What is Body Dysmorphic Disorder?

Her alarm goes off at 7:00am and before she’s even had a chance to turn it off her hands find their way to her face. She pats it left and right, feeling for any lumps, scars or other imperfections that may have arisen overnight. She heads straight for the bathroom and braces herself as she faces her reflection; still holding onto a glimmer of hope that somehow all of her flaws have disappeared overnight. Of course … they haven’t. She feels an overwhelming urge to scream or cry or just hide away, hide this monstrous face staring back at her from the world, because the thought of anyone seeing her like this is far too painful. How can somebody bear to look at her ugly face all day when she can’t even look at it for a few seconds in the mirror?

This is one example of the daily struggles of someone who has body dysmorphic disorder (BDD). We all get self-conscious from time to time, we don’t want to go to a party because our hair is a mess or we freak out before a date because our skin is breaking out, but for people with BDD these preoccupations with their appearance are persistent, distressing and disruptive to their daily life. BDD is considered to be a form of Obsessive Compulsive Disorder (OCD). This is because it is characterised by an obsessive preoccupation with an imagined or slight defect in ones appearance (obsessions) and going to great lengths to hide, manage or repair it (compulsions) e.g. mirror checking, skin picking etc. The thoughts surrounding this defect are often pervasive and intrusive and often cause one to feel a strong sense of distress and shame. Many of these people may even resort to plastic surgery to amend their perceived ugliness. These obsessions and compulsions often interfere with ones daily functioning, causing them to become socially isolated and disengage with important activities such as school or work.

Rates of suicide are unfortunately high in BDD sufferers with approximately 25% of these individuals attempting suicide. Although BDD is not very well known it is estimated to affect approximately 1.7% to 2.4% of the population - more common than other mental illnesses such as schizophrenia or anorexia nervosa. Rates of BDD are fairly similar among males and females though they do tend to differ in terms of what physical anomaly they are fixated on.

While females tend to be more focussed on facial features or perhaps a specific body part such as their thighs being too big, men tend to focus on not being ‘muscly’ enough. Muscle dysmorphia is a subtype of BDD and has become increasingly more prevalent in males. These people tend to hold delusions that they are too small and may spend hours a day in the gym and comparing themselves unfavourably to other men and bodybuilders.

The average age of onset for BDD is usually during adolescence in which one may become hypersensitive about their physical appearance. They may also fixate upon instances in which they were teased and believe that the reason this must have happened is as a direct result of their unattractiveness. However BDD has both environmental and genetic influences, with twin studies suggesting a large genetic basis to both BDD and OCD. Furthermore, a recent study in which 20 people diagnosed with BDD and 20 healthy controls were each put in an MRI scanner and then compared suggested that in people with BDD, the emotional regions of the brain and the rational reasoning areas of the brain didn’t seem to be communicating with each other as they were in the healthy control group.

What are the treatment options?

One of the challenges in treating BDD is that often, these people do not identify their struggles as a mental illness but genuinely believe that there is a defect in their physical appearance. As a result they are more likely to see plastic surgeons rather than psychologists and often when they do eventually engage in therapy it is due to a mental illness that has come about as a result of their BDD such as major depressive disorder. The good news is that Cognitive Behavioural Therapy (CBT) appears to be an effective treatment option for people with BDD. CBT works by working on reducing the disruption caused by their faulty body image beliefs. Exposure therapy may also be an effective way of treating BDD in which one is gradually exposed to once distressing circumstances such as looking in the mirror or social situations.

BDD can be a debilitating mental illness with a significant impact on ones mental and even physical health however treatment options are out there and once therapy is committed to, the prospect of recovery becomes a very realistic outcome.