Body Dysmorphic Disorder
Body Dysmorphic Disorder (BDD) is characterized by a preoccupation with perceived defects in one’s appearance or an excessive concern with small physical imperfections. Thoughts about the problem are intrusive and can cause suffering. Individuals with BDD spend a lot of time obsessing about their appearance and worrying about how they are perceived by others. This may lead to feelings of depression and the desire to avoid people and social situations where others may notice their perceived defect. Those with BDD will also spend a lot of time and energy trying to reduce their feelings of distress by performing rituals.These rituals include excessive grooming, camouflaging the perceived defect, checking reflective surfaces, repetitive touching or measuring of parts of the body, and asking for reassurance from others that their defect is not noticeable. Although most people have some concerns about their physical appearance or dislike some aspect of how they look, people with BDD differ in that their preoccupation is excessive, time consuming, and associated with significant distress or impairment in their functioning. Most people with BDD perceive imperfections on their face or head; however, any body part may be the focus.
Approximately 1-2% of the general population has BDD, and about 8% of people with depression have a diagnosis of BDD. BDD affects men and women equally, although men are more often concerned with their hairline and with how muscular they look.
Onset of BDD often begins in adolescence but may also develop during childhood. BDD may not be apparent until several years after the initial onset because of the embarrassment associated with one’s physical appearance concerns and the reluctance to reveal BDD symptoms to others. Onset may be sudden or more gradual, and BDD often lasts over a long period of time with some waxing and waning of symptom severity. BDD can get worse as a person ages.
BDD can be treated using the same techniques used to treat OCD and other obsessive-compulsive spectrum disorders. A form of Cognitive-Behavioral Therapy (CBT) known as Cognitive Restructuring can be used to challenge the person’s faulty beliefs about their appearance. In addition, Exposure and Response Prevention (E/RP), which is also a form of CBT, is an important part of the treatment. Typical exposures for someone with BDD would involve allowing others to see all or part of one’s perceived flaw while refraining from any rituals (mirror checking, reassurance seeking, etc.). People with BDD also often are prescribed the type of antidepressants known as selective serotonin reuptake inhibitors (SSRIs).