Body dysmorphic disorder

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Also known as body dysmorphia

Body dysmorphic disorder (BDD) is a type of anxiety disorder, related to how we think about our bodies.

Most of us have something we don't like about our appearance – our nose is too big, our legs are too short, our teeth aren’t straight, and so on. We don’t stress that much about it though, and it certainly doesn’t interfere with our daily life.

People who have BDD think about their flaws (either real or imaginary) for hours each day. When others tell them they look fine or that the flaw isn’t noticeable, people with BDD don’t hear or don’t take any notice.

They stay focused on their negative thoughts, and think that even small or invisible body imperfection is a cause for great concern. These thoughts cause severe emotional distress and interfere with daily functioning.

People with BDD may miss work or school, avoid social situations and isolate themselves, even from family and friends, because they fear others will notice their flaws.

BDD most often develops in adolescents and teens, and research shows that it affects men and women almost equally.

It’s known that people with any anxiety disorder stand a higher risk of developing obsessive-compulsive disorder (OCD) or social anxiety disorder, as well as depression and eating disorders, so it is important to talk to your doctor if you suspect yourself, or a loved one has any type of anxiety disorder. The risk of suicide in people with BDD is significant. It is important that if you are having any suicidal thoughts you seek help immediately.

Anxiety disorders, as a group, are the most common mental illnesses that doctors see. Fortunately, they are among the most successfully treated emotional disorders as well.

What causes BDD?

It’s unknown exactly what causes BDD. It may be caused by a chemical imbalance in the brain, which may be genetically based. A person with a family history of anxiety disorder or obsessive compulsive disorder is more prone to develop this type of problem.

Signs to look for (symptoms)

People suffering from BDD often lack self-esteem, may be self-conscious around others and avoid social situations. They may also seek medical reassurance about a particular physical feature that is often not noticeable to others.

Other signs include:

  • frequently comparing the appearance of the perceived flaw with that of others
  • avoiding mirrors
  • excessive grooming (e.g. combing hair, shaving, removing or cutting hair, applying makeup)
  • frequently checking appearance of specific part in mirrors and other reflective surfaces
  • camouflaging the perceived defect with clothing, makeup, hats, hands, or posture
  • seeking reassurance about the flaw or attempting to convince others of its ugliness
  • frequently touching the perceived defect.

How the doctor determines if you have BDD (diagnosis)

If you think you may have BDD there are some online self-tests that may help you decide if you need to seek help.

Anxiety NZ trust  has a phone app that you can download called the Mood Diary. This contains a self-test, plus it allows you to monitor your symptoms, plus much more. 

If you have BDD you may also be depressed or have social anxiety. When you see your doctor it is important to tell them as much as you can about how you are feeling and what you are going through.

They can then refer you to an appropriate mental health professional, who can help you tease out what the problem is and whether there is an additional problem.

Treatment options

For successful treatment, you must be at a stage where you accept that you have an anxiety disorder and want to take control of it. That may be very difficult as even though you may be aware that your concerns are excessive, you still worry about your perceived defect(s).

Psychosocial treatments (talking therapy)

These are non-medical treatments that address your emotional needs such as your thinking, behaviour, relationships and environment. This involves talking with a trained professional who uses clinically researched techniques, usually talking therapies, to assess and help you understand what has happened, and to help you make positive changes in your life.

Cognitive Behaviour Therapy (CBT) in particular has been found to be helpful.

Psychoeducation (i.e. providing education)

Education can be extremely important to help you, your family/whānau and supporters to understand this disorder and help in the recovery. Your mental health professional will give you information about the disorder, suggest different ways to handle it, and discusses any complications which may occur.

There are also numerous self-help books available in the shops which some find to be a useful first stage in getting help. They can teach you about some of the ways of dealing with your anxiety disorder and they can also get you used to reading about or discussing problems which you have previously kept completely to yourself. They are generally written by medical experts but draw on the experience of people who have anxiety disorders.

Medication

Antidepressant medication, in conjunction with CBT has proven effective in improving the symptoms of BDD.

You should be told what effects you should notice from any medication, receive clear instructions about how you should take them and what precautions are necessary.

If you are pregnant or breast feeding no medication is entirely safe.

Complementary therapies

The term complementary therapy is generally used to indicate therapies and treatments that differ from conventional western medicine and that may be used to complement and support it.

Certain complementary therapies may enhance your life and help you to maintain wellbeing. In general, mindfulness, hypnotherapy, yoga, exercise, relaxation, massage, mirimiri and aromatherapy have all been shown to have some effect in alleviating mental distress.

Physical health

It's also really important to look after your physical wellbeing. Make sure you get an annual checkup with your doctor. Being in good physical health will also help your mental health.

 

Thanks to Janet Peters, registered psychologist, for reviewing this content. Date last reviewed: September 2014.