Body Dysmorphic Disorder

Most people accept their body imperfections, and can successfully carry on with their lives.  However, individuals, who suffer from Body Dysmorphic Disorder (BDD) become obsessed with perceived flaws.  They can spend hours stressing about their appearance, and are continuously checking and comparing themselves to others. They are unable to control negative thoughts about their bodies, and reassurance from others is of no help.

The effects of BDD can be so severe that the sufferers become dysfunctional, spending all their time analysing their appearance. Their perceived flaws cause them to avoid social interactions and to become reclusive. They underperform at work or school, have relationship problems and can develop depression, anxiety, eating disorders, or obsessive-compulsive disorders (OCD).

Body dysmorphic disorder is not uncommon, with an incidence of 1 in 50 people. Both men and women can be affected equally. Teens and young adults are specifically vulnerable.

Diagnosis

Individuals with BDD are the least likely to accept that they suffer from a debilitating psychological condition.   Most commonly, it is the people close to the sufferer who will first become aware of behavioural problems.

Healthcare professionals specialising in cosmetic treatments, are likely to identify some of their patients as suffering from BDD.  These individuals will repeatedly seek treatments.  This is why clinicians should familiarise themselves and be aware of certain diagnostic criteria related to BDD:

  • Appearance preoccupation with one or more minor flaws.  This likely manifests itself as a daily preoccupation for the patient.
  • Repetitive compulsion such as mirror checking, excessive grooming, skin picking, reassurance seeking, and clothes changing. Other compulsions can include constant comparisons to others. This last is a strongly indicative criterion for BDD.
  • Clinically significant functional impairments such as social, occupational and personal dysfunctions.

Note that eating disorders are not included in the spectrum of BDD symptoms. If the patient is preoccupied with being fat or weighing too much then an eating disorder is the correct diagnosis instead of BDD.  It is possible for an individual to have both BDD and an eating disorder.

Doctor Responsibility

As cosmetic surgery normally does not alleviate problems of BDD, it is good practice for doctors offering cosmetic procedures to screen every patient for this problem.  It is expected that doctors take responsibility for identifying vulnerable patients, and to discuss the appropriate options. 

Treatment of BDD

Treatment of BDD requires a multidisciplinary team, and a variety of therapeutic interventions will likely be needed.  These can include:

  • Cognitive behavioural therapy (CBD), which teaches patients to recognize irrational thoughts, and changes negative thinking patterns. Patients learn to identify unhealthy thought patterns, and techniques for replacing them with positive ones.
  • Acceptance and commitment therapy (ACT), focusing
  • Medications such as SSRI antidepressants are often used to break the cycle of compulsion that leads to BDD.