Body Dysmorphic Disorder( updated Oct 2006)

 
Body dysmorphic disorder (BDD) is a preoccupation with an imagined or minor flaw in personal appearance. The affected person looks normal to others. BDD distresses the person, and may impair social or work functioning. The symptoms usually appear when the person is 15 to 20 years old. A person with BDD may become totally preoccupied and obsessed with his or her body appearance. The person's whole life can be taken over by this preoccupation. Symptoms of a body dysmorphic disorder include a preoccupation with a perceived physical flaw. It may be an imagined one, or a minor flaw in appearance. Behaviours that may indicate BDD include:

  • frequently looking in the mirror and other reflecting surfaces
  • frequently comparing appearance with that of others
  • camouflaging some aspect of appearance with clothing, makeup, hat, hair, or hand
  • frequently touching the supposed defect
  • excessive grooming
  • avoiding having photographs taken

There is no single clear cause for body dysmorphic disorder. Biological, psychological, and even social or cultural factors are thought to contribute.

The disorder is more common among women than men. Someone with this disorder is more likely to be unmarried. He or she may have a history of depression, anxiety, or psychosis.   Diagnosis of body dysmorphic disorder can be difficult because the person often keeps his or her symptoms secret due to shame. The diagnosis is based on the symptoms. A psychological and social history, as well as a medical history, is taken. Some people with BDD function fairly well. Others may be incapacitated by their symptoms. The ability to work, do schoolwork, manage a household, attend school, and function socially can be affected.

Many people with BDD become depressed, and some may consider suicide. A person with this disorder is more likely to seek plastic surgery to "correct" the perceived flaw. In more severe cases, he or she may seek multiple surgeries to alter appearance.
  
Antidepressant medications can control the symptoms associated with BDD. Counselling is often used to help the person deal with depression and anxiety. Cognitive-behavioural therapy may be used. The therapist helps the person change problematic beliefs and create more realistic beliefs and attitudes. At times, surgery is used to correct the perceived flaw. This is usually unsuccessful, since the root of this disorder is more psychological than physical.
 
It may take up to 3 months for medication to take effect. If surgery is done, the person usually has ongoing psychological treatment, since surgery alone will not resolve the person's negative self-image. Ongoing counselling may be needed to help the person with BDD deal with anxiety or depression, and to improve function at work and home.