Body Dysmorphic Disorder

For most of us, a look in the mirror provides a fairly accurate assessment. While it is almost universal to have a trait or two that you find to be less then perfect, for some people, they find something about their appearance to be a continuing source of enormous distress. If the preoccupation causes significant anguish and impairs school, personal or social functioning, it may warrant a diagnosis of Body Dysmorphic Disorder (BDD).

What Are the Symptoms?

Although any body part can become the source of preoccupation, most BDD sufferers focus on the eyes, ears, nose, skin, chin, jaw or other facial features. They become obsessed thinking about an imagined physical defect or vastly exaggerate a concern about a minimal defect. The individual thinks about this defect for at least an hour per day, but sometimes these thoughts can consume many of the person's waking hours.

This obsession with appearance manifests itself in several ways. Sufferers often:

• avoid social situations since they feel that they look hideous.
• spend an inordinate amount of time looking in the mirror.
• have trouble concentrating at school or work since their thoughts keep returning to their appearance.
• pick at their skin, or pull out hair or eyebrows, which can be symptomatic of a separate disorder, as well.
• need constant reassurance about the perceived defect.
• repeatedly measure the area of concern (for example, the length of their nose).
• dedicate a large a amount of time to daily grooming.
• continually touch the defect or attempt to cover it with one's hand.
• experience extreme anxiety when in the presence of other people, sometimes to a degree of rendering someone homebound.
• experience depression and suicidal thoughts.

Who is at Risk and What is the Cause?

Body Dysmorphic Disorder typically begins in adolescence, but often remains undiagnosed for a number of years. It is highly unusual for children under 12 to be diagnosed with BDD. Although females frequently show more obvious outward signs of appearance concerns, BDD appears to affect roughly equal numbers of boys and girls.

Although there is much speculation about the cause of BDD, there are no definitive answers at this point. Many experts feel that several factors, including biological, psychological, and socio-cultural contribute to its onset. While there may be a BDD link to abnormalities in brain chemical levels such as serotonin, psychological factors such as being teased about one's appearance are thought to play a large part, too. Some studies indicate that a child who has suffered emotional trauma or sexual abuse may be at increased risk for BDD. Lastly, the bombardment of media messages focusing on appearance are thought to increase the chance of an already vulnerable child developing the disorder.

What Can be Done?

Medication seems to be helpful, especially antidepressants known as SSRIs (selective serotonin reuptake inhibitors). A few of the more commonly known SSRIs are Prozac, Zoloft, and Paxil. The medications seem to help in a number of ways; sufferes spend less time overall thinking about their perceived defect and for the time that they do think about it, the thoughts seem less troubling. Also, there is a diminishing need for the camouflaging behaviors, such as covering the mouth with the hands. Since symptoms are reduced, anxiety is lessened and confidence often increases.

Cognitive-behavioral therapy (CBT) is also effective and is sometimes combined with the use of medication. Typically, a patient is repeatedly exposed to situations that cause fear and anxiety until they no longer have control over the patient. For example, a BDD patient who experiences anxiety in social situations severe enough to avoid leaving the house will at first go for quick trips out. This will be repeated until that becomes comfortable and then a slightly more difficult task will be attempted, such as sitting through an entire class. Gradually, the patient's anxiety lessens and their comfort and self-assurance increases.