UCSD Obsessive-Compulsive Disorders Clinic
UCSD Obsessive - Compulsive Disorders Clinic
5060 Shoreham Place, Suite 200
San Diego, CA 92122
(858) 334-4640

 

WHAT IS BDD?

Body dysmorphic disorder (BDD) is a serious illness when a person is preoccupied with minor or imaginary physical flaws, usually of the skin, hair, and nose. A person with BDD tends to have cosmetic surgery, and even if the surgeries are successful, does not think they are and is unhappy with the outcomes.

SYMPTOMS:

  • Being preoccupied with minor or imaginary physical flaws, usually of the skin, hair, and nose, such as acne, scarring, facial lines, marks, pale skin, thinning hair, excessive body hair, large nose, or crooked nose.

  • Having a lot of anxiety and stress about the perceived flaw and spending a lot of time focusing on it, such as frequently picking at skin, excessively checking appearance in a mirror, hiding the imperfection, comparing appearance with others, excessively grooming, seeking reassurance from others about how they look, and getting cosmetic surgery.

Some people with mild symptoms of BDD can function well, despite the stress they feel. For others, the illness can get so serious that they may be unable to work, socialize, or leave their homes. They worry that they look ugly, or that people will laugh at them. Some even commit suicide.

Getting cosmetic surgery can make BDD worse. They are often not happy with the outcome of the surgery. If they are, they may start to focus attention on another body area and become preoccupied trying to fix the new “defect.” In this case, some patients with BDD become angry at the surgeon for making their appearance worse and may even become violent towards the surgeon.

TREATMENT

  • Medications. Serotonin reuptake inhibitors or SSRIs are antidepressants that decrease the obsessive and compulsive behaviors.

  • Cognitive behavioral therapy. This is a type of therapy with several steps:

  • The therapist asks the patient to enter social situations without covering up her “defect.”

    • The therapist helps the patient stop doing the compulsive behaviors to check the defect or cover it up. This may include removing mirrors, covering skin areas that the patient picks, or not using make-up.

    • The therapist helps the patient change their false beliefs about their appearance.

Source: The National Women's Health Information Center

FREQUENTLY ASKED QUESTIONS:

What are some of the other symptoms of BDD?

People with BDD may complain of several specific features or a single feature, or a vague feature or general appearance, causing psychological distress that impairs important functioning (e.g. occupational or self-care) or social aspects of life.

Most people wish that they could change or improve some aspect of their physical appearance; but people suffering from BDD, generally of normal or even highly attractive appearance, believe that they are so unspeakably hideous that they are unable to interact with others or function normally for fear of ridicule and humiliation about their appearance. They tend to be very secretive and reluctant to seek help because they fear that others will think them vain or because they feel too embarrassed.

Other symptoms may include:

  1. Compulsive mirror checking, glancing in reflective doors, windows and other reflective surfaces.

  2. Alternatively, an inability to look at one's own reflection or photographs of oneself; often the removal of mirrors from the home.

  3. Compulsive skin-touching, especially to measure or feel the perceived defect.

  4. Reassurance-seeking from loved ones.

  5. Social withdrawal and co-morbid depression.

  6. Obsessive viewing of favorite celebrities or models whom the person suffering from BDD wishes to resemble.

  7. Excessive grooming behaviors: picking, combing hair, plucking eyebrows, shaving, etc.

  8. Obsession with plastic surgery or multiple plastic surgeries, with little satisfactory results for the patient.

  9. In extreme cases, patients have attempted to perform plastic surgery on themselves, including liposuction and various implants with disastrous results. Patients have even tried to remove undesired features with a knife or other such tool when the center of the concern is on a point, such as a mole or other such feature in the skin.

Why is BDD often linked to OCD?

BDD combines obsessive and compulsive aspects, linking it, among psychologists, to the OCD-spectrum disorders. People with BDD may compulsively look at themselves in the mirror or avoid mirrors, typically think about their appearance for at least one hour a day (and usually more), and in severe cases may drop all social contact and responsibilities as they become homebound. The disorder is linked to an unusually high suicide rate among all mental disorders.

How many people suffer from BDD?

A German study has shown that 1–2% of the population meet all the diagnostic criteria of BDD, with a larger percentage showing milder symptoms of the disorder (Psychological Medicine, vol 36, p 877). BDD is diagnosed equally in men and women.

What are some disorders associated with BDD?

A similar disorder, gender-identity disorder, in which the patient is upset with his or her entire sexual biology, often precipitates BDD-like feelings being directed specifically at external sexually dimorphic features, which are in constant conflict with the patient's internal psychiatric gender.

What is the course of BDD?

BDD usually develops in adolescence, a time when people are generally most sensitive about their appearance. However, many patients suffer for years before seeking help. When they do seek help through mental health professionals, patients often complain of other symptoms such as depression, social anxiety or obsessive compulsive disorder, but do not reveal their real concern over body image. Most patients cannot be convinced that they have a distorted view of their body image, due to the very limited knowledge of the disorder as compared to OCD or others.

An absolute cause of body dysmorphic disorder is unknown. However research shows that a number of factors may be involved and that they can occur in combination, including:

  1. A chemical imbalance in the brain. An insufficient level of serotonin, one of the brain's neurotransmitters involved in mood and pain, may contribute to body dysmorphic disorder. Although such an imbalance in the brain is unexplained, it may be hereditary.

  2. Obsessive-compulsive disorder. BDD often occurs with OCD, where the patient uncontrollably practices ritual behaviors that may literally take over their life. A history of, or genetic predisposition to, OCD may make people more susceptible to BDD.

  3. Generalized anxiety disorder. Body dysmorphic disorder may co-exist with generalized anxiety disorder. This condition involves excessive worrying that disrupts the patient's daily life, often causing exaggerated or unrealistic anxiety about life circumstances, such as a perceived flaw or defect in appearance, as in BDD.

How disabling is BDD?

BDD can be anywhere from slightly to severely debilitating. It can make normal employment or family life impossible. Those who are in regular employment or who have family responsibilities would almost certainly find life more productive and satisfying if they did not have the symptoms. The partners of sufferers of BDD may also become involved and suffer greatly, sometimes losing their loved one to suicide.
Sufferers of BDD may often find themselves getting almost 'stuck' in moping around. That is to say that sufferers, with such a type of depression, can in some cases appear to take a long time to get everything done. However, this is not actually the case, as it is simply that the BDD sufferers will often just sit or lie down for prolonged periods of time, without being able to actually motivate themselves until it becomes completely necessary to get back up. This can often cause little to get done by sufferers, and they can have little self motivation with anything, including relationships with other people. However, contrary to this, when the action is relevant to the person's image, it is more common for the sufferer to exhibit a fanatic and extreme approach, applying their attention fully to self-grooming/modification.

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University of California, San Diego, Department of Psychiatry, 9500 Gilman Drive, Mail Code 0603 La Jolla, CA 92037-0603
Telephone: (858) 534-3684, Fax: (858) 534-7653, Electronic Mail: psychiatry@ucsd.edu