Body Dysmorphic Disorder

Body Dysmorphic Disorder

Many people with Body Dysmorphic Disorder (BDD) go undiagnosed by mental health professionals. The under-diagnosis of BDD is because individuals with the condition see their body as the problem instead of the altered perceptions of their body.

Consequently, they are initially far more likely to seek the help of a plastic surgeon or a dermatologist as the first line of treatment. Most individuals with BDD do not think their perceptions of their body are skewed, and think that others see them just the way they do. If others tell the person they look “fine,” they may think that others are just trying to be nice or are outright lying to them.

Body dysmorphic disorder (BDD) is a diagnosis in which the person perceives minor body flaws or defects (sometimes imaginary) as catastrophic and often obsesses about these perceived flaws, thinks others also see these flaws, and in turn feel anxious, embarrassed, or ashamed of their appearance. In reality, others usually do not notice the flaws; if they do notice the flaws, others typically think it is less significant than the person with BDD and do not see them any differently.

Up to 2% of the adult population in the United States has BDD, which usually starts in adolescence and is about equally present in women and men. Most are surprised to hear they have symptoms of BDD and can even feel unsure of the diagnosis at first. Unfortunately, many people with BDD do not get properly diagnosed or ever find their way to mental health treatment and seek help elsewhere. Some people with BDD seek assistance from plastic surgeons, dermatologists, and other health or beauty professionals to achieve relief from dissatisfaction with their appearance. Despite the many changes people with BDD may try to make to reduce their perceived flaws, many are still very unhappy with their results due to continued distorted perceptions of themselves.

What it looks like

People with BDD obsess about one or more parts of the body. For example, one may worry about a specific facial feature or their body weight, whereas another may obsess about gender-specific features such as breasts, genitals, or other features that are seen as "ideal" in one’s society or culture. A person with BDD may spend hours every day obsessing and checking their perceived flaws in the mirror. However, when they look in the mirror, the imagined body flaw stands out sharply in their own perception and they may see imperfections that others do not see.

The person with BDD may believe that if only the body part (or parts) on which they fixate were improved, then their lives would transform dramatically, and they would become very happy people. This is the reason why people with BDD represent about 15% of the clients of plastic surgeons and 21% of patients seeking a rhinoplasty, although they are only 2% of the general population.

The person with BDD often attempts to camouflage the imagined flaws; for example, imaginary facial defects may be disguised with a heavy layering of cosmetics. Some engage in skin picking behavior in the attempt to rid themselves of blemishes or other defects. The individual may seek constant reassurance about their appearance from others, although such reassurances never seem to be sufficient.

Other indicators of BDD include the following:

• The use of scarves or hats to hide the perceived flaws
• The styling of hair to hide or minimize the perceived flaw
• Rigid adherence to particular beauty regimens
• Constant comparing of past photos of themselves to their current appearance to check for changes
• Avoiding people in general or other people who might be critical, such as adolescents
• Avoiding bright sunlight because it might highlight to others their perceived imperfections

Risk factors

Some experts report that an excessive reliance on social media significantly increases the risk for BDD. Another modern invention, the “selfie” photograph, may have increased the risk for BDD among individuals who worry about their personal appearance.

Untreated BDD

If the person with BDD is not treated, the behaviors are likely continue and may escalate. The person may have a less fulfilled life due to the constant focus and resources spent on their appearance. Identification and treatment of BDD is also vital because individuals with BDD have an elevated risk for suicidal behaviors.

Outlook

Most people with BDD can improve their symptoms with treatment, which will markedly improve the individual’s life as well as future prospects for happiness.

In good company

Some famous people and celebrities have shared that they have BDD symptoms, such as singer Billie Ellish and actor Robert Pattinson. It is likely that the late singer Michael Jackson had BDD, based on his numerous plastic surgeries and apparent constant striving for an ideal known only to him.

The current thinking on what causes BDD

People who suffered childhood abuse or bullying are more likely to develop BDD, but other individuals with this disorder have not been abused or bullied. There also appears to be a genetic risk for BDD because the disorder seems to “run in families,” although no specific gene has been identified to date.