxious when around other people
• Repeatedly consulting with medical specialists, such as plastic surgeons or dermatologists, to find ways to improve his or her appearance

Diagnosis

The secrecy and shame that often accompany BDD make its diagnosis difficult. Most experts agree that many cases of BDD go unrecognized. People with the disorder often are embarrassed and reluctant to tell their doctors about their concerns. As a result, the disorder can go unnoticed for years or never be diagnosed. One red flag to doctors is when patients repeatedly seek plastic surgery for the same or multiple perceived physical defects.

In diagnosing BDD, the doctor will likely begin his or her evaluation with a complete history and focused physical exam. If the doctor suspects BDD, he or she might refer the person to a psychiatrist or psychologist, health care professionals who are specially trained to diagnose and treat mental illnesses. The psychiatrist or psychologist makes a diagnosis based on his or her assessment of the person's attitude, behavior, and symptoms.

Treatment

Treatment for BDD likely will include a combination of the following therapies:

• Psychotherapy. This is a type of individual counseling that focuses on changing the thinking (cognitive therapy) and behavior (behavioral therapy) of a person with body dysmorphic disorder. The goal is to correct the false belief about the defect and to minimize the compulsive behavior.
• Medication. Certain antidepressant medications called selective serotonin reuptake inhibitors (SSRIs) are showing promise in treating body dysmorphic disorder.
• Group and/or family therapy. Family support is very important to treatment success. It is important that family members understand body dysmorphic disorder and learn to recognize its signs and symptoms.

Prognosis

The outlook is promising for people with BDD who receive and follow treatment. In addition, those with a strong support team tend to do better in the long run.