What are the other Names for this Condition? (Also known as/Synonyms)

• Body Image Dysfunction
• Dysmorphophobia
• Imagined Ugliness

What is Body Dysmorphic Disorder? (Definition/Background Information)

• Body Dysmorphic Disorder (BDD) is a chronic mental illness characterized by a persistent preoccupation with a flaw in one’s appearance, whether minor or imagined. BDD is also known as Dysmorphophobia
• Individuals with BDD often perceive themselves as being “ugly” and typically focus on one particular aspect of their physical body, including the skin, hair, face, nose, chest, or stomach
• Although an imperfection may seem minor or non-existent to those around individuals with BDD, the flaw is significantly important to them. It is so important that such individuals constantly have obsessive thoughts about their body image, causing great emotional distress, shame, and embarrassment to themselves
• In order to relieve these negative thoughts, patients suffering from the condition feel the urge to perform certain ritualistic behaviors. Checking oneself in front of the mirror frequently is one such obsession. These behaviors are both time and energy-consuming and only provide a measure of temporary relief
• Body Dysmorphic Disorder can also lead to further complications, such as social isolation, depression, or even suicidal behavior. This condition is neither well known, nor is it common
• Cognitive behavioral therapy and medication therapy (for depression) are helpful in treating Body Dysmorphic Disorder. The prognosis is generally optimistic, especially if there is a positive support from family and friends

Who gets Body Dysmorphic Disorder? (Age and Sex Distribution)

• The onset of Body Dysmorphic Disorder is often during adolescence
• Males and females are both equally affected by this disorder
• The condition is observed worldwide; individuals of all races and ethnic groups are vulnerable

What are the Risk Factors for Body Dysmorphic Disorder? (Predisposing Factors)

Even though the cause of Body Dysmorphic Disorder is not known with certainty, there are some factors that appear to lead towards it. These include:

• Having experienced a traumatic event or being an object of teasing (bullying), during one’s childhood
• Having low self-esteem
• Individuals having a family history of BDD
• As the cause for mental illnesses, such as depression and anxiety, may be similar to that for Body Dysmorphic Disorder; having these psychiatric disorders may increase the risk

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Body Dysmorphic Disorder? (Etiology)

The exact cause of Body Dysmorphic Disorder is yet unknown.

• There is speculation that the malfunctioning of a specific neurotransmitter, called serotonin, may play a role in BDD. Neurotransmitters are chemicals that help relay information among nerve cells
• It is believed that the cause may have a biological basis, because other mental disorders, including anxiety and depression, are caused by the inefficient regulation of serotonin
• Some of the other factors that may point towards the development of Body Dysmorphic Disorder are one’s culture, life experiences, and the environment surrounding an individual; all of which could influence one’s perception of their own body appearance
• Society’s definition of the ideal body appearance can also trigger BDD. Some with BDD become excessively sensitive to their body image, as a result of low self-esteem or emotional distress from traumatic events that happened during childhood

What are the Signs and Symptoms of Body Dysmorphic Disorder?

With Body Dysmorphic Disorder, which typically begins during adolescence, individuals are constantly obsessed with their physical appearance. They are preoccupied with an imagined or small defect in a specific part of their body.  Although the flaw may seem minor or even non-existent to others, the imperfection is visible and emotionally distressing to someone with BDD.

The specific body part an individual may focus their attention on varies and could include:

• Nose
• Hair
• Skin
• Wrinkles
• Complexion
• Acne, blemishes
• Breast size
• Muscle size
• Baldness
• Genitalia

The obsession with physical imperfections may ultimately result in ritualistic behaviors in an attempt to hide or fix the perceived flaw. Though these repeated behaviors can last a few hours a day and consume much energy, they only provide temporary relief from the obsessive thoughts an individual has concerning their appearance. In severe BDD cases, individuals lose the ability to focus on anything other than their perceived flaw, which can result in problems at school or work.

The common repeated behaviors among individuals with Body Dysmorphic Disorder include:

• Obsession with physical appearance
• Persistent belief in the presence of a physical flaw, which makes oneself appear ‘ugly’
• Repeatedly examining oneself in the mirror, or complete avoidance of mirrors
• Constant need to seek reassurance from others about body appearances
• Extreme self-consciousness
• Excessive grooming and measuring of minor defects
• Skin picking
• Avoidance of social situations; anxiety when surrounded by others
• Repeatedly consulting dermatologists or plastic surgeons to correct appearance
• Excessive use of make-up to cover or hide physical flaw(s)

How is Body Dysmorphic Disorder Diagnosed?

The diagnosis of Body Dysmorphic Disorder may include the following steps:

• If a physician suspects an individual of having BDD, they will perform a physical examination with medical history, as well as propose psychological tests
• Oftentimes, physicians may become alerted, when patients repeatedly seek cosmetic procedures for the same part or for several parts of their body. The patient may be referred to a mental health professional, such as a psychiatrist or a psychologist
• An individual may be diagnosed with a BDD depending on their behavior pattern, feelings, attitudes, and symptoms

To be diagnosed with BDD, individuals must meet the criteria set by the Diagnostic and Statistical Manual of Mental Disorders (DSM) published by the American Psychiatric Association.

• The diagnostic criteria include extreme obsession with a perceived or minor defect in one’s physical appearance
• The second criteria factor is having such great emotional distress, leading to problems at school, work, or in social relationships

It is also to be noted that it is difficult to diagnose Body Dysmorphic Disorder, as individuals with the disorder are embarrassed about their appearance and are unwilling to reveal their true concerns. This often results in undiagnosed cases of the condition. Moreover, since BDD shares similar symptoms with other mental conditions, including eating disorders, or obsessive-compulsive disorders - it becomes difficult in accurately diagnosing Body Dysmorphic Disorder.

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Body Dysmorphic Disorder?

There are several complications associated with Body Dysmorphic Disorder. These include:

• Depression, anxiety
• Eating disorders
• Obsessive-compulsive disorder
• The personal embarrassment and shame associated with BDD can lead to social isolation, lack of close relationships, or the inability to attend school or office
• Repeatedly having unnecessary cosmetic procedures is also a common complication
• Suicide, in extreme cases

How is Body Dysmorphic Disorder Treated?

There are two major treatment options for Body Dysmorphic Disorder. They are cognitive behavioral therapy and medication therapy.

Cognitive behavioral therapy:

• In cognitive behavioral therapy, the purpose is to help an individual acknowledge their false beliefs and irrational thoughts concerning their body appearance
• It can also help an individual learn and control their urge to perform ritualistic behaviors
• Cognitive behavioral therapy can help an individual with BDD to think and behave in a healthier, positive, and rational way

Medication therapy:

• There are no medications specifically available to treat Body Dysmorphic Disorder
• Medications used to treat other psychiatric disorders, such as depression, can be prescribed to manage BDD
• Given the fact that BDD is thought to be caused by poor regulation of the hormone serotonin; antidepressant medications, called selective serotonin reuptake inhibitors (SSRIs) are commonly prescribed
• SSRIs have been shown to help control obsessions and any compulsive behavior associated with BDD; though a higher dosage may be necessitated. Besides, it may take up to 12 weeks before significant improvement might occur
• In some cases, antipsychotic medications are prescribed in addition to antidepressant medications

How can Body Dysmorphic Disorder be Prevented?

There is no known method to prevent Body Dysmorphic Disorder.

• But, promoting a positive attitude about body image (especially during the adolescent stages) may help prevent the development or worsening of BDD
• Commencement of suitable treatment methods, as soon as symptoms arise and creating a supportive atmosphere for an individual with BDD is beneficial

What is the Prognosis of Body Dysmorphic Disorder? (Outcomes/Resolutions)

• The prognosis for individuals with Body Dysmorphic Disorder is good, if they receive medical help and follow treatment plans
• Being surrounded by a supportive family and friends may greatly benefit patients with BDD

Additional and Relevant Useful Information for Body Dysmorphic Disorder:

It is estimated that about 1% of the U.S. population suffer from Body Dysmorphic Disorder.