Body dysmorphic disorder

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Body dysmorphic disorder (BDD) is a mental disorder, which involves a disturbed body image. It is generally diagnosed of those who are extremely critical of their physique or self image, despite the fact there may be no noticeable disfigurement or defect.

Most people wish they could change or improve some aspect of their physical appearance, but people suffering from BDD, generally considered of normal apearence, believe that they are so unspeakably hideous that they are unable to interact with others or function normally for fear of ridicule and humiliation at their appearance.

BDD combines obsessive and compulsive aspects which has linked it to the OCD spectrum disorders among psychologists. People with BDD may engage in compulsive mirror checking behaviors or mirror avoidance, typically think about their appearance for more than one hour a day and in severe cases may drop all social contact and responsibilities as they become homebound. The disorder is linked to an unusually high suicide rate among all mental disorders.

A German study has shown that between 1-2% of the population meet all the diagnostic criteria of BDD, with a much larger percentage showing milder symptoms of the disorder (Psychological Medicine, vol 36, p 877). Chronically low self-esteem is characteristic of those with BDD due to their value of oneself being so closely linked with their perceived appearance. The prevalence of BDD is equal in men and women, and causes chronic social anxiety for those suffering from the disorder.

Phillips & Menard (2006) found the completed suicide rate in patients with BDD to be 45 times higher than in the general US population. This rate is more than double that of those with depression and three times as high as those with bipolar disorder[1]. There has also been a suggested link between undiagnosed BDD and a higher than average suicide rate among people who have undergone cosmetic surgery[2].

1 History of BDD
2 Diagnoses of BDD
3 Symptoms of BDD
4 Common locations of imagined defects
5 Treatments
6 See also
7 References
8 External links

[edit] History of BDD

BDD was first documented in 1886 by the researcher Morselli at the time naming the condition simply "Dysmorphophobia". BDD was first recorded/formally recognized in 1997 as a disorder in the [[Diagnostic and Statistical Manual of Mental Disorders|DSM], however, in 1987 it was first truly recognized by the American Psychiatric Association.

In his practice, Freud eventually had a patient who would today be diagnosed with the disorder; Russian aristocrat Sergei Pankejeff, nicknamed "The Wolf Man" by Freud himself in order to protect Pankejeff's identity, had a preoccupation with his nose to an extent that greatly limited his functioning.

[edit] Diagnoses of BDD

According to the DSM IV the following criteria must be met in order to receive a definite diagnosis for Body Dysmorphic Disorder.

The patient is preoccupied with an imagined defect of appearance or is excessively concerned about a slight physical anomaly.

This preoccupation causes clinically important distress or impairs work, social or personal functioning.

Another mental disorder (such as Anorexia Nervosa) does not better explain the preoccupation.

[edit] Symptoms of BDD

Compulsive mirror checking, glancing in reflective doors, windows and other reflective surfaces.
Inability to look at ones own reflection.
Compulsive skin-touching, especially to measure or feel the perceived defect
Reassurance seeking from loved ones.
Social withdrawal and co-existent depression.
Obsessive viewing of favorite celebrities or models the person suffering from BDD may wish to resemble.
Excessive grooming behaviors: combing hair, plucking eyebrows, shaving, etc.
Obsession with plastic surgery or multiple plastic surgery with little satisfactory results for the patient.
In obscure cases patients have performed plastic surgery on selves, including liposuction and various implants with disastrous results.

[edit] Common locations of imagined defects

hair
nose
skin
teeth
genitalia
eyes
Facial structure
overall body build
legs

cheeks
arms/wrists
lips
chin
stomach/waist
breasts/pectoral
buttocks
eyebrows
ears

People with BDD often have more than one area of concern.

[edit] Treatments

Typically the psychodynamic approach to therapy does not seem to be effective in battling BDD while in some patients it may even be countereffective.

CBT (Cognitive Behavioral Therapy) coupled with exposure therapy has been shown effective in the treatment of BDD. Low levels or insufficient use of serotonin in the brain has been implicated with the disorder and so SSRI drugs are commonly and with some success used in the treatment of Body Dysmorphic Disorder. Drug treatment will sometimes also include the use of an anxyolitic.

BDD tends to be chronic; as of current information it does not subside through time and in most patients often becoming worse as the symptoms and concerns of the sufferer diversify and social contacts further deteriorate. As so, treatment should be initiated as early as possible following the diagnoses.

[edit] See also

[edit] References

Phillips KA. The Broken Mirror: Understanding and Treating Body Dysmorphic Disorder. New York: Oxford University Press, 1996 (Revised and Expanded Edition, 2005)
Barlow, David H.; Durand, V. Mark. Essentials of Abnormal Psychology. Thomson Learning, Inc., 2006.
Neziroglu, F.; Roberts, M.; Yayura-Tobias, J.A. A behavioral model for body dysmorphic disorder. Psychiatric Annals 34 (12): 915-920, 2004.
Phillips, KA. Body dysmorphic disorder: the distress of imagined ugliness. American Psychiatric Association 148: 1138-1149, 1991.[3]
James Claiborn ; Cherry Pedrick 'The BDD Workbook'. New Harbinger Publications,U.S. Jan 2003