Body Dysmorphic Disorder

Body dysmorphic (dis-MORE-fik) disorder (BDD) is an extremely distressing; obsessive preoccupation with perceived jlaws in one's appearance.

What Are Normal Concerns About Appearance?

Most people pay attention to their appearance. They may check themselves in the mirror, think about which clothes look nice on them, and try to look their best. Adolescents, whose bodies are changing dramatically, are notorious for paying special attention to their appearance. It is normal for adolescents to feel self-conscious about their looks at times, especially the appearance changes triggered by puberty ^* .

Jack feels self-conscious about his lack of body hair, while his friend Ben thinks that he has too much. Both boys feel a bit uncomfortable when they first get on the court for basketball practice because their uniforms reveal their legs, upper chest, and armpits. Terry feels self-conscious about having some acne ^* and did not want his girlfriend to take his picture at the class picnic. Anna finds that her legs seem to be growing faster than the rest of her body and felt hurt when someone teased her by calling her a beanpole. Nick is sure he has not grown at all this year and does not like being shorter than most of the girls in his seventh grade class. Luckily, the awkward body changes of adolescence almost always even out eventually.

Some self-criticism involves aspects of appearance that have nothing to do with puberty. Megan dislikes the freckled skin on her arms. Darlene wishes her hair were straight instead of kinky, while Angela wishes she had Darlene's waves. Andrea does not like her nose, and Paula wishes her lips were different. Jeanne thinks her complexion is too fair, and Derek thinks he is too dark-skinned.

Learning to like one's own body, coming to accept its imperfections, and growing to appreciate its unique beauty means having a healthy body image. Developing a healthy body image is an important task of adolescence.

What Are Extreme Concerns About Appearance?

Some people continue to have problems with body image long after adolescence is over. Body dysmorphic disorder (BDD) is a condition that involves extremely negative body image. BDD goes beyond self-criticism of one's features, concern with one's appearance, or poor body image. People who have BDD become overly preoccupied with what they see as flaws in their physical appearance, and they are often the only ones to perceive their features or characteristics as flaws. They may pick out tiny imperfections that others may not even notice and worry over these imperfections in a way that is out of proportion. Their self-criticism can leave them very distressed and too self-conscious to enjoy a full life. People with BDD are plagued by critical thoughts about their appearance and have a distorted body image that causes them to believe that they are ugly.

Marianne spent hours each day worrying about whether the skin on her hands was too wrinkly. She looked at them over and over, checking to see if the wrinkles were deeper than they had been the day before. She used all types of lotions and creams but still felt that her hands were too ugly to be seen. She never left the house without gloves, even in summer. She often called her sister to talk about the wrinkles, and her sister always said the same thing, "To me, your hands look the same as mine do, just like normal hands. I don't know why you let this bother you so much. I wish I knew what to say to make you stop getting so worked up over your hands."

Some experts estimate that BDD affects 1 to 2 percent of adults in the United States. Both males and females can have BDD. People with BDD, or "imagined ugliness", often stay at home and often become depressed ^* or isolated, and many experience anxiety ^* . Some have unnecessary plastic surgery ^* or go to great lengths to change or hide aspects of their appearance. Preoccupation with their appearance can leave them distracted and unable to enjoy activities with family and friends. Experts say that people with BDD often:

• complain about their appearance, focusing on particular traits
• look in the mirror frequently constantly fix, adjust, or hide their perceived flaws
• talk constantly about their perceived flaws
• ask others over and over for confirmation or reassurance about their appearance
• avoid situations where their flaws might be seen

What Causes Body Dysmorphic Disorder?

Though it may not be recognized and diagnosed until later, BDD usually begins before age 18. BDD usually starts during adolescence when the body is undergoing a lot of changes and when teenagers are forming their ideas about what is acceptable or desirable in physical appearance. Media images that emphasize perfection, as well as a person's own extremely high expectations or perfectionism about appearance, can be factors in the development of BDD. Harsh critical comments or ridicule about appearance by family or friends can be very destructive to body image and may plant the seeds for BDD.

In addition to social influences that may cause body image to be negative or distorted, biological factors may make certain people more likely to develop body dysmorphic disorder. Many experts believe that BDD is linked to obsessive-compulsive disorder (OCD). Obsessive-compulsive disorder causes people to become obsessed or extremely preoccupied with certain distressing thoughts. OCD also causes people to feel compelled to perform certain repetitive actions. BDD involves extreme preoccupation or obsession with appearance, harsh self-critical thoughts, and repeated checking or fixing of appearance. Viewed in this way, BDD may be one form of OCD.

How Is Body Dysmorphic Disorder Treated?

Because people with BDD are plagued by insecurity or self-consciousness and tend to isolate themselves, sometimes they alone know that they have this problem. Seeking treatment by a mental health professional can help relieve their distress. Treatment of BDD often involves psychotherapy that focuses on understanding the person's negative thoughts and opinions about his or her appearance, making needed adjustments in distorted thinking patterns and body image, and decreasing avoidance and repetitive thoughts and behaviors. Medications are sometimes used to relieve distress and to reduce anxiety or depression that can accompany BDD.

In some cases, a person's preoccupation with his or her appearance may actually be a symptom of another underlying disorder, such as an anxiety disorder ^* , an eating disorder ^* , or obsessive-compulsive disorder. Evaluation by a mental health professional can determine whether someone's BDD symptoms are part of a related problem. When that is the case, the person is treated for the other disorder as well.

Can Body Dysmorphic Disorder Be Prevented?

Experts say that teenagers can help prevent BDD by getting help with body image concerns early. While it is normal for adolescents to feel self-conscious about their changing looks, it is also important that they learn to like and accept their body and appearance. In time, many adolescents find that the very features they once wished were different are actually the ones that make their looks uniquely attractive. Concerns about appearance that get in the way of enjoying activities, being with friends, or that cause distress, anxiety, or depression may be a sign of body image problems. By paying the right kind of attention to such concerns early, mental health professionals can help prevent body image problems from becoming more serious.