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Body Dysmorphic Disorder (BDD)

BDD reality and perception (by Joan Thomas).

Body Dysmorphic Disorder (BDD) is often called the 'imagined ugliness' disorder. It was formerly known as Dysmorphophobia and is an anxiety disorder whereby a person is abnormally preoccupied with an imagined or slight defect in their physical appearance.

They may compare their looks with other people’s, worry that they are physically flawed and spend a lot of time in front of a mirror concealing what they believe is a defect.

At some time or another, almost everybody feels unhappy about the way they look, but these thoughts come and go and can be forgotten. However, for someone with BDD the thought of a flaw is very distressing and does not go away. Even though other people may think there is nothing wrong with the way the person looks, for the sufferer it can lead to depression and thoughts of suicide.

Here in the United Kingdom current estimates suggest that 0.5% of the population will have BDD, from children and young people to older adults, which equates to 5 out of every 1000 people.  That is some 308.960 people based on the 2009 population estimate.

BDD obsessions may manifest themselves as excessive, disproportionate concerns about a minor flaw, or as recurrent, anxiety-provoking thoughts about an entirely imagined defect. The obsessions are most frequently focused on the head and face, but may involve any body part. When others tell them that they look fine or that the flaw they perceive is minimal, people with BDD find it hard to believe this reassurance.

The onset of BDD usually begins in adolescence up to the early twenties, a time when people are generally most sensitive about their appearance. While not unique to women, the condition is more predominant amongst females, although clinical samples tend to suggests it affects bith sexes equally. It has been noted that BDD has features that are quite similar to those of OCD. Some studies have shown that many of those people with BDD also have OCD.
Although the two disorders are quite different, there are also many similarities. For example, a person with BDD may have to repeat certain acts such as:

  • Checking how they look
  • Seeking reassurance about their looks
  • Picking their skin to make it ‘feel’ smooth or just right
  • Repeatedly grooming of hair, eyebrows or make-up to ‘feel’ just right
  • Avoiding mirrors to avoid being triggered by their reflection

Common BDD obsessions involve concerns about the face, namely the nose, the hair, the skin, the eyes, the chin, or the lips. Flaws on the face or head, such as hair thinning, acne, wrinkles, scars, vascular markings, paleness or redness of the complexion or excessive hair are perceived as major concerns. Sufferers may be concerned about a lack of symmetry, or feel that something is too big or swollen or too small, or that it is out of proportion to the rest of the body. Any part of the body may however be involved in BDD including the breasts, genitals, buttocks, abdomen, hands, feet, legs, hips, overall body size, body build or muscle bulk. These concerns lead most patients to engage in compulsive behaviours, such as mirror checking, excessive grooming, and skin picking.

The behaviour of BDD sufferers will include some or all of the following:

  • Checking the appearance of the specific body part in mirrors.
  • Camouflaging the perceived defect with clothing or makeup.
  • Excessive grooming, by combing, shaving, removing or cutting hair, applying makeup.
  • Picking their skin to make it smooth.
  • Picking the skin around the perceived defect.
  • Comparing the appearance of the perceived defect with that of others.
  • Dieting and excessive exercise or weight lifting.
  • Avoiding social situations in which the perceived defect might be exposed.
  • Possibly seeking surgery or dermatological treatment despite being told that surgery is not required.

Although some people with this disorder manage to function well, despite their distress, most find that their concerns about thir appearance causes  significant problems for them. They may find it hard to concentrate on their job or school work, which may suffer as a result, and relationship problems are common. People with BDD feel very self-conscious in social situations and generally have a very poor quality of life.

A person with BDD may feel that they cannot go out in public unless they have hidden the problem area in some way with clothing, make-up or covering with hair.  This can seriously affect a person’s quality of life affecting both employment and relationships.

Sufferers of BDD may also experience periods of depression, anxiety, and even suicidal thoughts because of their preoccupation with the perceived flaw.

People living with BDD are not vain, but believe themselves to be ugly or defective. They tend to be very secretive and reluctant to seek help because they are afraid that others will think them vain or self-obsessed.

Some people have resorted to cosmetic surgery (including dangerous and painful 'Do it yourself' surgery ), which can cause high levels of distress, is unlikely to improve the symptoms and has been shown to have poor outcomes.

There is still not a single clear cause for Body Dysmorphic Disorder, but experts believe that biological, psychological and socio-cultural factors have contributed to its emergence. Neurochemical factors, such as abnormalities in the brain chemical serotonin, may make some people more likely to express the symptoms of BDD than others. However, psychological factors such as teasing about one's appearance during childhood, families' or peers' emphasis on appearance and trauma or sexual abuse might also be risk stimuli for the expression of symptoms.

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