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Body dysmorphic disorder (BDD)

Dysmorphic Disorder

What is Body Dysmorphic Disorder?

Body dysmorphic disorder (BDD), or body dysmorphia, is a mental health condition where a person spends a lot of time worrying about flaws in their appearance; these flaws are often unnoticeable to others.In addition to feeling constantly self-conscious, people suffering from BDD often feel defined by their flaws and will believe that others will also think negatively about them and their flaw.Body Dysmorphic Disorder can vary in severity from person to person and from day-to-day; there may be times where people isolate themselves and are housebound, or it may be that people will seek needless cosmetic treatments. There is no doubt that the symptoms cause significant distress or handicap and there is an increased risk of suicide and attempted suicide. BDD affects people of any age, but it is most common in teenagers and young adults; it also affects both men and women. Often people with BDD do not seek help for their mental health because they may be worried that people will judge them or view them as being vain, which means BDD often goes untreated or those who suffer with it are likely to experience it for a long time before seeking support.


Symptoms

There are many symptoms of having BDD, for example, people may:

  • Obsessively worry about one or more perceived flaws in their physical appearance
  • Develop compulsive behaviours and routines (such as excessive use of mirrors, checking by feeling their skin with their fingers, cutting or combing their hair, picking at their skin to make it smooth, comparing themselves against models, discussing their appearance with others)
  • Feel guilt or shame towards themselves
  • Isolate themselves so to avoid other people criticizing them
  • Become depressed
  • Feel anxious
  • Have a compulsion to get unnecessary medical procedures, such as cosmetic surgery
  • Develop eating disorders
  • Over exercise
  • Have suicidal thoughts
  • Self-harm (including substance abuse)
  • Camouflage their appearance by wearing certain clothes or by wearing heavy make-up

These behaviors can start off as coping techniques (for example, camouflaging or isolating themselves), or ways to determine whether they think they look as bad as they think (for example, obsessively checking mirrors). However, they can lead to an increase in preoccupation and distress with appearance which can then lead to depression and other forms of anxiety, such as social anxiety disorder or obsessive compulsive disorder.

Obsessive worries about the body will vary from person to person, however, common worries may include them thinking that:

  • Parts of their body are out of proportion
  • They are too fat or too skinny
  • They are disfigured
  • They lack symmetry
  • Something about their body is abnormal

BDD can affect any area of the body but common worries revolve around weight, skin, hair, nose, lips and genitals.

Causes

The cause of BDD is still unknown, but it might be associate with:

  • Genetics (people may be more likely to develop BDD if they have a relative with BDD, obsessive compulsive disorder (OCD) or depression
  • A chemical imbalance in the brain
  • A traumatic experience in the past – people may be more likely to develop BDD if they were teased, bullied or abused when they were a child
  • Some people with BDD also have another mental health condition, such as OCD, generalized anxiety disorder or an eating disorder.

Myths

One myth is that people who suffer with BDD are self-obsessed. However, sufferers tend to be reluctant in seeking help for their issues specifically because they are afraid to be perceived as vain or self-obsessed; for many people who experience BDD, their issues often go untreated and can become very harmful as time progresses. BDD is a chronic form of anxiety that can have a big impact on an individual’s life; BDD shares similarities with obsessive-compulsive disorder, health anxiety and social anxiety.

Another myth is that BDD is a form of eating disorder, and although BDD and eating disorders share similar symptoms (e.g. poor body image, excessive worry about physical appearance, compulsive behaviours etc.), the disorders differ in that eating disorders are mainly concerned with body weight and shape, whereas BDD sufferers are likely to have more of a focus on specific parts of the body, such as facial features. Some people who suffer from BDD may suffer from an eating disorder, however not all people suffering with an eating disorder will have BDD.

Some people may not consider it a real disorder, which is linked in to the assumption that people are just self-obsessed. However, it is not some made up disorder to justify self-obsession, it is an intense form of anxiety where by sufferers spend the majority of their time wither trying to fix what they think is wrong with themselves. The intensity and chronic nature of the disorder is not to be taken lightly.

Additionally, it is a common misconception that BDD only affects women because of the likelihood of women having more concern for their appearance, however, research has shown that it affects men and women equally.

A final myth is that people suffering will focus on a major body part, however, the mind can distort any part of the body, no matter how small; for example, although some may focus on facial features, other people may focus on a small birthmark. It is important to remember that BDD can affect people in different ways.

Treatment

It can feel daunting to seek help for BDD but it is important that sufferers understand the severity of the disorder; people should not feel shamed or embarrassed about seeking help. If untreated, the symptoms are likely to get worse.

A technique often used in CBT for BDD is exposure and response prevention (ERP) which involved the sufferer to gradually face situations that would trigger the anxiety and then the therapist would help them find other ways of dealing with the feeling that are more healthy.

CBT for treating BDD will usually include a technique known as exposure and response prevention (ERP). This involves gradually facing situations that would normally make you think obsessively about your appearance and feel anxious. Your therapist will help you to find other ways of dealing with your feelings in these situations so that, over time, you become able to deal with them without feeling self-conscious or afraid.

Recovery and treatment is a gradual process, therefore it is important that there is an acknowledgement of physical safety. It is likely that by the time an individual seeks help for their issues, they will have already established unhealthy coping behaviors therefore, people suffering must look after themselves in the process. 

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