Body Dysmorphia

Body Dysmorphic Disorder or BDD is an anxiety disorder closely related to Obsessive Compulsive Disorder (OCD). Someone may have BDD if they are obsessed by their body image or by any physical flaws (perceived or real) that they may or may not have. This obsession may manifest itself in excessive worries and anxiety over their appearance or obsessive behaviours such as an overuse of mirrors or the reverse, a complete avoidance of and aversion to seeing their image in a mirror.

People with BDD do not see themselves as others see them. They see a distorted image of themselves – they can see themselves or the area of their body concerned as out of proportion, too big, too small, disfigured or unsymmetrical. BDD can affect mental health when it starts to intrude on a person’s life as a whole – sometimes causing depression, self-harm, loneliness (they avoid going out in public), substance abuse and addictions, eating disorders or even suicidal thoughts.

The most common areas of concern for people with BDD include:

• Skin imperfections such as wrinkles, scars, acne and blemishes
• Hair - head or body hair – absence or abundance
• Facial features, particularly the nose, but it also might involve the shape and size of any feature
• Body weight or muscle tone

Other areas of concern can include the size of the genitals, muscles, breasts, thighs, buttocks, and even the presence of certain body odours. Muscle dysmorphia effects particularly men – an obsession with muscle building which can also manifest itself in steroid overuse or substance abuse.

Causes

BDD can affect both men and women, but it tends to start in adolescence. It is thought that 0.5% of the UK population suffers from BDD.

It is not known what causes body dysmorphic disorder, but it is thought that it may result from a combination of causes such as:

• Abnormalities in brain structure or neurochemistry
• Hereditary causes - some studies show that BDD is more common in people whose blood relatives also have BDD or OCD
• Life experiences, culture and environment, and even childhood neglect or abuse may contribute to body dysmorphic disorder later on in life
• Media influence and celebratory culture is also thought to be a key influencer of body image, particularly with the prevalence of social media in recent years

Symptoms

Someone may be suffering from BDD if they display one or more of the following behaviours:

• An extreme preoccupation with a perceived flaw in their appearance which can't be seen by others or appears minor to others, which convinces them that they are ugly or deformed
• A belief that others are mocking their appearance
• Obsessive behaviour to try to fix or hide the perceived flaw, such as frequently checking the mirror, grooming or skin picking, or an obsession with styling, makeup or clothes
• Constant comparison with others and seeking reassurance about their appearance from others
• Perfectionist tendencies
• Seeking frequent cosmetic procedures with little satisfaction
• Avoiding social situations
• A severe preoccupation with appearance to the extent that it causes major distress or problems with social life, work, school or other areas of life

Treatment

It is important to seek help before BDD becomes too severe. The first step is to visit your GP who may then refer you to a specialist therapist or psychiatrist to treat the condition. The treatment for Body Dysmorphic Disorder usually takes the form of Cognitive Behavioural Therapy (CBT). SSRI antidepressant medication may also be prescribed to decrease the obsessive and compulsive behaviours which are a feature of this illness.

Further information on Body Dysmorphic Disorder can be found on the Body Dysmorphic Disorder Foundation website.