Body Dysmorphic Disorder: Symptoms and Treatment

People with body dysmorphic disorder (BDD) worry about their appearance. They worry, for example, that their skin is scarred, their hair is thinning, their nose is too big, or something else is wrong with how they look. When others tell them that they look fine or that the flaw they perceive is minimal, people with this disorder find it hard to believe this reassurance.

People with BDD think a lot about their perceived appearance flaw, generally for at least an hour a day. Some say they're obsessed. Most find that they don't have as much control over their thoughts about the body flaw as they would like.

In addition, the appearance concerns cause significant distress (for example, anxiety or depression) or significant problems in functioning. Although some people with this disorder manage to function well despite their distress, many find that their appearance concerns cause problems for them. For example, they may find it hard to concentrate on their job or school work, which may suffer, and relationship problems are common. People with BDD may have few friends, avoid dating, miss school, and feel very self-conscious in social situations.

The severity of BDD varies. Some people experience manageable distress and are able to function well, although not up to their potential. Others find that this disorder ruins their life.

Symptoms of Body Dysmorphic Disorder

Frequently comparing your appearance with that of others; scrutinizing the appearance of others

Often checking your appearance in mirrors and other reflecting surfaces

Camouflaging the perceived defect with clothing, makeup, a hat, your hand, your posture, or in some other way

Seeking surgery, dermatological treatment, or other non psychiatric medical treatment for appearance concerns when doctors or other people have said your flaws are minimal or such treatment isn't necessary

Questioning: seeking reassurance about the flaw or attempting to convince others of its ugliness

Excessive grooming (for example, combing hair, shaving, removing or cutting hair, applying makeup)

Avoiding mirrors 8. Frequently touching the perceived defect

Picking your skin

Measuring the disliked body part

Excessively reading about the defective body part

Exercising or dieting excessively

Using drugs (for example, anabolic steroids) to become more muscular or lose fat

Avoiding social situations in which the perceived defect might be exposed

Feeling very anxious and self-conscious around other people because of the perceived defect

BDD Is often underdiagnosed.

The diagnosis of BDD is often missed because of:

Secrecy and shame: Many people with BDD don't reveal their symptoms to others because of embarrassment.

Lack of familiarity with BDD: Many, including health professionals, are not aware that BDD is a known psychiatric disorder that often responds to psychiatric treatment.

Trivialization: BDD is easily trivialized, even though it is a serious and distressing condition.

Pursuit of non-psychiatric medical, dermatologic and surgical treatment: Many people with BDD see dermatologists, plastic surgeons, and other physicians rather than mental health professionals. These treatments often are not helpful.

BDD Can Be Misdiagnosed

BDD is often misdiagnosed as another psychiatric disorder. This occurs because BDD can produce symptoms that mimic other disorders such as social phobia, agoraphobia, panic disorder, trichotillomania (hair pulling), obsessive compulsive disorder, and depression.

Treatment of Body Dysmorphic Disorder

There is hope for BDD sufferers! Psychiatric treatment is often effective in decreasing BDD symptoms and the suffering it causes. The treatments that appear most effective are certain psychiatric medications and a type of therapy known as cognitive-behavioral therapy.

The medications that are most promising are serotonin reuptake inhibitors (SRIs). These medications are fluvoxamine (Luvox), fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), citalopram (Celexa) and clomipramine (Anafranil). These medications are not addicting and are usually well tolerated. They can significantly relieve BDD symptoms, diminishing bodily preoccupation, distress, depression, and anxiety; significantly increasing control over one's thoughts and behaviors; and improving functioning. In some cases, they are lifesaving.

Cognitive-behavioral therapy is a here-and-now type of therapy in which the therapist helps the person with BDD resist compulsive BDD behaviors (for example, mirror checking) and face avoided situations (for example, social situations). Cognitive approaches include helping the person with BDD develop a more realistic view of their appearance. It's important to determine whether a therapist has been specifically trained in cognitive-behavioral therapy. Other types of treatment (for example, counseling or psychotherapy) do not appear to be effective when used alone for BDD.

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